A cross-sectional study on the lifestyle of patients with Hashimoto's thyroiditis

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Lifestyle factors, including mood, sleep, diet, and exercise may influence disease progression and quality of life, but comprehensive characterization of HT patients’ lifestyle remains limited. Objective: To systematically assess the lifestyle patterns of HT patients, including psychological well-being, sleep quality, quality of life, dietary habits, and physical activity. Methods: A single-center, cross-sectional study was conducted with 226 participants (105 HT patients and 121 healthy controls). Emotional status was assessed using the GAD-7 and PHQ-9; sleep quality with the Pittsburgh Sleep Quality Index (PSQI); and health-related quality of life with the SF-36. Dietary habits and physical activity were evaluated using two study-specific questionnaires. Serum TPOAb and TgAb levels were measured, and correlations with exercise parameters were analyzed using Spearman correlation and multivariate regression. Results: HT patients exhibited significantly higher anxiety and depression scores, poorer sleep quality, and lower quality of life compared to controls. They also demonstrated distinct dietary patterns, including higher daily intake of meat, dairy, vegetables, and fruits, as well as limiting iodized salt intake. In terms of physical activity, HT patients exhibited more conservative exercise patterns, engaging predominantly in low-intensity activities and less in moderate-to-high intensity exercises. Notably, more engagement in higher intensity exercise was inversely correlated with TPOAb levels, independent of age, sex, and BMI, suggesting a potential immunomodulatory benefit of adequate-intensity activity in HT. Conclusion: HT patients present with impaired psychological health, altered sleep, distinct dietary adjustments, and conservative exercise patterns. Higher intensity exercise may contribute to lower thyroid autoantibody levels, highlighting the potential role of tailored lifestyle interventions in HT management. Figures Figure 1 Figure 2 Introduction Hashimoto's thyroiditis (HT) is the most common autoimmune disease leading to hypothyroidism. HT is pathologically characterized by massive lymphocytic infiltration of thyroid tissue, leading to the gradual destruction of thyroid follicular cells. The presence of high titers of thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb) is considered a hallmark of the disease, with up to about 90% of patients exhibiting elevated TPOAb levels [ 1 , 2 ]. The global prevalence of HT is on the rise, with epidemiological data varying by region and diagnostic criteria. The pathogenesis of the disease is complex, involving the interaction of genetic, environmental, and lifestyle factors[ 3 ]. Currently, there are no specific drugs that can effectively halt the progression of HT. A meta-analysis suggested that selenium supplementation might help reduce anti-thyroid peroxidase (TPOAb) levels in some patients[ 4 ]. But long-term, large-scale clinical trials are still needed for definitive confirmation. Consequently, most patients who eventually develop hypothyroidism must rely on lifelong levothyroxine (LT4) replacement therapy[ 5 ]. However, many patients continue to experience persistent non-specific symptoms such as debilitating fatigue, mood fluctuations, cognitive decline, and a generally low quality of life, even after their thyroid hormone levels have been normalized by treatment[ 6 , 7 ]. This has prompted us to explore complementary interventions beyond conventional drug therapy. In recent years, there has been a growing focus on the lifestyle interventions in the management of HT. These non-pharmacological approaches, such as mood management, dietary modifications, and improved sleep, are considered effective complements to medication[ 8 ]. For instance, existing literatures have confirmed that HT patients often suffer from depression and anxiety, with a significantly higher prevalence than in healthy individuals[ 9 ]. A high symptom burden and poor quality of life are common in HT patients, even in euthyroid individuals[ 10 ]. Furthermore, poor sleep quality is frequently reported in HT patients and is associated with increased fatigue[ 11 ]. In terms of nutrition, research has found that the dietary patterns of HT patients are linked to oxidative stress and inflammation, suggesting that a predominantly plant-based Mediterranean-style diet may be beneficial. In addition, supplementation with certain micronutrients and vitamins (e.g., selenium, zinc, vitamin D) may also have a positive impact on HT patients[ 12 , 13 ]. Among all lifestyle factors, exercise is particularly important for HT patients, although its effects and mechanisms are still a subject of debate. On one hand, numerous studies support the benefits of exercise for patients with thyroid diseases. A systematic review and meta-analysis of randomized controlled trials found that long-term exercise interventions can significantly reduce TSH levels and increase T4 levels in hypothyroid individuals[ 14 ]. Another study showed that aerobic, resistance, or combined training could improve quality of life in women with subclinical hypothyroidism[ 15 ]. On the other hand, a potential risk associated with high-intensity exercise has been a subject of controversy. Some reports suggest that chronic, excessive high-intensity training may trigger immune function, particularly cytokine profiles[ 16 ]. This complex, bidirectional influence makes the relationship between different exercise intensities and clinical markers in HT patients a critical area for investigation. Numerous studies have examined individual lifestyle factors in Hashimoto’s thyroiditis (HT), yet current lifestyle recommendations remain fragmented and sometimes controversial. A comprehensive understanding of the overall lifestyle patterns in HT patients is important for clinical management. Therefore, this study aims to systematically assess lifestyle characteristics—including anxiety, depression, sleep quality, quality of life, dietary habits, and physical activity—in individuals with and without HT. In addition, we will explore the relationship between exercise intensity and thyroid antibody levels among HT patients. The findings may contribute to a better understanding of lifestyle factors associated with HT. Methods Study population This study utilized a single-center, cross-sectional design. A total of 226 participants aged 18–65 years were enrolled from both the outpatient and inpatient departments of the Shanghai Geriatrics Medical Center. Among them, 105 were classified into the Hashimoto’s thyroiditis (HT) group, and 121 served as the non-HT (healthy control) group. Inclusion Criteria: 1) HT Group: The diagnostic criteria included positivity for serum thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb), or sonographic evidence of diffuse thyroiditis[ 17 ]. 2) Non-HT Group: No history of thyroid disease, negative serum TPOAb and TgAb, and normal thyroid function. Exclusion Criteria: History of thyroid surgery or radioactive iodine treatment. Current use of medications known to affect thyroid function (e.g., amiodarone, lithium salts). Severe impairment of cardiac, hepatic, or renal function, or other chronic wasting diseases. Pregnant or breastfeeding women. This study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Research Ethics Committee of Shanghai Geriatric Center. Written informed consent was obtained from all participants prior to enrollment. Anthropometric and biochemical measurements The information of the past history of hypertension, diabetes, dyslipidemia, rheumatoid arthritis, cerebrovascular disease, coronary heart disease, etc., and cigarette smoking, alcohol consumption for each participant was collected using a questionnaire. Body weight and height were measured while wearing light clothing without shoes, and body mass index (BMI) calculated as weight divided by the square of height (kg/m 2 ). Serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) were measured by electrochemiluminescence immunoassay (ECLIA) using the Roche Cobas e601 analyzer (Roche Diagnostics, Mannheim, Germany). Assessment of Anxiety and Depression To assess the emotional status of participants, we employed two widely used self-rating instruments: the Generalized Anxiety Disorder-7 (GAD-7) for anxiety and the Patient Health Questionnaire-9 (PHQ-9) for depression[ 18 , 19 ]. Both scales evaluate the frequency of symptoms experienced over the past two weeks. The GAD-7 comprises 7 items, each scored from 0 (“not at all”) to 3 (“nearly every day”), yielding a total score of 0 to 21. The PHQ-9 consists of 9 items with the same 0–3 scoring system, producing a total score of 0 to 27. For both scales, higher scores reflect more severe symptoms. All questionnaires were self-administered under the guidance of trained research staff to ensure data quality. Pittsburgh Sleep Quality Index (PSQI) Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated and standardized 19-item self-reported questionnaire evaluating sleep quality over the past month[ 20 ]. The questionnaire generates seven component scores, including subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction. Each component is scored from 0 to 3, and the global score is calculated as the sum of these seven components, ranging from 0 to 21. Lower global scores indicate better sleep quality, while a score greater than 5 suggests significant sleep difficulties. Health-Related Quality of Life Health-related quality of life was evaluated using the 36-Item Short Form Survey (SF-36)[ 21 ]. The SF-36 comprises 36 items covering eight core domains: physical functioning, role limitations due to physical health, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health. For these eight domains, participants were asked to report their health status over the past four weeks. Each domain is scored on a scale from 0 to 100, with higher scores indicating better health status and quality of life. The health change item, a separate question, is considered independently to reflect perceived changes in overall health over the past year. Dietary assessment A food frequency questionnaire was used to assess participants' dietary habits (Supplementary File S1). The questionnaire documented the weekly intake of 13 food items, with frequency classified as everyday, ≥ 3 times per week, < 3 times per week, and never. The assessed 13 food groups included protein sources (meat, fish, eggs, seafood, beans, and nuts), dairy products, vegetables, fruits, and carbohydrate sources (staple foods such as refined rice and flour, whole grains such as oats, millet, quinoa, rye, and brown rice), as well as olive oil and iodized salt. Exercise assessment Exercise was assessed using a self-reported physical activity questionnaire (Supplementary File S2). Participants were asked to report the types of physical activities they engaged in over the past month and the amount of time spent on each activity. Reported durations were standardized to minutes per month, and total physical activity volume was calculated by summing the time spent across all activity types. Activities were classified into three intensity levels based on physiological responses and functional capacity, consistent with established intensity criteria and the standards of the Yale Physical Activity Survey (YPAS)(22). : Low-intensity activities were defined as those requiring minimal effort, characterized by steady breathing and the ability to sing easily (e.g., walking, household chores, gentle stretching). Moderate-intensity activities were defined as those causing noticeably increased heart rate and breathing while still allowing conversation (e.g., brisk walking, dancing, aerobics, recreational cycling, gardening). High-intensity activities were defined as those involving substantially increased heart rate and rapid breathing, making conversation difficult (e.g., running, fast swimming, vigorous cycling, competitive sports). Statistical analysis All statistical analyses were performed using Stata software (version 18.0; StataCorp, College Station, TX). The continuous variables were presented as mean ± SD, except for the skewed ones that were presented as the median with the interquartile range (25–75%). The categorical variables were presented as counts and percentages of the total given in parentheses. Intergroup comparison was conducted using the Student’s t-test or the Wilcoxon rank-sum tests where appropriate. Chi-squared tests were used for the categorical variables. To investigate the association between exercise parameters and thyroid antibody levels (TPOAb and TgAb) in HT patients, Spearman correlation analysis was first performed. Subsequently, multivariate logistic regression analyses were conducted to further explore the independent associations between exercise parameters and thyroid antibody levels after adjusting for age, sex, and BMI. A two-sided P value < 0.05 was considered statistically significant. Results Baseline Characteristics A total of 226 participants were included in this study, with 105 in the Hashimoto’s thyroiditis (HT) group and 121 in the non-HT (healthy control) group (Table 1 ). No significant differences were observed between the two groups in basic demographic characteristics such as age and BMI. However, the proportion of females was significantly higher in the HT group compared with the non-HT group (81% vs. 62%, P = 0.002). Regarding comorbidities, the prevalence of diabetes (13.3% vs. 5.0%, P = 0.014) and dyslipidemia (32% vs. 17%, P = 0.010) was significantly higher in the HT group. In terms of lifestyle habits, alcohol consumption was significantly lower in the HT group (4.1% vs. 18%, P < 0.001). Table 1 Baseline Characteristics of the Study Population. Overall N = 226 1 Non-HT N = 121 1 HT N = 105 1 p-value 2 Women 160 (71%) 75 (62%) 85 (81%) 0.002 Age (years) 48.31 (13.56) 47.31 (12.59) 49.48(14.57) 0.231 BMI (kg/m2) 23.70 (3.93) 23.56 (4.40) 23.86 (3.33) 0.575 Smoke n(%) 28 (14%) 21 (17%) 7 (9.5%) 0.13 Drink n(%) 40 (21%) 22 (18%) 3 (4.1%) < 0.001 Hypertension n(%) 50 (22%) 24 (20%) 26 (25%) 0.373 Diabetes n(%) 20 (8.85%) 6 (5.0%) 14 (13.3%) 0.014 Hyperlipemia n(%) 44 (23%) 20 (17%) 24 (32%) 0.010 Osteoarthritis n(%) 7 (3.1%) 5 (4.1%) 2 (1.9%) 0.335 Rheumatoid arthritis n(%) 3 (1.3%) 1 (0.8%) 2 (1.9%) 0.480 Cerebrovascular disease n(%) 5 (2.2%) 1 (0.8%) 4 (3.8%) 0.128 Coronary heart disease n(%) 6 (2.7%) 1 (0.8%) 5 (4.8%) 0.066 Asthma n(%) 2 (0.9%) 1 (0.8%) 1 (1.0%) 0.920 Anemia n(%) 5 (2.2%) 4 (3.3%) 1 (1.0%) 0.230 Myalgia n(%) 1 (0.4%) 0 (0.0%) 1 (1.0%) 0.282 Depression n(%) 4 (1.8%) 1 (0.8%) 3 (2.9%) 0.248 1 n (%); Median (IQR) 2 Pearson's Chi-squared test; Wilcoxon rank sum test Emotional Status, Sleep Habits, and Quality of Life Participants in the HT group exhibited significantly poorer emotional and sleep profiles compared with the non-HT group, directly impacting their quality of life. Anxiety (5.28 vs. 3.36, P = 0.035) and depression (5.68 vs. 3.74, P = 0.005) scores were both significantly higher in the HT group. Regarding sleep habits, the HT group had significantly higher scores in sleep quality, sleep duration, sleep disturbances, use of sleeping medication and daytime dysfunction (all P < 0.05). Consequently, their total PSQI score was also significantly worse (6.92 vs. 4.92, P < 0.001), indicating overall poorer sleep quality. Based on the SF-36, the HT group reported significantly lower scores in multiple domains, including role limitations due to physical health, general health, social functioning, role limitations due to emotional problems, and mental health (all P < 0.01). Furthermore, The health change was significantly lower in the HT group than in the non-HT group (41.22 vs. 55.79, P < 0.001), indicating that patients with HT perceived a more negative change in their overall health over the past year (Table 2 ). Table 2 Mood, sleep and quality of Life in patients with Hashimoto’s thyroiditis and healthy individuals. Overall N = 226 1 Non-HT N = 121 1 HT N = 105 1 p-value 2 Anxiety 3.26 (1.03) 3.36 (1.87) 5.28 (2.30) 0.035 Depression 3.72 (1.99) 3.74 (1.80) 5.68 (2.92) 0.005 PSQI (Pittsburgh Sleep Quality Index) Sleep quality 1.00 (0.78) 0.81 (0.76) 1.23 (0.75) < 0.001 Sleep latency 1.04 (0.92) 0.97 (0.86) 1.11 (0.99) 0.232 Sleep duration 0.63 (0.87) 0.51 (0.84) 0.76 (0.89) 0.031 Sleep efficiency 0.10 (1.19) 1.10 (1.25) 0.88 (1.10) 0.159 Sleep disturbances 1.05 (0.66) 0.91 (0.52) 1.22 (0.76) < 0.001 Use of sleeping medication 0.28 (0.78) 0.10 (0.49) 0.40 (0.91) 0.013 Daytime dysfunction 1.18 (1.04) 0.99 (0.98) 1.31 (1.07) 0.048 Global score 5.85 (3.81) 4.92 (3.28) 6.92 (4.11) < 0.001 SF-36 Physical functioning 88.03 (15.24) 88.68 (16.63) 86.96 (12.68) 0.446 Physical limitation 86.15 (27.82) 91.32 (23.43) 77.70 (32.20) < 0.001 Bodily pain 83.52 (17.08) 85.04 (16.79) 81.03 (17.37) 0.111 General health 64.94 (22.13) 71.62 (18.52) 54.01 (23.30) < 0.001 Vitality 71.36 (17.14) 72.07 (16.29) 70.20 (18.50) 0.463 Social functioning 93.78 (19.43) 97.42 (19.63) 87.84 (17.67) < 0.001 Emotional limitation 86.33 (28.03) 90.63 (24.05) 79.28 (32.51) 0.006 Mental health 73.70 (16.93) 78.05 (17.62) 71.04 (15.98) 0.005 Health change 50.26 (21.69) 55.79 (20.86) 41.22 (20.03) < 0.001 1 Median (IQR) 2 Pearson's Chi-squared test Dietary Habits Significant differences in dietary habits were observed between the two groups. As shown in Table 3 , daily consumption of meat (64% vs. 42%, P = 0.011), dairy products (50% vs. 31%, P = 0.016), vegetables (89% vs. 72%, P = 0.007), and fruits (64% vs. 46%, P = 0.015) was significantly higher in the HT group. In contrast, a higher proportion of the non-HT group reported eating fish ≥ 3 times per week (34% vs. 20%, P = 0.032). Significant group differences were also observed in olive oil and iodized salt consumption: olive oil use was more frequent in the HT group (P = 0.031), while reduced use of iodized salt (< 3 times per week) was significantly more common among HT participants compared with controls (49% vs. 22%, P < 0.001), indicating a more cautious approach toward iodine intake in the HT group. Table 3 Intake frequencies of main food groups per week in patients with Hashimoto’s thyroiditis and healthy individuals. Everyday ≥ 3/week < 3/week Never p-value 2 Meat 0.011 Non-HT (%) 42 36 20 2 HT (%) 64 20 15 1 Fish 0.032 Non-HT (%) 5 34 59 2 HT (%) 8 20 72 0 Egg 0.219 Non-HT (%) 49 35 16 1 HT (%) 55 24 21 0 Bean 0.238 Non-HT (%) 13 40 45 2 HT (%) 10 30 59 1 Seafood 0.117 Non-HT (%) 2 18 66 13 HT (%) 4 9 78 10 Nuts 0.599 Non-HT (%) 14 17 60 10 HT (%) 20 12 58 10 Dairy 0.016 Non-HT (%) 31 25 39 6 HT (%) 50 22 25 3 Vegetable 0.007 Non-HT (%) 72 21 7 0 HT (%) 89 10 2 0 Fruit 0.015 Non-HT (%) 46 31 22 0 HT (%) 64 18 16 2 Staples 0.826 Non-HT (%) 86 12 2 0 HT (%) 86 10 4 0 Whole Grains 0.225 Non-HT (%) 17 29 50 4 HT (%) 19 17 60 4 Olive oil 0.031 Non-HT (%) 8 12 33 46 HT (%) 9 3 46 43 Iodized salt < 0.001 Non-HT (%) 33 17 22 27 HT (%) 28 7 49 17 1 Median (IQR) 2 Pearson's Chi-squared test Exercise Patterns and Their Association with Thyroid Autoantibodies In terms of activity intensity (Fig. 1 a), the HT group spent more time on low-intensity activities (median 385.19 vs. 240.01 min/week, P < 0.05) but less time on moderate-intensity activities (median 69.82 vs. 155.02 min/week, P < 0.05) and high-intensity activities (showed a tendency but without statistical significance). As shown in Fig. 1 b, the five most common types of physical activity in the HT group were housework (63.8%), walking (33.3%), brisk walking (10.5%), jogging (8.6%), and swimming (5.7%). While In the non-HT group, the top five were housework (52.1%), brisk walking (14%), jogging (14%), walking (12.4%), and cycling (8.3%). Furthermore, compared with the non-HT group, the HT group demonstrated more conservative exercise patterns and lower activity diversity (Fig. 1 c). In the HT group, Spearman correlation analysis revealed a significant negative correlation between high-intensity exercise time and TPOAb levels (r = − 0.32, P < 0.05). A trend toward a negative association was also observed between moderate-intensity exercise and TgAb levels, whereas no significant correlations were found for light-intensity exercise (Fig. 2 ). Further linear regression analysis, after adjusting for age, sex, and BMI, confirmed that high-intensity exercise time remained inversely associated with TPOAb levels (P = 0.039), suggesting that vigorous exercise may contribute to lower thyroid autoantibody levels in HT patients (Table 4 ). Table 4 Linear regression analysis of exercise parameters and thyroid antibodies levels in patients with Hashimoto’s thyroiditis. Model 1 Model 2 TPOAb Beta R 2 P value Beta R 2 P value Exercise types -1.95 0.01 0.280 -2.10 0.01 0.293 Low-intensity exercise time 0.01 0.00 0.864 -1.90 0.00 0.932 Moderate-intensity exercise time -0.08 0.00 0.655 -7.65 0.00 0.684 High-intensity exercise time -0.74 0.05 0.031 -4.79 0.05 0.039 TgAb Exercise types -4.04 0.00 0.966 4.79 0.07 0.605 Low-intensity exercise time 0.15 0.01 0.405 -1.52 0.07 0.882 Moderate-intensity exercise time -0.88 0.01 0.342 -7.17 0.07 0.441 High-intensity exercise time -1.25 0.01 0.481 -8.45 0.07 0.931 Model 1: crude model;Model 2༚adjusted for age, sex, BMI Discussion Hashimoto’s thyroiditis (HT) is the most common autoimmune cause of hypothyroidism worldwide and remains a major health concern[ 23 ]. In recent years, lifestyle factors, particularly stress management, diet, and exercise, have gained increasing recognition for their role in the development and management of autoimmune diseases[ 24 ]. In this study, we systematically investigated the combined lifestyle profile of HT patients compared with healthy controls. HT patients were found to have higher anxiety and depression scores, poorer sleep quality, and lower health-related quality of life. They also demonstrated distinct dietary habits and more conservative exercise patterns. Importantly, higher intensity physical activity was inversely associated with TPOAb levels, indicating that physical activity at an adequate intensity, rather than merely light activity, may play a meaningful role in modulating autoimmune responses in HT. HT patients frequently experience impaired psychological health and reduced quality of life (QoL). In this study, HT patients reported higher levels of anxiety and depression, poorer sleep quality, and reduced QoL, consistent with previous research. A meta-analysis pointed out that the risk of depression and anxiety in HT patients is higher than in the general population by different scales such as HADS, BDI, SAS, and SDS[ 25 ]. In our study, HT patients also showed significantly poorer sleep quality and lower scores in domains such as physical limitation, social functioning on the SF-36 scale. Emerging evidence indicates that these psychological and QoL impairments reflect not only the consequences of hypothyroidism but also the broader effects of autoimmunity. Higher levels of thyroid autoantibodies, particularly TPOAb, have been independently associated with fatigue, mood disturbances, and impaired QoL[ 26 ]. Notably, these impairments were observed even in euthyroid patients[ 27 ]. Potential mechanisms include low-grade systemic inflammation and cytokine release (e.g., IL-6, TNF-α) affecting central neurotransmission, as well as the chronic burden of symptoms such as continuous fatigue, sleep disturbances, weight changes, and emotional distress[ 28 ]. Collectively, these findings highlight the need to address lifestyle factors as integral components of HT management, beyond thyroid hormone replacement alone. Our findings also revealed distinctive dietary features among HT patients. The proportion of HT patients with a daily intake of meat and dairy products was significantly higher than in the healthy control group, while their high-frequency fish intake was more conservative. This resembles the "Western dietary pattern" associated with red and processed meat, and dairy products. This pattern may aggravate thyroid inflammation through oxidative stress, pro-inflammatory cytokines, and even alterations in the gut microbiota[ 29 ]. Consistently, diets with high Dietary Inflammatory Index (DII) scores, rich in saturated fats and refined carbohydrates, have been linked to higher HT risk and TPOAb levels, whereas antioxidant-rich diets appear protective[ 30 , 31 ]. At the same time, our findings also reflected conscious dietary adjustments by HT patients. For instance, greater intake of vegetables and fruits may represent an effort to enhance antioxidant defenses. Particularly, HT patients actively limit iodine consumption since excessive iodine intake is a well-established risk factor for HT. Collectively, these results underscore that dietary habits in HT are shaped not only by risk exposures but also by patient-driven behaviors, and that individualized, evidence-based dietary guidance should be an integral part of HT management. Regular physical activity is an important modifiable factor in the management of Hashimoto’s thyroiditis. Exercise exerts anti-inflammatory and antioxidant effects, improves metabolic function, and enhances mood and energy levels[ 32 ]. In patients with hypothyroidism, appropriate exercise can help regulate body weight, improve cardiovascular health, and support thyroid hormone balance[ 33 ]. These benefits highlight the potential role of regular exercise as an effective adjunct to conventional HT management. In this study, we provide a detailed analysis of the exercise habits of HT patients and reveals a significant association between their activity patterns and levels of thyroid autoantibodies. Our results indicate that HT patients exhibit more conservative and less diverse exercise patterns compared to healthy controls, primarily engaging in low-intensity activities such as housework and walking. This observation aligns with the distinction between "occupational physical activity" (e.g., housework), which may act as a chronic stressor, and "recreational exercise", which can serve as a positive immunomodulator, as proposed by Duñabeitia et al.. A key finding is the significant inverse correlation between time spent on high intensity exercise and TPOAb levels, which remained significant after adjusting for age, sex, and BMI. This provides strong evidence that exercise at an adequate intensity, rather than merely light activity, may play a meaningful role in modulating autoimmune responses. This finding is supported by a systematic review showing that long-term exercise interventions can significantly reduce TSH levels and increase T4 levels in hypothyroid individuals[ 14 ]. Mechanistic clues from animal studies further support this, as high-intensity interval training (HIIT) has been shown to improve cognitive function and reduce inflammatory markers like TNF-α in hypothyroid rats[ 34 ]. This suggests that higher intensity exercise may regulate the autoimmune response by mitigating systemic inflammation. However, the benefits of high-intensity exercise are not without controversy. Some studies caution that excessive or high-intensity exercise can act as a powerful physiological stressor, potentially leading to elevated cortisol levels[ 35 ]. High cortisol can suppress the hypothalamic-pituitary-thyroid (HPT) axis, inhibiting the conversion of T4 to the active T3 and increasing the production of inactive reverse T3 (rT3), which may functionally worsen fatigue symptoms and negatively impact thyroid function[ 36 ]. Our study supports the view that exercise, particularly at moderate to high intensity, can be a crucial component of HT management. However, we also emphasize that exercise interventions must be individualized and progressive. For patients who are clinically stable and have a foundation in exercise, introducing moderate to high-intensity activities under careful monitoring may be beneficial. Conversely, for those with active disease or severe fatigue, gradually progressive exercise is critical to avoid additional physiological stress, yet the recommendation awaits more evidence. This study has several limitations. Firstly, all lifestyle data were based on participant self-reporting, which may introduce recall bias and affect the objectivity and accuracy of the data. Secondly, our study population was recruited from a single center, which may limit the representativeness of our findings to other regions or different populations. Finally, as a cross-sectional study, it is unable to establish a causal relationship between lifestyle factors and the presence of HT or changes in autoantibody levels. Future research should employ prospective cohort studies or randomized controlled trials to verify our findings and further investigate the long-term effects of different lifestyle interventions on HT patients. Conclusion This study systematically describes the lifestyle characteristics of HT patients and reveals significant differences compared to healthy individuals. Our research confirms that HT patients not only exhibit poorer emotional and sleep status but also demonstrate unique dietary and exercise patterns. Most importantly, we found that diverse exercise at an adequate intensity was significantly and inversely correlated with TPOAb levels, providing important evidence for the potential benefits of higher intensity exercise in HT management. These findings collectively highlight the necessity of integrating personalized, comprehensive lifestyle interventions into the clinical management of HT, with the goal of providing new strategies to improve patients' overall health and quality of life beyond medication. Declarations Ethics approval and consent to participate Written informed consent was obtained from all participants. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai Geriatric Medical Center. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the corresponding authors upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Specialized Training Foundation of Zhongshan Hospital (Grant No. 2023-007). Authors’contributions SM collected the data, conducted the statistical analyses, and drafted the manuscript. YL conceived the study and supervised the work. PY contributed to the statistical analyses. QC, MA, and DM assisted with data collection and processing. LZ, JZ, and XS revised the manuscript. All authors reviewed and approved the final manuscript. Acknowledgements We thank all participants for their contribution to this study. We also express our gratitude to the clinical staff for their assistance in questionnaire administration and data collection. Clinical trial number Not applicable. References Chaker L, Papaleontiou M, Hypothyroidism. Rev JAMA. 2025. https://doi.org/10.1001/jama.2025.13559 . Ralli M, Angeletti D, Fiore M, D’Aguanno V, Lambiase A, Artico M, et al. Hashimoto’s thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. 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Interventions to improve symptomatology in patients with hypothyroidism and persistent symptoms: A systematic review. Endocrine. 2024;84:864–73. https://doi.org/10.1007/s12020-024-03816-1 . Hidalgo J, Vallejo BA, Soto Jacome C, Ayala IN, Cordova S, Duran M, et al. Real Practice Assessment of Persistent Symptoms After Initiation of Levothyroxine. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2024;30:95–100. https://doi.org/10.1016/j.eprac.2023.10.132 . Hernando V-U, Castellanos-Pinedo A, Urrego-Noguera K, Pinzón-Fernández MV, Meza-Cabrera IA, Vargas-Sierra H. A Scoping Review on the Prevalence of Hashimoto’s Thyroiditis and the Possible Associated Factors. Med Sci. 2025;13. https://doi.org/10.3390/medsci13020043 . Giynas Ayhan M, Uguz F, Askin R, Gonen MS. The prevalence of depression and anxiety disorders in patients with euthyroid Hashimoto’s thyroiditis: a comparative study. Gen Hosp Psychiatry. 2014;36:95–8. https://doi.org/10.1016/j.genhosppsych.2013.10.002 . Bianchi GP, Zaccheroni V, Solaroli E, Vescini F, Cerutti R, Zoli M, et al. Health-related quality of life in patients with thyroid disorders. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2004;13:45–54. https://doi.org/10.1023/B:QURE.0000015315.35184.66 . Green ME, Bernet V, Cheung J. Thyroid Dysfunction and Sleep Disorders. Front Endocrinol. 2021;12:725829. https://doi.org/10.3389/fendo.2021.725829 . Osowiecka K, Skrypnik D, Myszkowska-Ryciak J. Probiotic Supplementation Enhances the Effects of a Nutritional Intervention on Quality of Life in Women with Hashimoto’s Thyroiditis-A Double-Blind Randomised Study. Nutrients. 2025;17:3387. https://doi.org/10.3390/nu17213387 . Danailova Y, Velikova T, Nikolaev G, Mitova Z, Shinkov A, Gagov H, et al. Nutritional Management of Thyroiditis of Hashimoto. Int J Mol Sci. 2022;23. https://doi.org/10.3390/ijms23095144 . Sundus H, Khan SA, Zaidi S, Chhabra C, Ahmad I, Khan H. Effect of long-term exercise-based interventions on thyroid function in hypothyroidism: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2025;92:103196. https://doi.org/10.1016/j.ctim.2025.103196 . Werneck FZ, Coelho EF, Almas SP, Garcia MM do, Bonfante N, de Lima HLM, et al. Exercise training improves quality of life in women with subclinical hypothyroidism: a randomized clinical trial. Arch Endocrinol Metab. 2018;62:530–6. https://doi.org/10.20945/2359-3997000000073 . É C, Da M, Hp N. Inflammatory Effects of High and Moderate Intensity Exercise-A Systematic Review. Front Physiol. 2020;10. https://doi.org/10.3389/fphys.2019.01550 . Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014;13:391–7. https://doi.org/10.1016/j.autrev.2014.01.007 . Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7. https://doi.org/10.1001/archinte.166.10.1092 . K K, Rl S, Jb W. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16. https://doi.org/10.1046/j.1525-1497.2001.016009606.x . The Pittsburgh Sleep Quality Index. a new instrument for psychiatric practice and research - PubMed. https://pubmed.ncbi.nlm.nih.gov/2748771/ . Accessed 5 Jan 2026. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83. Solomito Pugh A. Validity of the Yale Physical Activity Survey for older adults. LSU Masters Theses. 2006. https://doi.org/10.31390/gradschool_theses.1383 . Ragusa F, Fallahi P, Elia G, Gonnella D, Paparo SR, Giusti C, et al. Hashimotos’ thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Pract Res Clin Endocrinol Metab. 2019;33:101367. https://doi.org/10.1016/j.beem.2019.101367 . Gacek M, Wojtowicz A, Kędzior J. Physical Activity, Nutritional Behaviours and Depressive Symptoms in Women with Hashimoto’s Disease. Healthcare. 2025;13:620. https://doi.org/10.3390/healthcare13060620 . Siegmann E-M, Müller HHO, Luecke C, Philipsen A, Kornhuber J, Grömer TW. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2018;75:577–84. https://doi.org/10.1001/jamapsychiatry.2018.0190 . Müssig K, Künle A, Säuberlich A-L, Weinert C, Ethofer T, Saur R, et al. Thyroid peroxidase antibody positivity is associated with symptomatic distress in patients with Hashimoto’s thyroiditis. Brain Behav Immun. 2012;26:559–63. https://doi.org/10.1016/j.bbi.2012.01.006 . Lankhaar JAC, Kemler E, Hofstetter H, Collard DCM, Zelissen PMJ, Stubbe JH, et al. Physical activity, sports participation and exercise-related constraints in adult women with primary hypothyroidism treated with thyroid hormone replacement therapy. J Sports Sci. 2021;39:2493–502. https://doi.org/10.1080/02640414.2021.1940696 . Gacek M, Agnieszka W, Jolanta K. Pro-Health Behaviours and Depressive Symptoms as Well as Satisfaction with and Quality of Life Among Women with Hashimoto’s Disease. Eur J Investig Health Psychol Educ. 2025;15. https://doi.org/10.3390/ejihpe15060097 . Rm R, Mc SG, Tm BMCAA. Influence of Dietary Habits on Oxidative Stress Markers in Hashimoto’s Thyroiditis. Thyroid Off J Am Thyroid Assoc. 2021;31. https://doi.org/10.1089/thy.2020.0299 . Karavelioglu B, Dayi T, Koseoglulari O, Oniz A. Association Between Anthropometric Measurements and Mediterranean Lifestyle in Women Diagnosed with Hashimoto’s Thyroiditis: Data from the Mediterranean Region. Nutrients. 2025;17. https://doi.org/10.3390/nu17050892 . Wojtas N, Wadolowska L, Bandurska-Stankiewicz E. Evaluation of Qualitative Dietary Protocol (Diet4Hashi) Application in Dietary Counseling in Hashimoto Thyroiditis: Study Protocol of a Randomized Controlled Trial. Int J Environ Res Public Health. 2019;16. https://doi.org/10.3390/ijerph16234841 . Ahmad AM, Serry ZH, Abd Elghaffar HA, Ghazi HA, El Gayar SL. Effects of aerobic, resistance, and combined training on thyroid function and quality of life in hypothyroidism. A randomized controlled trial. Complement Ther Clin Pract. 2023;53:101795. https://doi.org/10.1016/j.ctcp.2023.101795 . Ahn N, Kim HS, Kim K. Exercise training-induced changes in metabolic syndrome parameters, carotid wall thickness, and thyroid function in middle-aged women with subclinical hypothyroidism. Pflugers Arch. 2019;471:479–89. https://doi.org/10.1007/s00424-019-02254-7 . Akkaya EC, Koc B, Dalkiran B, Calis G, Dayi A, Kayatekin BM. High-intensity interval training ameliorates spatial and recognition memory impairments, reduces hippocampal TNF-alpha levels, and amyloid-beta peptide load in male hypothyroid rats. Behav Brain Res. 2024;458:114752. https://doi.org/10.1016/j.bbr.2023.114752 . U GBSSRK. Hypothalamic-pituitary-thyroid axis in moderate and intense exercise. Horm Metab Res Horm Stoffwechselforschung Horm Metab. 2005;37. https://doi.org/10.1055/s-2005-870427 . Nunez SG, Rabelo SP, Subotic N, Caruso JW, Knezevic NN. Chronic Stress and Autoimmunity: The Role of HPA Axis and Cortisol Dysregulation. Int J Mol Sci. 2025;26:9994. https://doi.org/10.3390/ijms26209994 . Additional Declarations No competing interests reported. Supplementary Files SupplementaryFileS1.DailyDietaryIntakeQuestionnaire.docx SupplementaryFileS2.DailyPhysicalActivityQuestionnaire.docx Cite Share Download PDF Status: Published Journal Publication published 02 May, 2026 Read the published version in BMC Endocrine Disorders → Version 1 posted Editorial decision: Revision requested 10 Feb, 2026 Reviews received at journal 05 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviews received at journal 04 Feb, 2026 Reviewers agreed at journal 04 Feb, 2026 Reviewers invited by journal 02 Feb, 2026 Editor assigned by journal 25 Jan, 2026 Editor invited by journal 20 Jan, 2026 Submission checks completed at journal 20 Jan, 2026 First submitted to journal 20 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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16:08:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8574696/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8574696/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12902-026-02296-w","type":"published","date":"2026-05-02T15:58:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":101872801,"identity":"3b6f245d-5ef5-44fa-b4b6-2a8c0c3c9c41","added_by":"auto","created_at":"2026-02-04 13:42:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":250853,"visible":true,"origin":"","legend":"\u003cp\u003ePhysical exercise per month in patients with Hashimoto’s thyroiditis and healthy individuals. \u003cstrong\u003ea\u003c/strong\u003e The distribution of exercise time at different intensity. \u003cstrong\u003eb\u003c/strong\u003e The top 5 most popular exercises. \u003cstrong\u003ec\u003c/strong\u003eNumbers of exercise types.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8574696/v1/bd772d988d2397a00e9b51a7.png"},{"id":101872790,"identity":"c0e4fd8c-42e1-4669-b651-13afc00c579c","added_by":"auto","created_at":"2026-02-04 13:41:59","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":569402,"visible":true,"origin":"","legend":"\u003cp\u003eThe correlation between exercise parameters and thyroid antibodies levels in patients with Hashimoto’s thyroiditis.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8574696/v1/14575155dbc25e930dc85b5d.jpeg"},{"id":108809067,"identity":"93b4bcf6-c233-4da9-be8f-e34015f36013","added_by":"auto","created_at":"2026-05-08 15:49:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1558740,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8574696/v1/b7c15d8f-b72c-4916-9b94-736d5e62daa8.pdf"},{"id":101872779,"identity":"33a1f120-cc26-48bd-82e6-9c916a04311c","added_by":"auto","created_at":"2026-02-04 13:41:46","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":46305,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFileS1.DailyDietaryIntakeQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-8574696/v1/e6855f79475aca2ff6a4481d.docx"},{"id":101872869,"identity":"ec90657c-7c43-4721-b6ec-8a24f6be91b8","added_by":"auto","created_at":"2026-02-04 13:42:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":46305,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFileS2.DailyPhysicalActivityQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-8574696/v1/d0dd9c68201833c3c89a2e7e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A cross-sectional study on the lifestyle of patients with Hashimoto's thyroiditis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHashimoto's thyroiditis (HT) is the most common autoimmune disease leading to hypothyroidism. HT is pathologically characterized by massive lymphocytic infiltration of thyroid tissue, leading to the gradual destruction of thyroid follicular cells. The presence of high titers of thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb) is considered a hallmark of the disease, with up to about 90% of patients exhibiting elevated TPOAb levels [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The global prevalence of HT is on the rise, with epidemiological data varying by region and diagnostic criteria. The pathogenesis of the disease is complex, involving the interaction of genetic, environmental, and lifestyle factors[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, there are no specific drugs that can effectively halt the progression of HT. A meta-analysis suggested that selenium supplementation might help reduce anti-thyroid peroxidase (TPOAb) levels in some patients[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. But long-term, large-scale clinical trials are still needed for definitive confirmation. Consequently, most patients who eventually develop hypothyroidism must rely on lifelong levothyroxine (LT4) replacement therapy[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, many patients continue to experience persistent non-specific symptoms such as debilitating fatigue, mood fluctuations, cognitive decline, and a generally low quality of life, even after their thyroid hormone levels have been normalized by treatment[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This has prompted us to explore complementary interventions beyond conventional drug therapy.\u003c/p\u003e \u003cp\u003eIn recent years, there has been a growing focus on the lifestyle interventions in the management of HT. These non-pharmacological approaches, such as mood management, dietary modifications, and improved sleep, are considered effective complements to medication[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. For instance, existing literatures have confirmed that HT patients often suffer from depression and anxiety, with a significantly higher prevalence than in healthy individuals[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A high symptom burden and poor quality of life are common in HT patients, even in euthyroid individuals[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Furthermore, poor sleep quality is frequently reported in HT patients and is associated with increased fatigue[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In terms of nutrition, research has found that the dietary patterns of HT patients are linked to oxidative stress and inflammation, suggesting that a predominantly plant-based Mediterranean-style diet may be beneficial. In addition, supplementation with certain micronutrients and vitamins (e.g., selenium, zinc, vitamin D) may also have a positive impact on HT patients[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong all lifestyle factors, exercise is particularly important for HT patients, although its effects and mechanisms are still a subject of debate. On one hand, numerous studies support the benefits of exercise for patients with thyroid diseases. A systematic review and meta-analysis of randomized controlled trials found that long-term exercise interventions can significantly reduce TSH levels and increase T4 levels in hypothyroid individuals[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Another study showed that aerobic, resistance, or combined training could improve quality of life in women with subclinical hypothyroidism[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. On the other hand, a potential risk associated with high-intensity exercise has been a subject of controversy. Some reports suggest that chronic, excessive high-intensity training may trigger immune function, particularly cytokine profiles[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This complex, bidirectional influence makes the relationship between different exercise intensities and clinical markers in HT patients a critical area for investigation.\u003c/p\u003e \u003cp\u003eNumerous studies have examined individual lifestyle factors in Hashimoto\u0026rsquo;s thyroiditis (HT), yet current lifestyle recommendations remain fragmented and sometimes controversial. A comprehensive understanding of the overall lifestyle patterns in HT patients is important for clinical management. Therefore, this study aims to systematically assess lifestyle characteristics\u0026mdash;including anxiety, depression, sleep quality, quality of life, dietary habits, and physical activity\u0026mdash;in individuals with and without HT. In addition, we will explore the relationship between exercise intensity and thyroid antibody levels among HT patients. The findings may contribute to a better understanding of lifestyle factors associated with HT.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis study utilized a single-center, cross-sectional design. A total of 226 participants aged 18\u0026ndash;65 years were enrolled from both the outpatient and inpatient departments of the Shanghai Geriatrics Medical Center. Among them, 105 were classified into the Hashimoto\u0026rsquo;s thyroiditis (HT) group, and 121 served as the non-HT (healthy control) group. Inclusion Criteria: 1) HT Group: The diagnostic criteria included positivity for serum thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb), or sonographic evidence of diffuse thyroiditis[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. 2) Non-HT Group: No history of thyroid disease, negative serum TPOAb and TgAb, and normal thyroid function. Exclusion Criteria: History of thyroid surgery or radioactive iodine treatment. Current use of medications known to affect thyroid function (e.g., amiodarone, lithium salts). Severe impairment of cardiac, hepatic, or renal function, or other chronic wasting diseases. Pregnant or breastfeeding women. This study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Research Ethics Committee of Shanghai Geriatric Center. Written informed consent was obtained from all participants prior to enrollment.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnthropometric and biochemical measurements\u003c/h3\u003e\n\u003cp\u003eThe information of the past history of hypertension, diabetes, dyslipidemia, rheumatoid arthritis, cerebrovascular disease, coronary heart disease, etc., and cigarette smoking, alcohol consumption for each participant was collected using a questionnaire. Body weight and height were measured while wearing light clothing without shoes, and body mass index (BMI) calculated as weight divided by the square of height (kg/m\u003csup\u003e2\u003c/sup\u003e). Serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) were measured by electrochemiluminescence immunoassay (ECLIA) using the Roche Cobas e601 analyzer (Roche Diagnostics, Mannheim, Germany).\u003c/p\u003e\n\u003ch3\u003eAssessment of Anxiety and Depression\u003c/h3\u003e\n\u003cp\u003eTo assess the emotional status of participants, we employed two widely used self-rating instruments: the Generalized Anxiety Disorder-7 (GAD-7) for anxiety and the Patient Health Questionnaire-9 (PHQ-9) for depression[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Both scales evaluate the frequency of symptoms experienced over the past two weeks. The GAD-7 comprises 7 items, each scored from 0 (\u0026ldquo;not at all\u0026rdquo;) to 3 (\u0026ldquo;nearly every day\u0026rdquo;), yielding a total score of 0 to 21. The PHQ-9 consists of 9 items with the same 0\u0026ndash;3 scoring system, producing a total score of 0 to 27. For both scales, higher scores reflect more severe symptoms. All questionnaires were self-administered under the guidance of trained research staff to ensure data quality.\u003c/p\u003e\n\u003ch3\u003ePittsburgh Sleep Quality Index (PSQI)\u003c/h3\u003e\n\u003cp\u003eSleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated and standardized 19-item self-reported questionnaire evaluating sleep quality over the past month[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The questionnaire generates seven component scores, including subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction. Each component is scored from 0 to 3, and the global score is calculated as the sum of these seven components, ranging from 0 to 21. Lower global scores indicate better sleep quality, while a score greater than 5 suggests significant sleep difficulties.\u003c/p\u003e\n\u003ch3\u003eHealth-Related Quality of Life\u003c/h3\u003e\n\u003cp\u003eHealth-related quality of life was evaluated using the 36-Item Short Form Survey (SF-36)[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The SF-36 comprises 36 items covering eight core domains: physical functioning, role limitations due to physical health, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health. For these eight domains, participants were asked to report their health status over the past four weeks. Each domain is scored on a scale from 0 to 100, with higher scores indicating better health status and quality of life. The health change item, a separate question, is considered independently to reflect perceived changes in overall health over the past year.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDietary assessment\u003c/h2\u003e \u003cp\u003eA food frequency questionnaire was used to assess participants' dietary habits (Supplementary File S1). The questionnaire documented the weekly intake of 13 food items, with frequency classified as everyday, \u0026ge;\u0026thinsp;3 times per week, \u0026lt;\u0026thinsp;3 times per week, and never. The assessed 13 food groups included protein sources (meat, fish, eggs, seafood, beans, and nuts), dairy products, vegetables, fruits, and carbohydrate sources (staple foods such as refined rice and flour, whole grains such as oats, millet, quinoa, rye, and brown rice), as well as olive oil and iodized salt.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExercise assessment\u003c/h3\u003e\n\u003cp\u003eExercise was assessed using a self-reported physical activity questionnaire (Supplementary File S2). Participants were asked to report the types of physical activities they engaged in over the past month and the amount of time spent on each activity. Reported durations were standardized to minutes per month, and total physical activity volume was calculated by summing the time spent across all activity types. Activities were classified into three intensity levels based on physiological responses and functional capacity, consistent with established intensity criteria and the standards of the Yale Physical Activity Survey (YPAS)(22). : Low-intensity activities were defined as those requiring minimal effort, characterized by steady breathing and the ability to sing easily (e.g., walking, household chores, gentle stretching). Moderate-intensity activities were defined as those causing noticeably increased heart rate and breathing while still allowing conversation (e.g., brisk walking, dancing, aerobics, recreational cycling, gardening). High-intensity activities were defined as those involving substantially increased heart rate and rapid breathing, making conversation difficult (e.g., running, fast swimming, vigorous cycling, competitive sports).\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using Stata software (version 18.0; StataCorp, College Station, TX). The continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, except for the skewed ones that were presented as the median with the interquartile range (25\u0026ndash;75%). The categorical variables were presented as counts and percentages of the total given in parentheses. Intergroup comparison was conducted using the Student\u0026rsquo;s t-test or the Wilcoxon rank-sum tests where appropriate. Chi-squared tests were used for the categorical variables. To investigate the association between exercise parameters and thyroid antibody levels (TPOAb and TgAb) in HT patients, Spearman correlation analysis was first performed. Subsequently, multivariate logistic regression analyses were conducted to further explore the independent associations between exercise parameters and thyroid antibody levels after adjusting for age, sex, and BMI. A two-sided P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e \u003cp\u003eA total of 226 participants were included in this study, with 105 in the Hashimoto\u0026rsquo;s thyroiditis (HT) group and 121 in the non-HT (healthy control) group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). No significant differences were observed between the two groups in basic demographic characteristics such as age and BMI. However, the proportion of females was significantly higher in the HT group compared with the non-HT group (81% vs. 62%, P\u0026thinsp;=\u0026thinsp;0.002). Regarding comorbidities, the prevalence of diabetes (13.3% vs. 5.0%, P\u0026thinsp;=\u0026thinsp;0.014) and dyslipidemia (32% vs. 17%, P\u0026thinsp;=\u0026thinsp;0.010) was significantly higher in the HT group. In terms of lifestyle habits, alcohol consumption was significantly lower in the HT group (4.1% vs. 18%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of the Study Population.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;226\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-HT\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;121\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;105\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWomen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.31 (13.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.31 (12.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.48(14.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.70 (3.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.56 (4.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.86 (3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoke n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrink n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetes n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (8.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHyperlipemia n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOsteoarthritis n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRheumatoid arthritis n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.480\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCerebrovascular disease n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoronary heart disease n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAsthma n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnemia n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMyalgia n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003en (%); Median (IQR)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e2\u003c/sup\u003ePearson's Chi-squared test; Wilcoxon rank sum test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eEmotional Status, Sleep Habits, and Quality of Life\u003c/h2\u003e \u003cp\u003eParticipants in the HT group exhibited significantly poorer emotional and sleep profiles compared with the non-HT group, directly impacting their quality of life. Anxiety (5.28 vs. 3.36, P\u0026thinsp;=\u0026thinsp;0.035) and depression (5.68 vs. 3.74, P\u0026thinsp;=\u0026thinsp;0.005) scores were both significantly higher in the HT group.\u003c/p\u003e \u003cp\u003eRegarding sleep habits, the HT group had significantly higher scores in sleep quality, sleep duration, sleep disturbances, use of sleeping medication and daytime dysfunction (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Consequently, their total PSQI score was also significantly worse (6.92 vs. 4.92, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating overall poorer sleep quality.\u003c/p\u003e \u003cp\u003eBased on the SF-36, the HT group reported significantly lower scores in multiple domains, including role limitations due to physical health, general health, social functioning, role limitations due to emotional problems, and mental health (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Furthermore, The health change was significantly lower in the HT group than in the non-HT group (41.22 vs. 55.79, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that patients with HT perceived a more negative change in their overall health over the past year (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMood, sleep and quality of Life in patients with Hashimoto\u0026rsquo;s thyroiditis and healthy individuals.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;226\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-HT\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;121\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;105\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.26 (1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.36 (1.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.28 (2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.72 (1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.74 (1.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.68 (2.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSQI (Pittsburgh Sleep Quality Index)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81 (0.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.23 (0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep latency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04 (0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97 (0.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.11 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.63 (0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.51 (0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76 (0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep efficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.10 (1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.10 (1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88 (1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep disturbances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.05 (0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91 (0.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.22 (0.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of sleeping medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.28 (0.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10 (0.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40 (0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaytime dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.18 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.31 (1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobal score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.85 (3.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.92 (3.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.92 (4.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSF-36\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.03 (15.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.68 (16.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.96 (12.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical limitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.15 (27.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.32 (23.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.70 (32.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBodily pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.52 (17.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.04 (16.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.03 (17.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.94 (22.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.62 (18.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.01 (23.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.36 (17.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.07 (16.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.20 (18.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93.78 (19.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.42 (19.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.84 (17.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional limitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.33 (28.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.63 (24.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.28 (32.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.70 (16.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.05 (17.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.04 (15.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.26 (21.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.79 (20.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.22 (20.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e2\u003c/sup\u003ePearson's Chi-squared test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDietary Habits\u003c/h2\u003e \u003cp\u003eSignificant differences in dietary habits were observed between the two groups. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, daily consumption of meat (64% vs. 42%, P\u0026thinsp;=\u0026thinsp;0.011), dairy products (50% vs. 31%, P\u0026thinsp;=\u0026thinsp;0.016), vegetables (89% vs. 72%, P\u0026thinsp;=\u0026thinsp;0.007), and fruits (64% vs. 46%, P\u0026thinsp;=\u0026thinsp;0.015) was significantly higher in the HT group. In contrast, a higher proportion of the non-HT group reported eating fish\u0026thinsp;\u0026ge;\u0026thinsp;3 times per week (34% vs. 20%, P\u0026thinsp;=\u0026thinsp;0.032). Significant group differences were also observed in olive oil and iodized salt consumption: olive oil use was more frequent in the HT group (P\u0026thinsp;=\u0026thinsp;0.031), while reduced use of iodized salt (\u0026lt;\u0026thinsp;3 times per week) was significantly more common among HT participants compared with controls (49% vs. 22%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating a more cautious approach toward iodine intake in the HT group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntake frequencies of main food groups per week in patients with Hashimoto\u0026rsquo;s thyroiditis and healthy individuals.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEveryday\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3/week\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3/week\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMeat\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFish\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEgg\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBean\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSeafood\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNuts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDairy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVegetable\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFruit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStaples\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhole Grains\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOlive oil\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIodized salt\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-HT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e2\u003c/sup\u003ePearson's Chi-squared test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eExercise Patterns and Their Association with Thyroid Autoantibodies\u003c/h2\u003e \u003cp\u003eIn terms of activity intensity (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea), the HT group spent more time on low-intensity activities (median 385.19 vs. 240.01 min/week, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) but less time on moderate-intensity activities (median 69.82 vs. 155.02 min/week, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and high-intensity activities (showed a tendency but without statistical significance). As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb, the five most common types of physical activity in the HT group were housework (63.8%), walking (33.3%), brisk walking (10.5%), jogging (8.6%), and swimming (5.7%). While In the non-HT group, the top five were housework (52.1%), brisk walking (14%), jogging (14%), walking (12.4%), and cycling (8.3%). Furthermore, compared with the non-HT group, the HT group demonstrated more conservative exercise patterns and lower activity diversity (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ec).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the HT group, Spearman correlation analysis revealed a significant negative correlation between high-intensity exercise time and TPOAb levels (r = \u0026minus;\u0026thinsp;0.32, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). A trend toward a negative association was also observed between moderate-intensity exercise and TgAb levels, whereas no significant correlations were found for light-intensity exercise (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Further linear regression analysis, after adjusting for age, sex, and BMI, confirmed that high-intensity exercise time remained inversely associated with TPOAb levels (P\u0026thinsp;=\u0026thinsp;0.039), suggesting that vigorous exercise may contribute to lower thyroid autoantibody levels in HT patients (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear regression analysis of exercise parameters and thyroid antibodies levels in patients with Hashimoto\u0026rsquo;s thyroiditis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eModel 1\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e\u003cem\u003eModel 2\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTPOAb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBeta\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eBeta\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003evalue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise types\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow-intensity exercise time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.932\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate-intensity exercise time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-7.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh-intensity exercise time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.74\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e-4.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTgAb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise types\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.605\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow-intensity exercise time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate-intensity exercise time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-7.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.441\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh-intensity exercise time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-8.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eModel 1: crude model;Model 2༚adjusted for age, sex, BMI\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eHashimoto\u0026rsquo;s thyroiditis (HT) is the most common autoimmune cause of hypothyroidism worldwide and remains a major health concern[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In recent years, lifestyle factors, particularly stress management, diet, and exercise, have gained increasing recognition for their role in the development and management of autoimmune diseases[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In this study, we systematically investigated the combined lifestyle profile of HT patients compared with healthy controls. HT patients were found to have higher anxiety and depression scores, poorer sleep quality, and lower health-related quality of life. They also demonstrated distinct dietary habits and more conservative exercise patterns. Importantly, higher intensity physical activity was inversely associated with TPOAb levels, indicating that physical activity at an adequate intensity, rather than merely light activity, may play a meaningful role in modulating autoimmune responses in HT.\u003c/p\u003e \u003cp\u003eHT patients frequently experience impaired psychological health and reduced quality of life (QoL). In this study, HT patients reported higher levels of anxiety and depression, poorer sleep quality, and reduced QoL, consistent with previous research. A meta-analysis pointed out that the risk of depression and anxiety in HT patients is higher than in the general population by different scales such as HADS, BDI, SAS, and SDS[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In our study, HT patients also showed significantly poorer sleep quality and lower scores in domains such as physical limitation, social functioning on the SF-36 scale. Emerging evidence indicates that these psychological and QoL impairments reflect not only the consequences of hypothyroidism but also the broader effects of autoimmunity. Higher levels of thyroid autoantibodies, particularly TPOAb, have been independently associated with fatigue, mood disturbances, and impaired QoL[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Notably, these impairments were observed even in euthyroid patients[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Potential mechanisms include low-grade systemic inflammation and cytokine release (e.g., IL-6, TNF-α) affecting central neurotransmission, as well as the chronic burden of symptoms such as continuous fatigue, sleep disturbances, weight changes, and emotional distress[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Collectively, these findings highlight the need to address lifestyle factors as integral components of HT management, beyond thyroid hormone replacement alone.\u003c/p\u003e \u003cp\u003eOur findings also revealed distinctive dietary features among HT patients. The proportion of HT patients with a daily intake of meat and dairy products was significantly higher than in the healthy control group, while their high-frequency fish intake was more conservative. This resembles the \"Western dietary pattern\" associated with red and processed meat, and dairy products. This pattern may aggravate thyroid inflammation through oxidative stress, pro-inflammatory cytokines, and even alterations in the gut microbiota[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Consistently, diets with high Dietary Inflammatory Index (DII) scores, rich in saturated fats and refined carbohydrates, have been linked to higher HT risk and TPOAb levels, whereas antioxidant-rich diets appear protective[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. At the same time, our findings also reflected conscious dietary adjustments by HT patients. For instance, greater intake of vegetables and fruits may represent an effort to enhance antioxidant defenses. Particularly, HT patients actively limit iodine consumption since excessive iodine intake is a well-established risk factor for HT. Collectively, these results underscore that dietary habits in HT are shaped not only by risk exposures but also by patient-driven behaviors, and that individualized, evidence-based dietary guidance should be an integral part of HT management.\u003c/p\u003e \u003cp\u003eRegular physical activity is an important modifiable factor in the management of Hashimoto\u0026rsquo;s thyroiditis. Exercise exerts anti-inflammatory and antioxidant effects, improves metabolic function, and enhances mood and energy levels[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In patients with hypothyroidism, appropriate exercise can help regulate body weight, improve cardiovascular health, and support thyroid hormone balance[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. These benefits highlight the potential role of regular exercise as an effective adjunct to conventional HT management. In this study, we provide a detailed analysis of the exercise habits of HT patients and reveals a significant association between their activity patterns and levels of thyroid autoantibodies. Our results indicate that HT patients exhibit more conservative and less diverse exercise patterns compared to healthy controls, primarily engaging in low-intensity activities such as housework and walking. This observation aligns with the distinction between \"occupational physical activity\" (e.g., housework), which may act as a chronic stressor, and \"recreational exercise\", which can serve as a positive immunomodulator, as proposed by Du\u0026ntilde;abeitia et al.. A key finding is the significant inverse correlation between time spent on high intensity exercise and TPOAb levels, which remained significant after adjusting for age, sex, and BMI. This provides strong evidence that exercise at an adequate intensity, rather than merely light activity, may play a meaningful role in modulating autoimmune responses. This finding is supported by a systematic review showing that long-term exercise interventions can significantly reduce TSH levels and increase T4 levels in hypothyroid individuals[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Mechanistic clues from animal studies further support this, as high-intensity interval training (HIIT) has been shown to improve cognitive function and reduce inflammatory markers like TNF-α in hypothyroid rats[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This suggests that higher intensity exercise may regulate the autoimmune response by mitigating systemic inflammation.\u003c/p\u003e \u003cp\u003eHowever, the benefits of high-intensity exercise are not without controversy. Some studies caution that excessive or high-intensity exercise can act as a powerful physiological stressor, potentially leading to elevated cortisol levels[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. High cortisol can suppress the hypothalamic-pituitary-thyroid (HPT) axis, inhibiting the conversion of T4 to the active T3 and increasing the production of inactive reverse T3 (rT3), which may functionally worsen fatigue symptoms and negatively impact thyroid function[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Our study supports the view that exercise, particularly at moderate to high intensity, can be a crucial component of HT management. However, we also emphasize that exercise interventions must be individualized and progressive. For patients who are clinically stable and have a foundation in exercise, introducing moderate to high-intensity activities under careful monitoring may be beneficial. Conversely, for those with active disease or severe fatigue, gradually progressive exercise is critical to avoid additional physiological stress, yet the recommendation awaits more evidence.\u003c/p\u003e \u003cp\u003eThis study has several limitations. Firstly, all lifestyle data were based on participant self-reporting, which may introduce recall bias and affect the objectivity and accuracy of the data. Secondly, our study population was recruited from a single center, which may limit the representativeness of our findings to other regions or different populations. Finally, as a cross-sectional study, it is unable to establish a causal relationship between lifestyle factors and the presence of HT or changes in autoantibody levels. Future research should employ prospective cohort studies or randomized controlled trials to verify our findings and further investigate the long-term effects of different lifestyle interventions on HT patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study systematically describes the lifestyle characteristics of HT patients and reveals significant differences compared to healthy individuals. Our research confirms that HT patients not only exhibit poorer emotional and sleep status but also demonstrate unique dietary and exercise patterns. Most importantly, we found that diverse exercise at an adequate intensity was significantly and inversely correlated with TPOAb levels, providing important evidence for the potential benefits of higher intensity exercise in HT management. These findings collectively highlight the necessity of integrating personalized, comprehensive lifestyle interventions into the clinical management of HT, with the goal of providing new strategies to improve patients' overall health and quality of life beyond medication.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai Geriatric Medical Center.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Specialized Training Foundation of Zhongshan Hospital (Grant No. 2023-007).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSM collected the data, conducted the statistical analyses, and drafted the manuscript. YL conceived the study and supervised the work. PY contributed to the statistical analyses. QC, MA, and DM assisted with data collection and processing. LZ, JZ, and XS revised the manuscript. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all participants for their contribution to this study. We also express our gratitude to the clinical staff for their assistance in questionnaire administration and data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChaker L, Papaleontiou M, Hypothyroidism. 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Hypothalamic-pituitary-thyroid axis in moderate and intense exercise. Horm Metab Res Horm Stoffwechselforschung Horm Metab. 2005;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1055/s-2005-870427\u003c/span\u003e\u003cspan address=\"10.1055/s-2005-870427\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNunez SG, Rabelo SP, Subotic N, Caruso JW, Knezevic NN. Chronic Stress and Autoimmunity: The Role of HPA Axis and Cortisol Dysregulation. Int J Mol Sci. 2025;26:9994. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijms26209994\u003c/span\u003e\u003cspan address=\"10.3390/ijms26209994\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-endocrine-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bend","sideBox":"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bend/default.aspx","title":"BMC Endocrine Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8574696/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8574696/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Hashimoto’s thyroiditis (HT) is the most common autoimmune cause of hypothyroidism, often accompanied by persistent non-specific symptoms despite normalized thyroid hormone levels. Lifestyle factors, including mood, sleep, diet, and exercise may influence disease progression and quality of life, but comprehensive characterization of HT patients’ lifestyle remains limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To systematically assess the lifestyle patterns of HT patients, including psychological well-being, sleep quality, quality of life, dietary habits, and physical activity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A single-center, cross-sectional study was conducted with 226 participants (105 HT patients and 121 healthy controls). Emotional status was assessed using the GAD-7 and PHQ-9; sleep quality with the Pittsburgh Sleep Quality Index (PSQI); and health-related quality of life with the SF-36. Dietary habits and physical activity were evaluated using two study-specific questionnaires. Serum TPOAb and TgAb levels were measured, and correlations with exercise parameters were analyzed using Spearman correlation and multivariate regression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e HT patients exhibited significantly higher anxiety and depression scores, poorer sleep quality, and lower quality of life compared to controls. They also demonstrated distinct dietary patterns, including higher daily intake of meat, dairy, vegetables, and fruits, as well as limiting iodized salt intake. In terms of physical activity, HT patients exhibited more conservative exercise patterns, engaging predominantly in low-intensity activities and less in moderate-to-high intensity exercises. Notably, more engagement in higher intensity exercise was inversely correlated with TPOAb levels, independent of age, sex, and BMI, suggesting a potential immunomodulatory benefit of adequate-intensity activity in HT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e HT patients present with impaired psychological health, altered sleep, distinct dietary adjustments, and conservative exercise patterns. Higher intensity exercise may contribute to lower thyroid autoantibody levels, highlighting the potential role of tailored lifestyle interventions in HT management.\u003c/p\u003e","manuscriptTitle":"A cross-sectional study on the lifestyle of patients with Hashimoto's thyroiditis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-04 13:39:26","doi":"10.21203/rs.3.rs-8574696/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-10T10:31:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-05T12:20:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83532901881083547481367680787618464014","date":"2026-02-05T08:54:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T16:46:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250573100769697424923865160019127174361","date":"2026-02-04T05:57:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-02T15:51:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-25T22:30:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-20T08:01:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-20T06:33:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Endocrine Disorders","date":"2026-01-20T06:25:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-endocrine-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bend","sideBox":"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bend/default.aspx","title":"BMC Endocrine Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ac2975ba-091e-4d20-bc34-e8171d37e4ae","owner":[],"postedDate":"February 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T15:09:08+00:00","versionOfRecord":{"articleIdentity":"rs-8574696","link":"https://doi.org/10.1186/s12902-026-02296-w","journal":{"identity":"bmc-endocrine-disorders","isVorOnly":false,"title":"BMC Endocrine Disorders"},"publishedOn":"2026-05-02 15:58:26","publishedOnDateReadable":"May 2nd, 2026"},"versionCreatedAt":"2026-02-04 13:39:26","video":"","vorDoi":"10.1186/s12902-026-02296-w","vorDoiUrl":"https://doi.org/10.1186/s12902-026-02296-w","workflowStages":[]},"version":"v1","identity":"rs-8574696","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8574696","identity":"rs-8574696","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}