Abstract
Thyroid disorders are highly prevalent in Saudi Arabia and represent a significant public health burden. Primary care physicians (PCPs) are the first point of contact for most patients, playing a critical role in diagnosis, initial management, and referral. However, a synthesis of evidence specific to primary care settings in the Kingdom is lacking. This systematic review aimed to synthesize available evidence on the diagnosis and management of thyroid disorders in primary care settings in Saudi Arabia. A systematic search was conducted following PRISMA guidelines for relevant studies published up to 2025. Observational studies reporting on the prevalence, diagnosis, or management of thyroid disorders in Saudi primary care were included. Four studies met the inclusion criteria and revealed a variable but substantial burden of thyroid disease in primary care, with high prevalence rates of hypothyroidism (reported up to 31.1% in a diabetic cohort), thyroiditis (43%), and thyroid nodules (~25%). Key diagnostic tools highlighted were thyroid function tests, ultrasound, and fine-needle aspiration (FNA), with one study reporting a 17.5% malignancy rate post-thyroidectomy. Studies consistently identified strong associations between thyroid dysfunction and comorbidities such as type 2 diabetes mellitus, obesity, and vitamin D deficiency. Thyroid disorders are a common and complex challenge in Saudi primary care. The high prevalence, particularly among high-risk groups like women and diabetic patients, coupled with significant comorbidities, necessitates a proactive, systematic approach. Streamlined referral pathways for ultrasound and FNA, integrated management of comorbidities, and the development of national primary care-focused guidelines are essential to optimize patient outcomes and empower frontline healthcare providers.

Key words: Thyroid disorders, primary health care, family practice, Saudi Arabia, systematic review