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Background  The association between subclinical hypothyroidism (SCH) and metabolic risk factors in the general health examination-based population has been widely explored. However, the results have been inconclusive. Additionally, the sex differences in the prevalence of SCH and the association of SCH with metabolic risk factors remain unknown.    Methods  We conducted this cross-sectional study using data from health examination-based participants between June 2016 and April 2018 in our health examination centre. Sex differences SCH and the association of SCH with metabolic risk factors were explored.    Results  The total prevalence of SCH was 3.40% among the 5319 included participants, and 4.90% among the 2306 female participants, which was much higher than the prevalence of 2.26% among the 3013 male participants ( p  &lt; 0.05). In males, the difference between participants younger than 60 and aged 60 or older was not significant ( p  = 0.104); while in females, the difference between participants younger than 40 and participants aged 40 or older was statistically significant ( p  = 0.023). Multivariate logistic regression analysis demonstrated that age (OR = 0.568,  p  = 0.004), body-mass index (BMI) (OR = 5.029,  p  &lt; 0.001) and systolic/diastolic blood pressure (SBP/DBP) (OR = 5.243,  p  &lt; 0.001) were independent predictors of SCH in females, but no metabolic risk factor was significantly associated with SCH in males. Further analysis revealed that the prevalence was much higher in participants with one or two metabolic risk factors than in those with no above metabolic risk factors regardless of age ( p  &lt; 0.01).    Conclusions  Our study demonstrates that high BMI and/or high blood pressure are associated with SCH in female participants, and the prevalence of SCH among women with one or two metabolic risk factors ranges from 7.69–14.81%, which indicates that in such a population, serum concentrations of TSH and FT4 may be routinely screened in mainland China. Certainly, prospective, large-scale studies with long follow-up period are still necessary to further verify our results.

Sex differences in subclinical hypothyroidism and associations with metabolic risk factors: a health examination-based study in mainland China