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The authors suggested that environmental factors, such as ambient temperature, may modulate hypothalamic-pituitary-thyroid axis activity, contributing to fluctuations in disease activity or laboratory values in patients with Hashimotos thyroiditis, highlighting the importance of considering the seasonal context in the diagnosis and treatment of thyroid disorders.Finally, living in overly sterile environments with limited exposure to environmental agents has been linked to a higher incidence of HT, possibly due to reduced immune system training and altered microbiota composition (Klubo-Gwiezdzinska And Wartofsky 2022)