A G Hill1, I Mwangi, L Wagana. 1. Department of Surgery, South Auckland Clinical School, University of Auckland, New Zealand.
Abstract
OBJECTIVES: To review the spectrum of thyroid pathology diagnoses likely to be encountered by surgeons working in East African hospitals. DESIGN: A retrospective review of all thyroidectomies performed over a three year period. SETTING: A rural church based hospital in Kenya. SUBJECTS: Two hundred and twenty two patients who underwent thyroidectomy over a three year period at Kijabe hospital. INTERVENTIONS: A simple protocol was used to manage thyroid disease involving history, clinical examination, measurement of TSH and needle aspiration of lesions where appropriate, and excision when clinically indicated. MAIN OUTCOME MEASURES: Clinical diagnosis, tribe, operation performed, pathology, and complications of surgery. RESULTS: Two hundred and twenty thyroidectomies were performed. Overall there was a malignancy rate of 11.7% (15 papillary, 11 follicular). The commonest pathological diagnosis was multinodular goitre (47%). Graves' disease was a relatively common diagnosis in this series (13%). The mortality rate was 0.5% and the morbidity rate was 3.6%. CONCLUSION: Graves' disease is not as uncommon in rural Africa as previously thought. Malignancy is relatively common and there appears to be a change in the papillary to follicular cancer ratio perhaps reflecting widespread iodinisation of salt in Kenya.
OBJECTIVES: To review the spectrum of thyroid pathology diagnoses likely to be encountered by surgeons working in East African hospitals. DESIGN: A retrospective review of all thyroidectomies performed over a three year period. SETTING: A rural church based hospital in Kenya. SUBJECTS: Two hundred and twenty two patients who underwent thyroidectomy over a three year period at Kijabe hospital. INTERVENTIONS: A simple protocol was used to manage thyroid disease involving history, clinical examination, measurement of TSH and needle aspiration of lesions where appropriate, and excision when clinically indicated. MAIN OUTCOME MEASURES: Clinical diagnosis, tribe, operation performed, pathology, and complications of surgery. RESULTS: Two hundred and twenty thyroidectomies were performed. Overall there was a malignancy rate of 11.7% (15 papillary, 11 follicular). The commonest pathological diagnosis was multinodular goitre (47%). Graves' disease was a relatively common diagnosis in this series (13%). The mortality rate was 0.5% and the morbidity rate was 3.6%. CONCLUSION:Graves' disease is not as uncommon in rural Africa as previously thought. Malignancy is relatively common and there appears to be a change in the papillary to follicular cancer ratio perhaps reflecting widespread iodinisation of salt in Kenya.