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Thyroid disease in a rural Kenyan hospital
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.
East African Medical Journal Vol.81(12) 2004: 631-633
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.
East African Medical Journal Vol.81(12) 2004: 631-633
