Multidisciplinary thyroid disease management in The Gambia: Results of a 6-year multinational collaboration

Abstract

Background

Thyroid disease remains prevalent in West Africa, with pathogenetic contributions from dietary and genetic factors. Specialist ser­vices for the management of thyroid disease were previously unavailable at Serrekunda General Hospital, leaving a considerable unmet need at this large urban referral hospital in The Gambia.

This study sought to document clinical characteristics and outcomes among patients attending a multidisciplinary, collaborative, 1-stop clinic offering surgical and medical management of thyroid disease in The Gambia.

Methods

We retrospectively evaluated demographic, clinical, and outcome data from patients with thyroid disease who were medically or surgically treated from March 2012 through January 2018 by visiting teams representing Medicos en Accion (MEA), a Canadian nonprofit organization. Variables evaluated included history of presenting concern, comorbidities, current medications, thyroid function status, surgical procedure, histopathology, and postoperative outcomes, including surgical complications. Patients were followed up at least biannually; long-term follow-up was defined as ≥1 year after thyroidectomy. A subset of surgical specimens underwent histopathologic analysis.

Results

A total of 352 patients were assessed (331 female; median age, 36 years). Primary diagnoses included toxic multinodular goitre (MNG, 30.6%), nontoxic MNG (37.5%), solitary nodule (8.6%), and Graves’ disease (13.8%). Hyperthyroidism was present in 49.2% of patients at initial assessments, yet only 28.5% of these patients were on appropriate medical therapy. Hypertension was found in 33.8% of all patients, but less than half (42.9%) of these were on treatment at presentation.

Thyroidectomy was performed for 83 patients (23.6%): 35 total thyroidectomies and 48 partial thyroidectomies. At the end of a median follow-up duration of 12 months, all patients were disease-free with reference to their initial surgical indications. Serious postoperative complications occurred in 2 patients, both of whom recovered fully with no long-term sequelae.

Conclusions

This study demonstrated the feasibility of establishing a multidisciplinary thyroid clinic in a low-resource setting, leading to im­proved access to care and public awareness of thyroid disease, as evidenced by the annual increase in patients managed through the study period at Serrekunda General Hospital. These results provide previously unavailable evidence on the profile of thyroid disease in The Gambia.