Hyperthyroidism in a Private Medical Services Center, Addis Ababa: A 5-Year Experience

  • Tessema Ersumo Addis Ababa University School of Health Sciences
  • Girmaye Tamrat Bogale Addis Ababa University School of Health Sciences,Department of Surgery
  • Burka Mohammedsani Adem Addis Ababa University School of Health Sciences,Department of Surgery Senior Surgical Resdent

Abstract

Abstract

Background: Hyperthyroidism is a common thyroid disorder especially in women. The disorder manifests predominantly as Graves’ disease in iodine-sufficient areas and nodular toxic goiter in iodine-deficient countries. In Ethiopia, the magnitude of the disorder is unknown and its management remains suboptimal.

Objective: The aim of this study was to analyze the pattern and management of patients with hyperthyroidism at the United Vision Medical Services Center (UVMSC), between August 30, 2013 and February 1, 2018.

Patients and Methods: The study was a retrospective analysis of all patients with hyperthyroidism at UVMSC. The data was statistically analyzed using the SPSS package. The results were tabulated and discussed with literature review.

Results: A total of 589 patients were studied. The median age was 40 years; the male to female ratio was 1.0:7.9; and 93% of patients presented with goiter. Majority presented more than two years after the onset of symptoms, in 91% with a toxic nodular goiter. A low thyroid stimulating hormone was noted in 83% of patients and 94% used propylthiouracil. Among 213 patients, 96% underwent a near-total thyroidectomy, in 92% without incident.

Conclusions: The incidence and prevalence of hyperthyroidism is apparently on the increase in Addis Ababa. Hyperthyroidism predominantly affects women and toxic nodular goiter is more common than diffuse goiter and the treatment of choice in experienced hands is near-total thyroidectomy.

Keywords:-Hyperthyroidism, pattern, management, United vision Medical Services, Addis Ababa.

Author Biographies

Tessema Ersumo, Addis Ababa University School of Health Sciences
Surgery,AAUSOM
Girmaye Tamrat Bogale, Addis Ababa University School of Health Sciences,Department of Surgery
Surgery,Consultant Surgeon
Burka Mohammedsani Adem, Addis Ababa University School of Health Sciences,Department of Surgery Senior Surgical Resdent

Department of Surgery
Senior Surgical Resdent

References

References

Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, et.al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018 May; 14(5):301-316.

De Leo S, Lee SY and Braverman LE. Hyperthyroidism. Lancet (London, England). 2016;388(10047):906-918.

Mark P. J. Vanderpump. The epidemiology of thyroid disease. British Medical Bulletin. September 2011; 99 1, 1:39–51.

Vanderpump MPJ, Braverman LE and Utiger RD. The epidemiology of thyroid diseases.- In: Werner and Ingbar's. The Thyroid: A Fundamental and Clinical Text 9th ed. Philadelphia JB Lippincott-Raven, 2005:398-496

Knut K, Dagmar F, Yvonne B, Markus E, Volker B, Susanne N, et al.Molecular Pathogenesis of Euthyroid and Toxic Multinodular Goiter. Endocrine Reviews, 2005 June; 26, 4(1):504–524.

Terry J. Smith and Laszlo Hegedüs. Graves’ disease. N Engl J Med 2016; 375:1552-1565.

Laurberg p, cerqueira c, ovesen l, rasmussen lb, perrild h, andersen s, et.al. Iodine intake as a determinant of thyroid disorders in populations: 2010 Feb; 24(1):13-27.

Anthonia Okeoghene Ogbera, Sonny Folunrusho Kuku. Review Article: Epidemiology of thyroid diseases in Africa. Indian Journal of Endocrinology and Metabolism; 2011: 15 Supplement 2.

Available from http://www.ijem.in on Friday, August 24, 2018, IP: 197.156.107.226

Alam K, M Muzaffar A and Shamim A. Thyroid Disorders, Etiology and Prevalence. Journal of Medical Sciences 2002; 2:89-94.

Osei Sarfo-Kantanka, Ishmael Kyei, Fred Stephen Sarfo and Eunice Oparebea Ansah. Thyroid Disorders in Central Ghana: The Influence of 20 Years of Iodization.Hindawi Journal of Thyroid Research.Volume 2017 (2017), Article ID 7843972, 8 pages.

Cherinet A, Yemane B, Girma A,Zewditu G and Tessema E. Prevalence of goiter in children 6 to 12 years of age in Ethiopia. Food and Nutrition Bulletin, The United Nations University 2007; 28(4):391-397.

Fualal J, Moses W, Jayaraman S, Nalugo M, Ozgediz D, Duh QY, et.al. Characterizing Thyroid Disease and Identifying Barriers to Care and Treatment in Uganda. World J Endoc Surg. 2012; 4(2):47-53.

Elizabeth N. Clinical Review: Diagnosis and management of thyrotoxicosis. British Med J 2006; 332:1369–73.

Huang HL and Aw TC. Thyroid Function Testing:A Review. Annals Thyroid Res. 2014; 1(2): 17-22.

Grimaldi, Antonio, et al. Neck Mass in Rural Africa. Clinical communication to the editor. The American Journal of Medicine 2015; 128 (2):e3 - e4.

Abdulkadir J, Besrat A, Abraham G and Gebre P. Thyrotoxicosis in Ethiopian patients-a prospective study. Trans R Soc Trop Med Hyg. 1982; 76(4):500-2.

Ayandipo OO, Orunmuyi AT, Akande TO, Ogun OA, Afuwape OO, Afolabi AO, et al. Presentation and Management Outcomes of Hyperthyroidism in a Sub-Saharan African Teaching Hospital. Annals Thyroid Res. 2018; 4(1):130-135.

Díez J, J: Hyperthyroidism in Patients Older than 55 Years: An Analysis of the Etiology and Management. Gerontology 2003;49:316-323.

Mengistu M Thyrotoxicosis in an Ethiopian teaching hospital. Trop Geogr Med. 1991 Jul; 43(3):276-82.

Mengistu M. The pattern of thyroid diseases in adult Ethiopians and experience in management. Ethiop Med J. 1993 Jan; 31(1):25-36.

Goichot B, Caron P, Landron F and Bouée S. Clinical presentation of hyperthyroidism in a large representative sample of outpatients in France: relationships with age, etiology and hormonal parameters. Clin Endocrinol (Oxf). 2016 Mar; 84(3):445-51.

Kotisso B, Ersumo T, Ali A. and Wassie A. Thyroid disease in Tikur Anbessa Hospital: a five-year review. Ethiop Med J. 2004 Jul; 42(3):205-9.

Ogbera AO. , Fasanmade O. , Isiba A. The Scope of Cardiac Complications of Thyrotoxicosis in Lagos, Nigeria. Pak J Med Sci October - December 2007 (Part-I) 23, 5: 671-675.

Sarr, A., Diédhiou, D., Ndour-Mbaye, N.M., Sow, D., Diallo, I.M., et.al. Graves’ Disease in Senegal: Clinical and Evolutionary Aspects. Open Journal of Internal Medicine, 2016; 6:77-82.

Ekpe E. Correlation between Diabetes Mellitus and Thyroid Dysfunction: Genetic Basis and Literature Review. Advances in Biosciences & Clinical Medicine.2016; 4,2:3

Yair Liel and Nitay Fraenkel. Brief report: Use and Misuse of Thyroid Ultrasound in the Initial Workup of Patients with Suspected Thyroid Problems Referred by Primary Care Physicians to an Endocrine Clinic. J GEN INTERN MED 2005; 20:766–768.

Anthonia Okeoghene Ogbera and Onyebuchi E Okosieme.Thyroid diseases in Africa: epidemiology and management challenges.Thyroid international.Peter PA Symyth, UCD, Dublin. Merk KGaA, Darmstardt,Germany 1.2014.

Pazaitou-Panayiotou, K. Michalakis and R. Pastiche. Review: Thyroid Cancer in Patients with Hyperthyroidism. Horm Metab Res 2012; 44:255–262.

Cerci C, Cerci S S, Eroglu E, Dede M, Kapucuoglu N, Yildiz M and Bulbul M. Thyroid cancer in toxic and non-toxic multinodular goiter. J Postgrad Med 2007; 53:157-60.

Christopher R. and a Roy P. Follicular Adenoma and Carcinoma of the Thyroid Gland.CME on Endocrinology.The Oncologist. 2011; 16:585–593.

Rebecca S., Henry B., David S., Jeffrey R., M. Carol, Irwin K. et.al. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. THYROID Volume 21, Number 6, 2011 @ Mary Ann Liebert, Inc.

Burali G, Martin OD, Fiorini FR, Mannelli G, Giachetti R, Oreste G, et al. Total Thyroidectomy in North Uganda: A Cultural and Socioeconomic Challenge for an African Country. Thyroid Disorder Ther 2016; 5:206.

Abebe B, Girmaye T Mensur O M, Sentayehu T and Sissay B. The Patterns Of Surgical Thyroid Diseases And Operative Treatment In Gondar College of Medical sciences, North-western Ethiopia. East and Central African Journal of Surgery. 2004; 9(1):1-7.

Watters D A and Wall J. THYROID SURGERY IN THE TROPICS. ANZ Journal of Surgery, 2007; 77: 933-940.

Published
2019-12-30
Section
Original Article