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Thyroid disease in a rural Kenyan hospital.

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.