MANAGEMENT OF SOLITARY THYROID NODULES IN RURAL AFRICA

Objectives: To review a simple protocol for the management of solitary thyroid nodulesand to document the spectrum of pathological diagnoses associated with this condition.Design: A retrospective review of all solitary solid thyroid nodules excised over a threeyearperiod from 1st January 1999 to 31st December 2001.Setting: A rural church-based hospital in Kenya.Subjects: All patients undergoing thyroidectomy for solitary solid thyroid nodule overa three-year period at Kijabe Hospital.Interventions: A simple protocol was used to manage this condition involving history,clinical examination, needle aspiration of the lesion, and excision when clinicallyindicated.Main Outcome Measures: Clinical diagnosis, tribe, operation performed, pathology, andcomplications of surgery.Results: Eighty-one operations were performed for a solitary thyroid nodule. The mostcommon operations were lobectomy and isthmusectomy. There were two complicationsaneck haematoma that required surgery and one recurrent laryngeal nerve injury. Thecommonest pathological diagnosis was multinodular goitre (42%). There was a 16%malignancy rate with eight papillary carcinomas, five follicular carcinomas, and onehurthle cell carcinoma.Conclusions: The simple protocol described gives good results in a rural African hospital.Solitary solid thyroid nodules should be routinely excised due to the 16% malignancyrate in this condition. There is a possibility that there is a shift in the ratio of papillaryto follicular carcinomas compared to older African studies and this would be aninteresting area for further study