Goitre in a Teaching Hospital in North Western Ethiopia

Background: The endemicity of goitre in Ethiopian high lands has been well established. There are however few studies done in the country, especially the study area, on the pattern and surgical management of goitres. This study was aimed at determining the pattern and surgical management of goitres in patient seen at Gondar College of Medical Sciences (GCMS), a teaching and referral Hospital, North Western Ethiopia. Methods: A prospective study of 80 patients with goitres was done between December 2003 and August 2004. The patients' history, physical findings and relevant laboratory results were recorded using a standard uniform format. Operative findings, postoperative course and follow up information were noted. The results were compiled and analyzed using computer statistical software. Results: The male to female ratio was 1: 4.7. The mean duration of illness was 8.8 years. A total of 78.8% of the patients had a Grade III goitre. Cosmetic disfigurement and respiratory symptoms were the leading reasons for hospital visit. Simple goitres, thyroid carcinoma and toxic goitres occurred in 80%, 11.3% and 6.25% of the patients respectively. The incidence of thyroid carcinoma was found to be higher compared to other studies in Ethiopia, Africa and Asia. Clinical evaluation was found to be valuable in identifying patients with toxic goitres. Seventy-five (93.8%) of the cases were treated surgically. The weight of thyroid tissue removed ranged between 20-1200 grams (Mean=320 grams). Blood transfusion was required in twelve patients for significant intra operative bleeding and four patients required tracheostomy post operatively. Three patients died. Blood group O+ was found to be frequently associated with goitre. Conclusion: Most of our patients know very little about the cause and treatment options of goitre. FNAC examination of the thyroid gland is found to be a very useful, cost effective and reasonably accurate diagnostic tool and we recommend its routine use. However, we discourage the routine determination of thyroid function tests in all patients, unless indicated by a suggestive clinical index score for thyrotoxicosis, especially in health facilities where these tests are scarcely available. We recommend further clinical and community based studies to assess reasons for the high incidence of thyroid carcinoma