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Management of solitary thyroid nodules in rural Africa
1Department of Surgery, Africa Inland Church, Kijabe Hospital, PO Box 20, Kijabe, 02220, Kenya.
Objectives:
To review a simple protocol for the management of solitary thyroid nodules and to document the spectrum of pathological diagnoses associated with this condition.
Design:
A retrospective review of all solitary solid thyroid nodules excised over a three-year period 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 over a 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 clinically indicated.
Main Outcome Measures:
Clinical diagnosis, tribe, operation performed, pathology, and complications of surgery.
Results:
Eighty-one operations were performed for a solitary thyroid nodule. The most common operations were lobectomy and isthmusectomy. There were two complications--a neck haematoma that required surgery and one recurrent laryngeal nerve injury. The commonest pathological diagnosis was multinodular goitre (42%). There was a 16% malignancy rate with eight papillary carcinomas, five follicular carcinomas, and one hurthle 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% malignancy rate in this condition. There is a possibility that there is a shift in the ratio of papillary to follicular carcinomas compared to older African studies and this would be an interesting area for further study.