A two-year audit of thyroid disorders in an urban hospital in Nigeria

Thyroid disorders are the second commonly encountered disorders in endocrine clinics and are significant causes of medical morbidity and mortality. It is pertinent to note that in the Nigerian setting, there are challenges of sub-optimal investigative and therapeutic facilities especially as concerning thyroid disorders hence there is underreporting of this important group of endocrine disorders from our part of the world.

The objective of this audit is to describe the pattern of presentation, investigation, management and outcome of thyroid disorders in patients attending the Lagos State University Teaching Hospital (LASUTH) Endocrine Center.

This was a retrospective medical record review of patients with thyroid disorders who presented to the out patient department, the Medical and Emergency wards of LASUTH between June 2007-June 2009. The clinical, biochemical, serological and histological parameters were used to characterize the patients. Investigations done, treatment type, complications of thyroid disorders, hospitalization records and outcome of management were all documented.

One hundred and seventy patients with thyroid disorders aged between 11 and 70 years were seen during the period under review. The male: female ratio was 1:7. Patients presenting with thyrotoxicosis were 128 in number thus giving an incidence rate per year of 64. Therapeutic options were essentially thionamides, betablockers, steroids, surgery, radioactive iodine (RAI) and thyroxine. The mean (SEM) duration of medication usage was 24.5 and the median medication duration was 24 months. RAI usage was low as its use was documented in 7% of the subjects with thyroid dysfunction. The rate of occurrence of variable glucose intolerance was 28% with frank diabetes mellitus diagnosed in 9% of the cases of hyperthyroidism. Thyroid storm, psychiatric manifestations, thyrocardiac disease and cerebrovascular diseases were indications for hospitalizations. Two deaths were documented and these were due to thyrocardiac disease and thyroid storm.

RAI usage is underutilized and the thionamides are the main stay of treatment for people presenting with thyrotoxicosis. Given the peculiarities of presentation of thyroid disorders in our practice and the challenges of poor accessibility to diagnostic and therapeutic facilities, it is imperative that management guidelines that take into consideration our resource poor background be set up.