Carcinoma of the thyroid in Khartoum

One hundred and twelve patients with thyroid malignancy seen at The Radio-isotope Centre, Khartoum (RICK) during the period 1982-1989 were studied. The female to male ratio was 2.5:1.0 with a high incidence of the disease between the ages of 40 and 70 years. Follicular carcinoma was the commonest (42%) followed by papillary (22.3%) and anaplastic (21.4%). Goitre was the main presenting symptom (92.9%). Cervical lymphadenopathy was present almost equally in these three histological types, 26.6%, 32%, and 33% respectively. Blood borne metastasis was seen in 32 (28.6%) patients in the whole series. Follicular carcinoma had the highest incidence of blood borne metastasis (21 out of 47 patients) being mostly osseous (16 patients). Anaplastic and squamous cell carcinoma showed a locally aggressive behaviour to nearby structures resulting in hoarseness of voice, dyspnoea and dysphagia indicating advanced disease. Most patients presented with advanced disease limiting the option of total thyroidectomy (40%). A high index of clinical suspicion is needed in areas of endemic goitres in order that selected cases can be subjected to surgery at an earlier stage of the disease. Doctors and medical assistants should be taught how to diagnose solitary thyroid nodules and clinically hard glands so that they can be evaluated at an earlier stage of the disease.