The pattern of thyroid diseases in adult Ethiopians and experience in management

During the study period, between February 1986 and July 1991, a total of 373 thyroid patients (68.3% of the total endocrine cases) were seen in the weekly endocrine referral clinic of Tikur Anbessa Hospital (TAH); 258 (69.2%) came from Addis Abeba, 41 were males and 332 females (M:F = 1:8.1) and 71.9% were below 40 years of age. Thyrotoxicosis was seen in 43.7% of the patients, followed by euthyroid solitary nodules (23.6%) and simple goitres (22.3%). Euthyroid multinodular goitre was seen in 6.7% while hypothyroidism and thyroiditis were less frequent. Graves' disease was the main cause (41.7%) of thyrotoxicosis, followed by toxic multinodular goitre TMNG (31.9%), toxic solitary nodule (22.1%), Jodbasedow phenomenon (3.1%) and thyroiditis (1.2%). All thyrotoxic patients responded to the treatment, but 4 of 21 Graves' cases with relative triiodothyronine (T3) elevation relapsed after treatment was discontinued. Nine thyrotoxic patients had surgery after euthyroid state was attained; 1 each became hypothyroid and hyperthyroid a year later, 6 remained euthyroid and 1 did not return. Fine needle aspiration biopsy (FNAB) was helpful both as a diagnostic and therapeutic tool. Of 42 cystic nodules, 30 were repeatedly aspirated; 6 were cured and the rest had a reduction in size by 50%. Nine cases of solitary nodule, 3 cystic and 6 solid, were operated and the histology confirmed the cytology diagnosis in all but 1; in that one case, the cytology showed a benign lesion while the histology revealed papillary carcinoma.