[Clinical characteristics of primary hypothyroidism in Dakar. Apropos of 37 cases]

Primary hypothyroidism, other than cases of endemic goiter, has rarely been described in Africa. We conducted a retrospective study of the patients admitted to our hospital unit between 1985 and 1996. The inclusion criteria were clinical signs of hypothyroidism and low levels of thyroid-stimulating hormone. We investigated socio-demographic, clinical (hypometabolic syndrome, cutaneomucal syndrome, muscular syndrome) and etiological (spontaneous thyroid atrophy, thyroidectomy, multinodular goiter) factors. Overall, our study population contained 37 cases, 8 men and 29 women. The mean age of the men was 40.8 +/- 19.2 years and that of the women was 41.5 +/- 14.5 years. Eighteen patients (about 50%) lived in the suburbs, 25% of patients were from urban areas and 25% from rural areas. The associated clinical signs were: 1) hypometabolism: constipation (51% of cases), bradycardia (45%), physical asthenia (40%), sleeping during the day (32%), frilosity (35%); 2) cutaneomucal syndrome: hoarseness (48%), alopecia (32%), facial puffiness (27%), macroglossia (24%), hypoacousia (21%), weight gain (18%), dry skin (16%), pallor (2%); 3) muscular syndrome was rare: myalgia (4 cases), muscle weakness (2 cases). Mean total cholesterol concentration was 2.54 +/- 0.75 g/l; mean total T3 was 1.027 +/- 0.84 nmol/l; mean total T4 was 16.70 +/- 16.89 nmol/l; mean TSH concentration, measured by radiometry, was 63.74 +/- 51.01 mIU/l. The etiology was goiter in 13 cases, thyroidectomy (11 cases) and spontaneous thyroid atrophy (13 cases). Thus, primary hypothyroidism does occur in African hospitals, particularly in Senegal. This disease, which has traditionally been reported in public health studies of endemic goiter, also occurs in cosmopolitan African environments.