|Year : 2016 | Volume
| Issue : 3 | Page : 137-140
Spectrum and prevalence of thyroid diseases seen at a tertiary health facility in Sagamu, South-West Nigeria
Babatunde Abayomi Salami1, Olatunde Odusan2, Henry Okuchukwu Ebili3, Patrick Akintunde Akintola3
1 Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
2 Department of Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
3 Department of Morbid Anatomy & Histopathology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
|Date of Web Publication||12-Sep-2016|
Babatunde Abayomi Salami
Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu
Source of Support: None, Conflict of Interest: None
Background: The prevalence of goitrous swelling has reduced in Nigeria since the introduction of salt iodisation programme. Thyroid disorders are the second most common endocrine disorder after diabetes mellitus worldwide. They present to general outpatient, medical and surgical clinics accompanied by great anxiety and poor health-related quality of life.
Objectives: The study aimed to determine and describe the spectrum of thyroid disorders seen at Olabisi Onabanjo University Teaching Hospital over a 10-year period.
Materials and Methods: This was a retrospective analysis of records of patients who presented to the hospital with thyroid swellings over a 10-year period (June 2004 to June 2014). Clinicopathological and demographic data obtained from hospital records in 175 patients diagnosed by clinical examination, thyroid ultrasound, hormone profile and histological confirmation in cases that had surgery were analysed for this study.
Results: The records of 175 patients were obtained comprising 151 (86.3%) females and 24 (13.7%) males (female to male ratio of 6.3:1) with age range from 18 to 76 years and mean age of 42.3 years, standard deviation 13.5. With clinical diagnosis, distribution of thyroid diseases was simple goitre 103 (58.9%), toxic goitre 64 (36.6%), hypothyroidism 3 (1.7%), malignant goitre 4 (2.3%) and thyroiditis 1 (0.6%). The age group of 30–49 years had the highest prevalence of the thyroid diseases 100 (57.2%) while the extremes of age, below 20 and over 70 years had the least (5.1 and 2.9%, respectively).
Conclusion: The prevalent form of thyroid diseases seen at Olabisi Onabanjo University Teaching Hospital was simple goitre and most common in females. Studies on autoimmunity and other goitrogens are required to further elucidate the cause of this high prevalence.
Keywords: Goitre, prevalence, South-western Nigeria, spectrum
|How to cite this article:|
Salami BA, Odusan O, Ebili HO, Akintola PA. Spectrum and prevalence of thyroid diseases seen at a tertiary health facility in Sagamu, South-West Nigeria. Niger Postgrad Med J 2016;23:137-40
|How to cite this URL:|
Salami BA, Odusan O, Ebili HO, Akintola PA. Spectrum and prevalence of thyroid diseases seen at a tertiary health facility in Sagamu, South-West Nigeria. Niger Postgrad Med J [serial online] 2016 [cited 2020 Jan 18];23:137-40. Available from: http://www.npmj.org/text.asp?2016/23/3/137/190345
| Introduction|| |
Thyroid disorders are one of the most common endocrine disorders seen worldwide., They are the second most common endocrine disorders seen in endocrinology clinics in Nigeria and majority of them are benign., Thyroid disorders may present as a derangement of thyroid hormone secretion, thyroid enlargement or pain. The varieties of thyroid disorders include hypothyroidism or hyperthyroidism, simple nodular enlargement, neoplastic enlargement and thyroiditis. Developmental abnormalities which are rare include lingual thyroid, absence or hypoplasia. The common causes of hyperthyroidism are Grave's disease, toxic multinodular goitre and solitary toxic adenoma. Less common causes are thyroid carcinoma, excessive ingestion of thyroid hormone and struma ovarii. An important cause of hypothyroidism is Hashimoto's thyroiditis whereas less common causes are hypopituitarism and developmental abnormalities. The spectrum of thyroid enlargements includes solitary thyroid nodules which may be caused by cysts, adenomas and malignancy and the non-toxic multinodular goitres. Pain may be caused by infective thyroiditis and haemorrhage into an adenoma. Thyroid enlargements are more common in females and most of them present in the clinics for cosmetic reasons.,
Nearly, one-third of the population of the world inhabit areas of iodine deficiency, and the prevalence of goitre in areas of deficiency can be as high as 80%., Iodisation programmes have been shown to be of value in reducing and preventing thyroid disorders. The prevalence of goitrous swelling has reduced in Nigeria since the introduction of iodisation programme by the government through the increased availability of iodised salt and other food supplements.
Olabisi Onabanjo University Teaching Hospital in Sagamu is geographically located close to two major expressways – Lagos/Ibadan and Lagos/Benin. Sagamu town is not in an endemic region for goitres. It serves the surrounding communities and the neighbouring states of Lagos and Oyo in South-western Nigeria. Anecdotally, patients with thyroid-related problems especially enlargements are usually referred to the surgical or medical clinics from the general outpatient department. Referrals from outside the health care facility are seen in the medical or surgical clinic.
The purpose of this study was to document the types of thyroid disorders seen in a tertiary health facility in South-western Nigeria. Knowledge of the spectrum of thyroid disorders will help in planning for appropriate treatment modalities. For example, the need for radiotherapy unit for malignant thyroid diseases and radioiodine therapy for toxic goitre. It will also facilitate and stimulate further studies on etiological factors.
| Materials and Methods|| |
A retrospective study and analysis of medical records of all patients with thyroid disorders seen in the hospital between June 2004 and June 2014 were carried out. Information obtained included demographic data (age, sex, occupation, religion, level of education), clinical diagnosis, histological diagnosis were available and treatment modalities. Descriptive statistical analysis was done using SPSS version 21.0 by IBM Corporation, USA to determine frequencies and percentages as well as mean, range and standard deviation (SD) of age. The data were presented in frequency tables.
| Results|| |
The study population of 175 cases obtained comprised 151 females and 24 males with a female to male ratio of 6.3:1. The ages ranged from 18 to 76 years with a mean of 42.3 years and SD 13.5 years [Table 1]. The majority of the patients 75 (42.9%) had tertiary education. Only 13 (7.4%) had no formal education. The majority of the patients 56 (32.0%) were traders while 23 (13.1%) were artisans and farmers. Professionals and civil servants were 35 (20%).
[Table 2] shows that the most common clinical diagnosis in these patients was simple goitre 103 (58.9%) followed by toxic goitre 64 (36.6%). Diagnosis of hypothyroidism was made in 3 (1.7%), malignant goitre in 4 (2.3%) and only 1 (0.6%) case of thyroiditis.
Eighty-nine (51.9%) of the patients had surgical treatment while 68 (38.9%) had medical treatment which included antithyroid drugs for thyrotoxicosis and medications for heart failure. Eighty-one (91%) of the patients that had surgery had subtotal thyroidectomy while 8 (9%) had lobectomy. Only one patient had radiotherapy for papillary carcinoma of the thyroid. Seventeen (9.7%) patients had not had treatment [Table 3].
[Table 4] shows the histological diagnosis in the patients that had surgery. Only 80 (89.9%) of the 89 patients that had surgery had histological diagnosis. Simple goitre was the predominant histological diagnosis in 65 (73%) while thyroid malignancy was found in 4 (4.4%) of these patients. Two were papillary carcinoma, and two were follicular carcinoma. Histology of 9 (10.1%) cases could not be retrieved.
| Discussion|| |
Thyroid disorders are the second most common endocrine problems after diabetes mellitus and usually present with enlargement of the thyroid gland or sometimes pain., Pain may be as a result of infection or haemorrhage into an adenoma. Sometimes, they present with derangement of hormone secretion resulting in hyperthyroidism. Most cases of hyperthyroidism are easily diagnosed clinically and if left untreated may cause progressive catabolic disturbances and cardiac damage leading to poor quality of life.
The female to male ratio was 6.3:1 which is similar to findings in other studies from Karachi, Kano, Ile-Ife and Enugu.,,, The mean age of patients in this study was 42.3 years with a range of 18–76 years. The age group 30–49 had the highest prevalence of goitrous lesions 100 (57.2%). This is similar to the findings in other studies from Southern Nigeria where the majority of cases were found in the age group 30–39 from Lagos and 31–40 from Port-Harcourt., In another report from Tanzania, the peak age incidence was 31–40 age group majority of cases were younger than 40 years. Eighty-five per cent of thyroid diseases were found in the age group 20–59 by Tsegaye and Ergete. This confirms that thyroid diseases are not common in the extremes of age.
The distribution of thyroid disorders in this study shows that the most common clinical diagnosis was simple goitre 58.9% followed in decreasing order by toxic goitre 36.6%, malignancy 2.3%, hypothyroidism 1.7% and thyroiditis 0.6%. The prevalence of malignancy and thyroiditis in this study is low compared to the findings in other studies.,,,,, The only case of thyroiditis in the study was in an HIV-positive patient who developed bacterial thyroiditis in a simple goitre while awaiting surgery. The infection resolved with antibiotics after which the patient defaulted. Thyroid abscess which is not commonly reported was found by Chalya et al. in two patients who were HIV positive. This association highlights immunosuppression as an important factor in the development of thyroiditis. In the 10-year review of histological diagnosis of thyroidectomy specimen in Kano, there were only two cases of thyroiditis 0.4%. A similar pattern was also reported from Tanzania with two cases (1.3%) of thyroiditis in their study.
The 175 cases reviewed showed that 68 (38.9%) were on medical treatment for thyrotoxicosis and heart failure while 89 (50.9%) had surgical treatment. The surgical options offered were either a subtotal thyroidectomy or a lobectomy. One patient with thyroid malignancy who had papillary carcinoma was referred to another health facility for radiotherapy. The 17 patients that did not have treatment were patients who had defaulted or were still awaiting surgery at the time of this review.
Eighty-nine patients had surgery out of which 80 (89.9%) had histological confirmation. The most common histological diagnosis was multinodular goitre (73%) followed by follicular adenoma (5.6%) which is similar to the findings by other authors.,,, Toxic goitre was confirmed by histological diagnosis in 4 (4.5%) of the patients that had surgery. This low prevalence is similar to findings in earlier studies where prevalence ranged from 5.4% to 13%. The clinical diagnosis of toxic goitre was 36.6% in the study population. This low percentage of histological diagnosis when compared to the clinical diagnosis is a reflection of the rate of surgery for toxic goitre in this facility which is probably related to the efficacy of medical treatment for thyrotoxicosis.
Most of the patients (41.1%) were first seen in the surgical clinic while 39.4% were first seen in the general outpatient clinic. Only 19.4% were first seen in the medical outpatient clinic. This is understandable because swellings of the thyroid gland are usually referred to the surgical unit. Patients can go to the general outpatient department without a referral letter. Patients with toxic symptoms or complications are usually seen in the medical clinic. In the study by Ogbera et al., cardiovascular complications of thyrotoxicosis, for example, atrial fibrillation were the most common cause of prolonged hospital stay. Grave's disease was 84% in the study by Ogbera et al. compared to 36.6% in this study. This is because their study population was from the Department of Medicine. This study population was from the surgical, medical and general outpatient departments unlike studies limited to surgically or medically treated thyroid disease. The limitations of this study are inability to find some histology reports and the case notes of patients eligible for the study.
| Conclusion|| |
Concluding, simple goitre is the most common form of thyroid disorder and predominant in the female sex. It is not common at the extremes of life. There are differences in disease spectrum depending on the specialty where the study is carried out. A prospective study on autoimmunity and goitrogens are required to further elucidate the causes of this sex predominance as well as determine other possible etiological factors. This will help outline plans for prevention, early diagnosis and management of the common thyroid disorders.
The authors acknowledge and thank the staff of the Medical Records Department of Olabisi Onabanjo University Teaching Hospital, Sagamu, for their assistance in retrieving the case notes of the patients used in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hussain N, Anwar M, Nadia N, Ali Z. Pattern of surgically treated thyroid disease in Karachi. Biomedica 2005;21:18-20.
Ogbera AO, Fasanmade O, Adediran O. Pattern of thyroid disorders in the southwestern region of Nigeria. Ethn Dis 2007;17:327-30.
Watkinson JC. Fifteen years' experience in thyroid surgery. Ann R Coll Surg Engl 2010;92:541-7.
Hill AG, Mwangi I, Wagana L. Thyroid disease in a rural Kenyan hospital. East Afr Med J 2004;81:631-3.
Flynn RW, MacDonald TM, Morris AD, Jung RT, Leese GP. The thyroid epidemiology, audit, and research study: Thyroid dysfunction in the general population. J Clin Endocrinol Metab 2004;89:3879-84.
Zimmermann MB. Iodine deficiency. Endocr Rev 2009;30:376-408.
Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull 2011;99:39-51.
Solomon R, Iliasu Y, Mohammed AZ. Histopathological pattern of thyroid lesions in Kano, Nigeria: A 10-year retrospective review (2002-2011). Niger J Basic Clin Sci 2015;12:55-60.
Egbuta J, Onyezili F, Vanormelingen K. Impact evaluation of efforts to eliminate iodine deficiency disorders in Nigeria. Public Health Nutr 2003;6:169-73.
Chalya PL, Rambau P, Mabula JB, Kanumba ES, Giiti G, Chandika AB, et al
. Patterns and outcome of surgical treatment of goitres at Bugando Medical Centre in Northwestern Tanzania. Tanzan J Health Res 2011;13:1-10.
Nggada HA, Ojo OS, Adelusola KO. A histopathological analysis of thyroid diseases in Ile-Ife, Nigeria. A review of 274 cases. Niger Postgrad Med J 2008;15:47-51.
Nzegwu MA, Ezume ER, Njeze GE, Olusina DB, Ugochukwu. A histological update of thyroid lesions in Enugu Nigeria. A 5 year retrospective review. Asian J Exp Biol Sci 2010;1:430-3.
Seleye-Fubara D, Numbere N, Etebu EN. Pathology of common diseases of the thyroid gland in Pot-Harcourt. Port Harcourt Med J 2009;3:312-7.
Abdulkareem FB, Banjo AA, Elesha SO. Histological review of thyroid lesions: A 13-year retrospective study (1989-2001). Niger Postgrad Med J 2005;12:210-4.
Tsegaye B, Ergete W. Histopathologic pattern of thyroid disease. East Afr Med J 2003;80:525-8.
[Table 1], [Table 2], [Table 3], [Table 4]