Management of solitary thyroid nodules in rural Africa

Abstract

Objectives: To review a simple protocol for the management of solitary thyroid nodules and to document the spectrum of pathological diagnoses associated with this condition. Design: A retrospective review of all solitary solid thyroid nodules excised over a three-year period from 1st January 1999 to 31st December 2001. Setting: A rural church-based hospital in Kenya. Subjects: All patients undergoing thyroidectomy for solitary solid thyroid nodule over a three-year period at Kijabe Hospital. Interventions: A simple protocol was used to manage this condition involving history, clinical examination, needle aspiration of the lesion, and excision when clinically indicated. Main Outcome Measures: Clinical diagnosis, tribe, operation performed, pathology, and complications of surgery. Results: Eighty-one operations were performed for a solitary thyroid nodule. The most common operations were lobectomy and isthmusectomy. There were two complications-a neck haematoma that required surgery and one recurrent laryngeal nerve injury. The commonest pathological diagnosis was multinodular goitre (42%). There was a 16% malignancy rate with eight papillary carcinomas, five follicular carcinomas, and one hurthle cell carcinoma. Conclusions: The simple protocol described gives good results in a rural African hospital. Solitary solid thyroid nodules should be routinely excised due to the 16% malignancy rate in this condition. There is a possibility that there is a shift in the ratio of papillary to follicular carcinomas compared to older African studies and this would be an interesting area for further study.