Management of solitary thyroid nodules in rural Africa

Abstract

To review a simple protocol for the management of solitary thyroid nodules and to document the spectrum of pathological diagnoses associated with this condition. A retrospective review of all solitary solid thyroid nodules excised over a three-year period from 1st January 1999 to 31st December 2001. A rural church-based hospital in Kenya. All patients undergoing thyroidectomy for solitary solid thyroid nodule over a three-year period at Kijabe Hospital. A simple protocol was used to manage this condition involving history, clinical examination, needle aspiration of the lesion, and excision when clinically indicated. Clinical diagnosis, tribe, operation performed, pathology, and complications of surgery. 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. 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.