Total Thyroidectomy in Subsaharan Countries: Challenging Perspectives in Non-Governmental Hospital

  • Background/Purpose
    Thyroid disorders represent a severe public health problem in countries of the sub-Saharan area, such as Uganda. The lack of iodine is the primary cause of thyroid gland disease, and goiters are the most common manifestations. This study is a retrospective analysis of our surgical experience in a non-governmental hospital of North Uganda between 2012 and 2019. Our aim is to identify the indications for different types of thyroid surgery in these areas and standardize indications for total thyroidectomy.

    Methods
    We included patients referred to our attention during 8 camps from April 2012 to January 2019 at Saint Mary’s hospital Lacor, Uganda, and submitted to thyroid surgey.

    Results
    From an initial pool of 503 patients exmined, 260 were submitted to thyroid surgery. We performed 170 lobectomies/loboisthmusectomies (65,4%), 27 sub-total thyroidectomies (10,4%), and 63 total thyroidectomies (24,2%). TTs increased in number compared with partial thyroidectomies (p=0.02) (p<0.0001) during the years.

    Discussion
    In developed countries, TT represents the treatment of choice for cancers, multi-nodular goiter and hyperthyroidism. In sub-Saharan areas, the risk of hypothyroidism due  to difficult access to hormone replacement therapy and higher possibility of complications after TT need to be balanced with the risk of recurrence after partial resections. Recommendations for TT vs. partial thyroidectomies appear to be in conflict and reflect the dilemma of choosing an optimal operative strategy.

    Conclusions
    This study updates our previous data in reporting the progressive introduction of TT into a sub-Saharan area.

 

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