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 threeyear
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 complicationsa
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.
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 threeyear
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 complicationsa
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.
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