Characterization of thyroid disorders among patients attending surgical clinic at Nakuru Level 5 Hospital - Nakuru County, Kenya

Abstract

Background: Thyroid disorders are among the most common endocrine disorders seen worldwide. Among these disorders, goitre is commonest in Kenya. Thyroid disorders are manifested by derangement of thyroid hormone secretion, goitre formation and / or pain. Thyroid disorders severely affect the quality of life as they usually result in compressive symptoms, impaired physical and intellectual development and pregnancy complications. The present study sought to characterize thyroid disorders to avail baseline data that can be relied upon for preventive policy development, improvement of patient treatment, care and management for better disease prognosis. Differential diagnosis for thyroid disorders is performed by biochemical assays, ultrasound, and fine needle aspirate. Objectives: To identify socio-demographic factors associated with biochemical and non-biochemical characteristics of thyroid disorders and common clinical presentation among patients attending surgical clinic at Nakuru level 5 Hospital. Methods: A descriptive, cross sectional study was conducted from 4th February to 28th June 2018 at Nakuru level 5 Hospital surgical clinic using structured questionnaires. Sampling was done by census enrollment of patients with thyroid disorders or clinical features of thyroid disorders with or without goitre and who fulfilled the eligibility criteria. Patients‘ clinical findings and demographic characteristics were documented. Thyroid hormonal profile and auto-antibodies were performed using automated Electrochemiluminescence-Immuno-assay method. Serum iodide levels estimation was performed using Iodometric titration techniques. Other investigation techniques including thyroid ultrasound and Fine needle aspirate for cytology were also done for 123 and 15 participants respectively. Results: The mean age of participants was 40.5 years (SD: 15.4) comprising 114 (92%) females and 10 (8%) males. Majority 102 (82.3%), were in the age group 21- 60 years, with females representing 90.2%. The most common clinical presentation was goitre 95 (76.6%). Based on biochemical assays (T4, T3 and TSH), 66 (55%) were Euthyroid, 48 (40.0%) hyperthyroid, 4 (3%) subclinical hyperthyroid and 1 (1%) each for both hypothyroid and subclinical hypothyroid. Thyroid ultrasound detected 86 nodular goitres, 27 diffuse goitres, 7 thyroid masses and 3 solitary thyroid nodules. Thyroid stimulating immunoglobulin antibodies (diagnostic of Graves‘ disease) were detected in 19 (39.6 %) of hyperthyroid patients. Serum iodide levels (Iodometric titration) revealed 48 (40%) patients with slightly elevated iodide levels >18 μg/dl, 1 (1%) had low iodide level < 5.0 μg/dl, while 71 (59%) had iodide levels within normal ranges (5 - 18μg/dl). Toxic nodular goitre (based on ultrasound, raised T4 and decreased TSH) were found in 26 (54.2%) of hyperthyroid patients and was the commonest pathological cause of hyperthyroidism, followed by Grave‘s disease. Fine needle aspirate for cytology (FNAC) was conducted in 15 (12.1%) suspected cases of malignancy, with 7 (46.7%) being confirmed histologically as malignant goitres. Conclusion: Goitre was the most common presentation of thyroid disorder with toxic nodular goitre contributing 54.2% of the hyperthyroid patients and was most common in females. The peak age of presentation was 21 – 60 years. Further studies are required to elucidate the risk factors contributing to the increase in cases of goitres especially among females in the central rift valley region of Kenya.