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.