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Patterns and outcome of surgical management of goitres at Bugando Medical Centre in northwestern Tanzania
CHALYA, PHILLIPO L.; RAMBAU, PETER; MABULA, JOSEPH B.; KANUMBA, EMMANUEL S.; GIITI, GODFREY; CHANDIKA, ALPHONCE B. & GILYOMA, JAPHET M.
Abstract
Despite the well established endemicity of goitres little work has been done on the
management of goiters in Tanzania. A cross-sectional study was conducted at Bugando Medical
Centre (BMC) in Mwanza, Tanzania to determine the pattern and outcome of surgical management of
goitres. Data was collected using a pre-tested, coded questionnaire. A total of 152 patients were
studied of which 140 (92.1%) were females and males were 12 (7.9%) (F: M = 11.7: 1). Their ages
ranged from 18 to 72 years (mean =38.412.5 years). The mean duration of illness was 9.2 years. The
thyroid gland size at admission was grade III in 63.8% of patients. Multinodular goitres were reported
in 51.3% of patients. The majority of patients (92.1%) presented with euthyroid goitres and the
remaining (7.9%) patients had toxic goitres. Pressure symptoms and cosmetic disfigurement were the
common indications for thyroidectomy in 47.4% and 23.7%, respectively. Near total thyroidectomy
and total thyroidectomy were the surgical procedures performed for benign and malignant goitres in
47.3% and 8.1% of patients, respectively. Simple multinodular goitres were the most common
histopathological pattern accounting for 67.2% of cases. Twelve (7.9%) patients had a histologically
proven thyroid malignancy, of which follicular and papillary carcinoma were reported in 41.7% and
33.3% of cases, respectively. Post-operative complications rate was 7.9%. The mean length of hospital
stay was 14.4 days (range 3 to 34 days). Five patients died giving a mortality rate of 3.4%. In
conclusion, this study has shown that the pattern of surgical goitres seen at Bugando Medical Centre
is similar to what is reported from other parts of the world. However, the majority of patients present
for surgery very late with huge goitres predisposing them to increased risk of post-operative
complications, prolonged length of hospital stay and cost of medical care. It is therefore
recommended that health education should be given to the community about the cause, prevention
and treatment options so that patients could seek early medical attention.
Keywords
goiters; pattern; outcome; surgical management; Tanzania
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