The spectrum of thyroid disease requiring surgery: a single centre experience in South Africa

Abstract

Background: Thyroid disease is a frequently encountered condition for the general surgeon. Limited literature on surgery for thyroid disease is available from the study area in KwaZulu-Natal which has a largely rural Black population of over three million people. The aim of the study is to audit the spectrum of surgically managed thyroid disease in a tertiary hospital.

Methods: Descriptive analysis of six-years of prospectively collected thyroid surgery data from a tertiary hospital. Demographics, surgical indications, procedures, and histologies were studied and comparative analysis performed.

Results: 346 patients with a female:male ratio of 22:1; age: 19–91 years, mean 51. The majority (77%) were Black ethnicity. 377 operations were performed. 346 patients had either a lobectomy (64.7%), subtotal thyroidectomy (13.6), or total thyroidectomy (21.7%) at the initial surgery. Re-do surgery was performed in 31 patients. The majority of surgery was for therapeutic indications, 65% for symptomatic multinodular goitre (MNG). Thyroid carcinoma (TC) was more frequently diagnosed in older female patients and 91.8% were well-differentiated TC. Two-thirds of diagnostic thyroid procedures found an adenoma.

Conclusion: Thyroid pathology is prevalent in the study region. Most thyroid surgery was for middle-aged women with MNG which harboured TC in 11.2% of cases. A larger thyroid nodule did not correlate with the increased likelihood of TC. Follicular carcinoma was higher than international studies as was follicular variant of papillary thyroid cancer which may be explained by the study population. A national database is needed to audit the spectrum of thyroid disease requiring surgery across South Africa.