Clinical aspects of hyperthyroidism in hospitalised patients in Albania.

The purpose of this study was to evaluate certain clinical aspects of hyperthyroidism in Albania, which is an iodine deficient country, as it is known that iodine intake may influence the type of thyroid hyperfunction. The files of sixty-six patients with thyrotoxicosis who were hospitalised for their disease were retrospectively analysed. 59.1% of these patients suffered from toxic multinodular goiter, 27.3% from Grave's disease (toxic diffuse goiter), 10.6% from toxic adenoma, 1.5% from iodide-induced hyperthyroidism and 1.5% from transient hyperthyroidism due to subacute thyroiditis. There was an increased female to male ratio (83.3% vs 16.7%, respectively, p<0.001). 83.9% of all hyperthyroid patients lived in cities, while 16.1% lived in villages. Ophthalmopathy was found in 11.1% of patients with Graves' disease, and thyrotoxic heart disease was found in 14% of patients with thyrotoxicosis. 71.9% of all patients with hyperthyroidism were treated with propylthiouracil (PTU), while 28.1% of them were treated with methimazole; 67.2% of all these patients also received propranolol hydrochloride, while 32.8% were prescribed atenolol. Compliance was lower than that reported in other studies as only 41% of all patients received their treatment regularly. Side effects from treatment with antithyroid drugs were as follows: 4.1% (2/48) of patients treated with propylthiouracil presented leukopenia with agranulocytosis, and 6.1% of them toxic hepatitis, while 11.1% (2/18) of patients treated with methimazole presented agranulocytosis. In conclusion, the mode of presentation and side effects of hyperthyroidism appears to be different in Albania when compared with other countries, probably as a result of iodine deficiency and/or possibly nutritional status. Compliance with treatment is lower than that reported in other series, while antithyroid drug side effects seem to be more frequent. The latter observation may be due to the fact that only hospitalised patients were analysed in this study.