Dakubo J C, Naaeder S B, Tettey Y, Gyasi R K
Departments of Surgery and Pathology, University of Ghana Medical School, P. O. Box 4236, Accra, Ghana.
West Afr J Med. 2013 Jan-Mar;32(1):45-51.
Goitre in the West African sub-region is caused by iodine deficiency and goitrogens in the diet. Supplementary iodine nutrition on a mass scale was started in Ghana in 1996. In areas where iodine deficiency have been corrected the histological pattern of goitre changes and this influences surgical decision making. Data on the histological types of goitre in our institution is lacking.
To define the histopathological types of goitre in this initial period of iodine supplementation and relate this to the types of thyroid surgeries that were performed.
It was a prospective study of consecutive patients who underwent thyroidectomy from January 2003-December 2007. Descriptive statistics was employed in analyzing the data
Five hundred and twenty eight cases were studied made up of 470 (89%) females and 58 (11%) males with mean age of 41.98 yrs, SD ± 12.90 yrs. The excised mean thyroid tissue weight was 161.4 g, SD ± 116.3 yrs. Hyperplastic goitres were 373 (70.7%), toxic goitre 70 (13.3%), adenoma 37 (7.0%), carcinoma 25 (4.7%) and thyroiditis 23 (4.4%). Papillary carcinoma accounted for 56% (14) cancers. Subtotal thyroidectomy was performed in 278 (52.7%) of patients, near total thyroidectomy 107 (20.3%), lobectomy 98 (18.6%),total thyroidectomy 24 (4.5%), excision or completion thyroidectomy 20 (3.8%) and de-bulking 1 patient. Overall, complications occurred in 32 patients (6.1%) and were made up mostly of haemorrhage in 10 (1.9%), Hypocalcaemia 10 (1.9%), unilateral Recurrent Laryngeal Nerve(RLN) injury 3 (0.57%), Tracheal collapse 3 (0.57%) and Bilateral RLN injury 2 (0.4%).
The introduction of iodine supplementation on a mass scale in Ghana is yet to have its fullest impact on thyroid diseases. Goitres are still large and cause pressure effects. Toxic, inflammatory and malignant goitres are gaining prominence, and surgery for malignant goitre was oncologically inadequate.Near total thyroidectomy is recommended as the minimum surgery to avert the need for completion thyroidectomies in view of the lack of preoperative pathological diagnosis of thyroid lesions.
西非次区域的甲状腺肿是由饮食中碘缺乏和致甲状腺肿物质引起的。1996年加纳开始大规模补充碘营养。在碘缺乏得到纠正的地区，甲状腺肿的组织学模式会发生变化，这会影响手术决策。我们机构缺乏甲状腺肿组织学类型的数据。
确定在碘补充初期甲状腺肿的组织病理学类型，并将其与所进行的甲状腺手术类型相关联。
这是一项对2003年1月至2007年12月接受甲状腺切除术的连续患者的前瞻性研究。采用描述性统计分析数据。
共研究了528例病例，其中女性470例（89%），男性58例（11%），平均年龄41.98岁，标准差±12.90岁。切除的甲状腺组织平均重量为161.4克，标准差±116.3岁。增生性甲状腺肿373例（70.7%），毒性甲状腺肿70例（13.3%），腺瘤37例（7.0%），癌25例（4.7%），甲状腺炎23例（4.4%）。乳头状癌占癌症的56%（14例）。278例（52.7%）患者行次全甲状腺切除术，107例（20.3%）行近全甲状腺切除术，98例（18.6%）行叶切除术，24例（4.5%）行全甲状腺切除术，20例（3.8%）行切除或完成甲状腺切除术，1例患者行减瘤手术。总体而言，32例患者（6.1%）发生并发症，主要包括出血10例（1.9%）、低钙血症10例（1.9%）、单侧喉返神经损伤3例（0.57%）、气管塌陷3例（0.57%）和双侧喉返神经损伤2例（0.4%）。
加纳大规模引入碘补充对甲状腺疾病的影响尚未完全显现。甲状腺肿仍然很大并产生压迫效应。毒性、炎症性和恶性甲状腺肿日益突出，恶性甲状腺肿的手术在肿瘤学上并不充分。鉴于缺乏甲状腺病变的术前病理诊断，建议近全甲状腺切除术作为避免进行完成甲状腺切除术的最低限度手术。
