College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
College of Health Sciences, Adigrat University, Adigrat, Ethiopia.
BMC Endocr Disord. 2021 Jun 28;21(1):132. doi: 10.1186/s12902-021-00796-5.
Thyrotoxicosis is the state of thyroid hormone excess. But, in sub-Saharan Africa (SSA), specifically Northern Ethiopia, scientific evidence about thyrotoxicosis and its cardiac complications like dilated cardiomyopathy is limited. Therefore, this study aimed to explore the thyrotoxicosis presentation and management and identify factors associated with dilated cardiomyopathy in a tertiary hospital in Northern Ethiopia.
An institution-based cross-sectional study was conducted in Ayder Comprehensive Specialized Hospital from 2017 to 2018. Data from 200 thyrotoxicosis cases were collected using a structured questionnaire. After describing variables, logistic regression was conducted to identify independent predictors of dilated cardiomyopathy. Statistical significance was declared at p < 0.05.
Mean age at presentation of thyrotoxicosis was 45 years and females accounted for 89 % of the cases. The most frequent etiology was multinodular toxic goiter (51.5 %). As well, the most common symptoms and signs were palpitation and goiter respectively. Thyroid storm occurred in 6 % of the cases. Out of 89 patients subjected to echocardiography, 35 (39.3 %) of them had dilated cardiomyopathy. And, the odds of dilated cardiomyopathy were higher in patients who had atrial fibrillation (AOR = 15.95, 95 % CI:5.89-38.16, p = 0.001) and tachycardia (AOR = 2.73, 95 % CI:1.04-7.15, p = 0.040). All patients took propylthiouracil and 13.0 % of them experienced its side effects. Concerning β-blockers, propranolol was the most commonly (78.5 % of the cases) used drug followed by atenolol (15.0 %). Six patients underwent surgery.
In developing countries like Ethiopia, patients with thyrotoxicosis have no access to methimazole which is the first-line anti-thyroid drug. Besides, they greatly suffer from dilated cardiomyopathy (due to late presentation) and side effects of propylthiouracil. Therefore, we recommend that patients should get adequate health information about thyrotoxicosis and anti-thyroid drugs including their side effects. Additionally, hospitals and other concerned bodies should also avail of TSH tests and methimazole at an affordable cost. Furthermore, community awareness about iodized salt and iodine-rich foods should be enhanced.
甲状腺毒症是甲状腺激素过多的状态。然而，在撒哈拉以南非洲（SSA），特别是在埃塞俄比亚北部，关于甲状腺毒症及其心脏并发症（如扩张型心肌病）的科学证据有限。因此，本研究旨在探讨埃塞俄比亚北部一家三级医院的甲状腺毒症表现和治疗方法，并确定与扩张型心肌病相关的因素。
这是一项 2017 年至 2018 年在阿德尔综合专科医院进行的基于机构的横断面研究。使用结构化问卷收集了 200 例甲状腺毒症患者的数据。在描述变量后，进行逻辑回归以确定扩张型心肌病的独立预测因素。统计显著性定义为 p < 0.05。
甲状腺毒症发病时的平均年龄为 45 岁，女性占病例的 89%。最常见的病因是多结节毒性甲状腺肿（51.5%）。同样，最常见的症状和体征分别是心悸和甲状腺肿。6%的病例发生甲状腺危象。在 89 名接受超声心动图检查的患者中，有 35 名（39.3%）患有扩张型心肌病。并且，患有心房颤动（AOR=15.95，95%CI：5.89-38.16，p=0.001）和心动过速（AOR=2.73，95%CI：1.04-7.15，p=0.040）的患者发生扩张型心肌病的几率更高。所有患者均服用丙基硫氧嘧啶，其中 13.0%的患者出现其副作用。关于β受体阻滞剂，普萘洛尔（78.5%的病例）是最常用的药物，其次是阿替洛尔（15.0%）。6 名患者接受了手术。
在像埃塞俄比亚这样的发展中国家，甲状腺毒症患者无法获得甲巯咪唑，而甲巯咪唑是一线抗甲状腺药物。此外，他们深受扩张型心肌病（由于延迟就诊）和丙基硫氧嘧啶副作用的困扰。因此，我们建议患者应获得有关甲状腺毒症和抗甲状腺药物（包括其副作用）的足够健康信息。此外，医院和其他相关机构还应提供负担得起的 TSH 检测和甲巯咪唑。此外，还应提高社区对碘盐和富含碘的食物的认识。
