Clinicopathological characteristics and outcomes of Thyroidectomy at Muhimbili National Hospital.

Abstract

ABSTRACT Background: Thyroid disorders are increasingly becoming common worldwide with a significant portion of the burden falling in Low- and middle-income countries (LMIC). Despite the significant advancements, thyroidectomy is still not without complications. Through continuous follow-up and research on patient characteristics and surgical outcomes, thyroidectomy is increasingly becoming a safer treatment option. Aim of Study: This study aims at assessing the clinical and pathological characteristics as well as surgical outcomes and their associated factors among patients who underwent thyroidectomy at Muhimbili National Hospital. Methodology: A 5-year (April 2018-March 2023) retrospective cohort study design was conducted at Muhimbili national hospital. All patients undergoing thyroid surgery were included. Perioperative data such as patient demography, clinical presentation, radiological investigations, cytology results and intraoperative factors. Outcome of interest was the occurrence of post operative complications. Patient records were used to extract data on their surgical outcomes. Analysis was done to identify predictors of post operative complications where P value of < 0.05 was considered significant. Results: A total of 405 candidates were included in the analysis with a female predominance of 89.6% the mean age was 48years. A total of 108(26.67%) had at least one comorbidity. Anterior neck mass was the most common presenting feature at 98.5%. Thyroid USS was the most widely used investigation. Benign conditions had a higher prevalence at 77% with Nontoxic Multinodular goiter being the most common conditions overall and Papillary carcinoma being the most prevalent among malignant conditions. Preoperative anemia was seen in 42% of the candidates with only 58% reported to be euthyroid at the time of surgery. Suspicion of malignancy was the most common (43.7%) indication for surgical intervention followed by cosmesis 30.1%. Most patients had undergone lobectomy (27.2%) or Total thyroidectomy (24%). Post v operatively, hypocalcemia was the most prevalent complication (13.3%) observed. Overall complication rate was 15.3%, with a mortality rate of 0.5%(n=2) and a 5-day mean length of hospital stay. Extensive surgical resections (Total thyroidectomy) and duration of symptoms (>10years) were observed to be statistically significant factors predicting occurrence of post thyroidectomy complications on multivariable Linear regression analysis. Conclusion: Though considered a safe procedure, thyroidectomy is not without complications. Patients with a long-standing goiter and those requiring extensive resections (undergoing total thyroidectomy) are at a relatively higher risk of such complications. Preoperative preparations and precautions need to be employed to ensure a safe surgical intervention with a short hospital stay.