Scholarly Article
Assessing Management and Outcomes in Toxic Goitre: A Multicentre Retrospective Cohort Study from Southern Ethiopia
Aregawi, Alazar Berhe, Long, Kristin L., Tegene, Yadessa
2025-07-31 · Impact Surgery · Impact Health Publishing Group
Abstract
Background: Hyperthyroidism in Ethiopia is treated mainly with antithyroid drugs (ATDs) and surgery, but adherence to international standards is unknown. We assessed thyroid-function test (TFT) ordering, ATD use, and operative practice in adults with toxic goitre managed at three public hospitals in Sidama Regional State, and explored factors linked to procedure choice and early morbidity. Methods: A retrospective cohort included every adult (≥18 years) who underwent thyroidectomy for toxic goitre from 1 October 2020 to 30 September 2024. Case notes, theatre registers and a brief telephone interview provided clinical and drug data. Primary outcomes were guideline-concordant TFTs, appropriate ATD prescribing, and extent of resection. Secondary outcomes were drug adverse events, postoperative thyroxine, length of stay, and complications within three months. Logistic regression examined predictors. Results: We analysed 287 patients; 89.9 % were women, median age 38 years (IQR 30-45). Toxic multinodular goitre accounted for 93.4 % of cases. Baseline testing most often comprised TSH + total T₃ + total T₄ (54.3 %); TSH alone was ordered in 16.1 %. Every patient received propylthiouracil, and 70.7 % also received propranolol; methimazole was unavailable. Near-total or total thyroidectomy (NTT/TT) was performed in 152 patients (53 %) and subtotal resection in 135 (47 %). Complications occurred in 17.4 % (hypocalcaemia 3.8 %, hoarseness 3.8 %, haematoma 0.7 %). Only 19.1 % of NTT/TT recipients received postoperative thyroxine. Treatment facility was the only independent predictor of NTT/TT (χ² = 21.6, p < 0.001). Median hospital stay was shorter after NTT/TT than after subtotal surgery (3 vs 4 days, p < 0.001). Conclusions: This study showed clear areas to improve clinical practice in keeping with guideline standards. Region-specific protocols, stable access to methimazole and levothyroxine, and concentration of thyroid surgery in higher-volume teams are warranted to improve the quality and safety of toxic-goitre care.
Keywords
Thyrotoxicosis, Hyperthyroidism, Toxic nodular goiter, Thyroidectomy
Citation Details
Impact Surgery, No. 11, pp. 5-10