Thyroid Disease at the University Hospital of Conakry, Guinea

Objectives: To describe the epidemiological, clinical and therapeutic characteristics of thyroid disease at the University Hospital of Conakry, Guinea. Methods: This was a descriptive study with prospective data collection, car-ried out over the period of December 2016 to April 2019 at the endocrinology outpatient consultation at the University Hospital of Conakry. All the epidemiological, clinical and therapeutic data of the patients followed-up for thyroid disease were collected, analyzed and classified according to the epidemiological, clinical and therapeutic profile. The functional, morphological and autoimmune aspects of the thyroid gland were studied. Results: Out of a total of 3.517 endocrinology consultations during the study period, 204 patients were diagnosed with thyroid disease (180 women and 24 men, F/H ratio: 7.5). The average age was 47 ± 16 years. A total of 90 patients (44.33%) had hyperthyroidism, including 52 cases of Graves-Basedow disease (57.6%) and 24 cases of toxic multi-nodular goiter


Introduction
Thyroid gland disease is the most common endocrinopathy after diabetes mellitus. In developing countries, this condition was traditionally confined to endemic goiter in connection with the high prevalence of iodine deficiency [1].
However, since the rise of salt iodization programs in the early 1990s, endemic goiter has been declining, giving way to the emergence of other manifestations of thyroid disease, particularly autoimmune diseases [1] [2] [3]. Indeed, the clinical, biological and morphological manifestations are diverse, requiring a typological approach to this pathology.
In Guinea, the frequency of thyroid disease in endocrinology consultations at Conakry University Hospital was 3% in 2007, dominated by hyperthyroidism [4].
The objective of this study was to describe the epidemiological, clinical and therapeutic characteristics of thyroid pathology at the University Hospital of Conakry, Guinea.

Setting, Population and Design
This was a descriptive study with prospective data collection between December 2016 and April 2019. All patients received consecutively in the Endocrinology Department of the University Hospital of Conakry for a thyroid gland disease were included in the study.
A systematic anamnesis and clinical examination seeking for signs of dysthyroidism, cervical compression, inflammation and malignancy arguments was performed.
-Depending on the clinical context, hormonal (ultrasensible Thyroid Stimulationg Hormone-TSHus; Free Triiodithyronin-FT3; and Free Tetraiodothyronin-FT4), inflammatory, immunological (thyroperoxidase, thyroglobulin and TSH receptor antibodies), morphological (ultrasound and thyroid scintigraphy), and cytological (thyroid fine needle aspiration biopsy) assessment was performed. Thyroid disease was classified into different nosological categories according to the following criteria: -Hyperthyroidism: defined by the observation of clinical manifestations of hyperthyroidism (or thyrotoxicosis) associated with an increase in FT3 and FT4 levels, and a decrease in TSHus levels.

Ethical Aspects
Informed consent was obtained for the collection and analysis of patient data and anonymity was respected in accordance with the Helsinki Declaration on Human subject research.

Statistical Analysis
The data were entered and analyzed using the SPSS software version 22. Continuous variables were presented as mean and standard deviation if the distribution was normal, otherwise as median and interquartile range. The categorical variables were presented in numbers and percentages. No association or causality tests were performed.

Results
Out of a total of 3517 endocrinology consultations during the study period, thyroid pathology involved 204 patients (180 women and 24 men, F/H ratio: 7.5).
The average age was 47 ± 15 years (range: 2 -85). The description of patients by socio-professional category and residence is presented in Table 1  Partial (n = 5) or complete (n = 12) thyroid surgery was performed in the presence of aesthetic discomfort (n = 6), cervical compression symptoms (n = 8) and for suspicion of thyroid cancer (n = 3). Hormone replacement therapy by levothyroxine was used in all patients with hypothyroidism.

Discussion
In this study, the frequency of thyroid disease was 17.24%. It is the most common endocrinopathy after diabetes mellitus in our context. This frequency is higher than the 3% found by Baldé NM et al. in 2007 in Conakry [4]. This study certainly has its limitations, in particular the modest size of the sample and the lack of systematic hormonal and immunological testing. However, it had the merit of having, for the first time in our country, data on all thyroid pathology.
Thyroid disease is commonly known as a condition of young adult women.
This female predominance of thyroid disorders was confirmed in this study with a ratio of approximately 8 women to 1 man. The average age of our patients was  Hypothyroidism, described in 12% of cases in the present study, seems to be under-estimated. Indeed, the predominantly post-surgical etiology of hypothyroidism found in this cohort raises the question of the diagnosis of hypothyroidism related to autoimmune thyroiditis, which was 36%. In the African series, hypothyroidism appears to be less frequent compared to the Western series, probably linked to an under-diagnosis of Hashimoto autoimmune thyroiditis [4] [10] [11]. Patients with normal thyroid function, most of them carrying multi-nodular goiter in this study, are candidate to close surveillance seeking for signs of tumor progression and/or thyroid dysfunction. The rate of thyroid cancer confirmed in 1 case (0.5%) among 3 suspected cases who underwent thyroid surgery is marginal this study in coherence with the low rate (below 1%) found in most of the studies conducted in Africa [12]. These rates seem consistent with the rarity of thyroid cancer in general and the lack of screening and diagnostic Open Journal of Internal Medicine procedures in our context, including thyroid fine needle aspiration biopsy and histopathological analysis.
However, it has to be mentioned that there is variability in the nosological distribution of thyroid disease in Africa in general, linked to the socio-demographic heterogeneity of the populations studied on one hand and, on the other hand, to the difficulties of access to biological and morphological exploration for diagnostic [1] [5] [9] [13]. The hormonal exam, particularly us-TSHus, was performed by 87% of patients, which seems to be a good rate in our practice context. This frequency is higher than the 46.66% found by Akoussou SY et al. [8]  Regarding the morphological explorations, the thyroid ultrasound performed in 74% of patients and thethyroid fine needle aspiration biopsy in a single patient highlights the challenge in accessing to the essential diagnostic tools for a comprehensive management of thyroid disease in this context. Indeed, these diagnostic tools are essential to characterize the thyroid disease for a better care [14].
The treatment by synthetic antithyroid drugs for hyperthyroidism and hormone replacement therapy with levothyroxine for hypothyroidism, which was the common practice in this study, is classic in the thyroid disease. Thyroid surgery was mostly complete and performed in the presence of signs of local complications, explaining the high rate of post-surgery hypothyroidism found in this study.

Conclusion
Thyroid disease is a frequent outpatient condition at the University Hospital of

Conflicts of Interest
The authors declare that they do not have any conflict of interest for this article.