Characterizing Thyroid Disease and Identifying Barriers to Care and Treatment in Uganda

Thyroid disease in Uganda continues to be endemic, despite national salt iodinization. This study describes the local characteristics of thyroid disease and identifies potential barriers to surgical access. A prospective database was established for all patients with suspected thyroid disease who presented to the Endocrine Surgery Clinic at Mulago National Referral Hospital in Kampala, Uganda in 2008. A cross-sectional study collected and analyzed for presentation, diagnostics and the surgical plan. A total of 89 patients were included, with an average age of 40 years, and 88% were women. The most common presentation was compressive symptoms (39%, n = 35), signs and symptoms of hyperthyroidism (30%, n = 27) and cosmetic concerns (16%, n = 14). Ultrasound, which is subsidized by the hospital, was performed in 85% of patients (n = 76). Thyroid function tests (TFTs), which are less subsidized, were done in 67% (n = 60). Of these, 27% (n = 16) were hyperthyroid and 7% (n = 4) were hypothyroid. Fine needle aspiration was done in 30% (n = 27) and were suspicious for malignancy in 27% of patients (n = 7). The most common diagnosis was multinodular goiter (n = 55) and tracheal compression or deviation and/or retrosternal extension was seen on imaging in 22 of 75 patients (29%). Thyroid disease in Uganda is more advanced, involves a different population than in Western countries and includes high rates of symptomatic multinodular goiter and cancer. Resource constraints limit the care of these clinically challenging conditions. Further evaluation of these potential barriers to surgical care needs to be conducted.