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Total Thyroidectomy in North Uganda: A Cultural and Socio-economic Challenge for an African Country

Giulia Burali, Ogwang David Martin, Francesca Romana Fiorini, Giuditta Mannelli, Rita Giachetti, Oreste Gallo and Roberto Santoro

Background: Disease of the thyroid in Sub-Saharan Africa mainly present as multinodular goiter (MNG). Our aim was to standardize indications for total thyroidectomy (TT) after our experience in the major non-governmental hospital of North Uganda. Methods: We included patients submitted to thyroid surgery during 5 camps held by a team of Italian ENT surgeons from April 2012 to December 2015 at Saint Mary’s hospital Lacor, Uganda, for single lobe macronodules or MNGs. From an initial pool of 218, we selected 142 (65.14%) patients: 137 (96.48%) were submitted to thyroidectomy. Results: We performed 84 lobectomies (61.3%), 13 loboisthmusectomies (9.49%), 25 sub-total thyroidectomies (18.25%), and 15 TTs (10.95%). We observed 5 postoperative complications and 1 intraoperative death. TTs increased in number compared with partial thyroidectomies (p=0.02) and STTs (p<0.0001). Conclusions: Partial and sub-total thyroidectomies were the primary procedures, however TT was confirmed to be feasibile for treating MNG in a rural area.