ASSESSING MANAGEMENT AND OUTCOMES IN TOXIC GOITER: A MULTICENTRE RETROSPECTIVE COHORT STUDY FROM SOUTHERN ETHIOPIA aleberhe.ab@gmail.com

396-06

ASSESSING MANAGEMENT AND OUTCOMES IN TOXIC GOITER: A MULTICENTRE RETROSPECTIVE COHORT STUDY FROM SOUTHERN ETHIOPIA

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Ethiopia

Oral or Poster

Hyperthyroidism in Ethiopia is treated mainly with antithyroid drugs and surgery, but adherence to international standards is unknown. We assessed thyroid-function test ordering, anti-thyroid drug use, and operative practice in adults with toxic goiter managed at three public hospitals in Sidama Regional State, and explored factors linked to procedure choice and early morbidity.

A retrospective cohort included every adult (≥18 years) who underwent thyroidectomy for toxic goiter from 1 October 2020 to 30 September 2024. Case notes and a brief telephone interview provided clinical data. Primary outcomes were guideline-concordant TFT ordering, appropriate ATD prescribing, and extent of surgery. Secondary outcomes were drug adverse events, postoperative thyroxine prescribing, length of hospital stay, and post-op complications within three months. Logistic regression examined predictors.

We analyzed 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%); Every patient received only propylthiouracil (PTU). Near-total or total thyroidectomy (NTT/TT) was performed in 153 patients (53.3 %) and subtotal resections in 134 (46.7%). Only 19% of those who underwent NTT/TT received postoperative thyroxine. Treatment facility was the only independent predictor of NTT/TT (χ² 21.6, p<0.001).

This study showed clear areas to improve clinical practice keeping with guideline standards. The study also revealed a significant variation in the extent of thyroidectomy performed. Region-specific protocols, stable access to methimazole and levothyroxine are warranted to improve the quality and safety of toxic-goitre care.