Purpose: To describe the aspects of the positive diagnosis of large goiters. Patients and Methods: We conducted a retrospective and prospective study including 115 patients from January, 2009 till December, 2014 (6 years) in Central Hospital of University of Point G in Bamako (Mali). The diagnosis of large goiters was based on the measurements of the anterior neck swelling. Thus large goiter was defined as any goiter including the height or width was greater than or equal to 10 cm (centimeters). Results: We operated 115 cases of large goiters on 760 goiters operated either 15.1%. The average age of patients was 44, 43 years ±14, 3 with extremes of 9 and 80 years. There was 101 women (87.8%) and 14 men (12.2%) with a sex ratio of 7.2 in favor of women. The signs of compression were dyspnea in 40% of cases (46/115), dysphonia in 13.0% (15/115), and dysphagia in 8.6% (10/115). The average height of goiter was 12.1 cm ± 3.5 cm with extremes of 10 and 29 cm and the average width was 14.4 cm ± 5.4 cm with extremes of 10 and 32 cm. Thyroid ultrasound found large goiters multinodular in 100%. Cervical radiography found the tracheal deviation in 48.2% (42/87), tracheal compression in 20.6% (18/87), plunging goiters in 11.5% (10/87). Cytology found a benign goiter in 97.4% of cases (112/115), malignant (thyroid cancer) in 2.6% of cases (3/115). Conclusion: Diagnosis of large goiters was based on the measurement of the swelling in our context. The signs of compression are the severity of this condition.
References
[1]
Agarwal, A., Agarwal, S., Tewari, P., Gupta, S., Chand, G., Mishra, A., Agarwal, G., Verma, A.K. and Mishra, S.K. (2012) Profil clinico-pathologique, la gestion des voies respiratoires, et le résultat d’énormes goitres multinodulaires: Une expérience institutionnelle d’une région de goitre endémique. Département de chirurgie endocrinienne, Sanjay Gandhi Poster Institut universitaire des sciences médicales en Inde. World Journal of Surgery, 36, 755-760.
https://doi.org/10.1007/s00268-012-1447-x
[2]
Gardiner, K.R. and Russel, C.F. (1995) Thyroidectomy for Large Multinodular Colloid Goiters. Journal of the Royal College of Surgeons of Edinburgh, 40, 367-370.
[3]
Tahsin, C., Tamera, K., Arzu, K., Davud, Y. and Suha, A. (2004) Total versus Subtotal Thyroidectomy for the Management of Benign Multinodular Goiter in an Endemic Region. ANZ Journal of Surgery, 74, 974-978.
https://doi.org/10.1111/j.1445-1433.2004.03139.x
[4]
Chohaill, H. (2002) Les indications chirurgicales dans la pathologie thyroidienne. Thèse demédecine Casablanca Maroc, No. 54.
[5]
Tall, A., Diouf, R., Diallo, B. and Diop, E. (2001) Importance et prise en charge des trachéo-malacies dans la chirurgie des goitres multi-hétéro-nodulaires au CHU de Dakar. Les cahiers d’oto-rhino-laryngologie. De Chirurgie Cervico-Faciale et D’audiophonologie, 36, 95-100.
[6]
OMS, FAO (2003) Régime alimentaire, nutrition et prévention des maladies chroniques. Rapport d’une consultation OMS/FAO d’experts, Genève, 12, 8-11.
[7]
Dyde, A.K.C., Huysmans, M.D., Annonce, R.M.M., Hermus, M.D., Frans, H.M., Corstens, M.D., Jelle, O., Barentsz, M.D., Peter de, W.C. and Kloppenborg, M.D. (1994) Les grandes goitres compressifs traités à l’iode radioactif. Pays-Bas Annals of Internal Medicine, 12110, 757-762.
[8]
Haddad, L., Haddad, F.L., Bittencourt, L., Gregório, L.C., Tufik, S. and Abrahao, M. (2013) Clinical and Polysomnographic Findings of Patients with Large Goiters. Sleep and Breathing, 17, 673-678. https://doi.org/10.1007/s11325-012-0741-z
[9]
Leonardo, H., Fernanda, L., Martinho, H., Lia, B., Luis, C.G., Sergio, T. and Marcio, A. (2013) Impact de la thyroidectomie sur la lutte contre le syndrome d’apnée obstructive du sommeil chez les patients avec de grandes goitres. Universidade Federal de Sao Paulo—UNIFESP, Sao Paulo, 2, 4-6.
[10]
Bricha, M. (2011) les goitres plongeants (A propos de 41 cas). Thèse de médecine Maroc, No. 60, 16-138.
[11]
Rim, Z., Chafik El, A., Rim, B., Najeh, B., Semia, S. and Ghazi, B. (2011) Les gros goitres plongeants: à propos de 43 cas. La Tunisie Medicale, 89, 860-865.
[12]
Andreas, H., Andreas, O. and Manfred, B. (2011) L’efficacité d’une thérapie à l’iode radioactif unique de dose individuelle, en grande goitre en fonction du type de la maladie de la thyroide bénigne. Médecine nucléaire, CHU de Halle (Saale) Allemagne, No. 1927.
[13]
Keita, M., Diango, D., Traoré, C., Kamaté, B. and Mohamed, A. (2007) Les goitres bénins en orl aspects épidémiologiques et anatomocliniques: Etude de 97 cas. Journal Tunisien d’ORL et de Chirurgie Cervico-Faciale, 18, 16-19.
https://doi.org/10.4314/jtdorl.v18i1.42039
