Graves’ Disease in Senegal: Clinical and Evolutionary Aspects

Abstract

Objectives: To assess the clinical particularities and management of Graves' disease at the Medical Clinic II of the Abass Ndao Hospital Centre in Dakar. Patients and methods: This was a retrospective, descriptive study on records of patients monitored for Graves' disease from 1 January 2010 to 31 December 2014 (5 years). Socio-demographic, clinical treatment and changing parameters were evaluated. Outcomes: 878 patients were included and among them 542 had been monitored for at least 18 months. The sex ratio (M/F) was 0.2 and the average age was 34.8 ± 12 years. The average consultation period was 10.7 ± 2 months. Free T4 at diagnosis was > 80 pmol/l (36.6%). Prolonged medical treatment was reported in 96.7% of patients. The average dose for initial therapy with Carbimazole was 37 ± 9 mg/day. Beta-blockers were used in 64% and anxiolytics in 40.5% of cases. The average period for administering the maintenance dose was 5.6 months. Patients' attendance and compliance stood at 17.7% and 53.1% respectively. Complications, mainly cardiothyreosis, were found in 13% of cases. Goitre regression was found in 13.9% of cases and that of exophthalmos stood at 19.5%. Among our patients, 38.2% were lost to follow-up. The remission rate was 36.5% and thyroidectomy involved 14.5% of patients. Only stage of goiter (p = 0.007) and initial free T4 value (p = 0.003) were statistically associated with remission. Conclusion: Graves' disease management raises follow-up problems. Indeed, the medical treatment is long while the number of patients lost to follow-up is high. As the only radical alternative available is surgery, it is therefore essential to promote the development of radioactive iodine therapy to expand the therapeutic choice.

Graves' Disease in Men's Subjects

“…In Africa, values between 8.6% and 12.4% are found [13,14]. Like data in our patients, the average age stabilizes between 35 and 45 years [13,14,[15][16][17][18]. The inclusion of children and adolescents partly explains the decline of this average age to 32.1 years in our study.…”

“…In the western countries, frequencies vary from 12.1% in French [9] to 17.2% in the United Kingdom [12]. In Africa, values between 8.6% and 12.4% are found [13,14]. Like data in our patients, the average age stabilizes between 35 and 45 years [13,14,[15][16][17][18].…”

“…Diop et al [24], had already described the role and impact of stress in the onset of Graves' disease. In Senegal, Sarr et al [13], found family conflict and psycho-emotional shock in 22.8% and 14.9% respectively.…”