Graves Disease in Central Ghana: Clinical Characteristics and Associated Factors

Abstract

BackgroundGraves disease (GD) has increased in prevalence over the past decade in Africa. Despite this, the condition is not well described, especially in sub-Saharan Africa.ObjectiveWe have described the clinical characteristics and associated factors of GD in a cohort of patients attending a resource-limited setting tertiary hospital.MethodsPatients were examined thoroughly and systematically tested for the degree of clinical and biochemical thyroid status. Thyroid volume, characteristics, and blood flow were assessed at presentation using ultrasonography. Factors associated with an inability to achieve clinical and biochemical thyroid remission were evaluated using multiple logistic regression analysis.ResultsOverall, 182 patients were studied, 152 (83.5%) were women with a female:male ratio of 5.1:1.0. The mean age at presentation was 39.9 ± 14.7 years with women significantly older than men. Thyroid-associated orbitopathy (TAO) was observed in 56% of the participants and pretibial myxoedema in 6%. About 84% of the participants were hyperthyroid at presentation, 9% were euthyroid, 4% were hypothyroid, and 3% had subclinical hyperthyroidism. Inability to achieve biochemical and clinical remission at 24 months was associated with increased thyroid volume (odds ratio [OR]: 2.35, 95% confidence interval [CI]: 1.85-2.52, P < .001), presence of TAO (OR: 2.15, 95% CI: 2.12-2.33, P < .001), increased FT3/FT4 ratio (OR: 1.33, 95% CI: 1.24-2.56, P = .004), and missed clinic appointment (OR: 5.2, 95% CI: 4.55-7.89, P < .001).ConclusionsGraves disease among Ghanaians is associated with significant signs at presentation. Inability to achieve remission within the first 24 months is associated with increased thyroid volume, TAO, an increased FT3/FT4 ratio, as well as missed clinic appointment.

Clinical Spectrum and Outcome of Patients with Graves’ Disease: A Single-Center Experience from a Tertiary Care Institution in the Kashmir Valley, India

“…The predominant involvement of women in the present study is in agreement with the findings documented in the literature (4,15,16). This is also consistent with the autoimmune nature of GD, as autoimmune diseases tend to affect females more than males (17).…”

“…This is also consistent with the autoimmune nature of GD, as autoimmune diseases tend to affect females more than males (17). While the females outnumbered the males in the present study, the proportion was less than that reported in the other studies (4,16). This could be the result of the improved iodine status of the population (11), following the universal iodization program and a consequent increase in the tendency for autoimmune disorders (18), which might have ultimately resulted in a lower female to male ratio.…”

Determining the Level of Knowledge about Graves’ Disease: Single-Center Results

“…6 Bu hastalık 30 ile 50 yaşları arasında görülmektedir. 7,8 Hastalarımızın yaş ortalaması 43,86±13,19 yıl saptanmış olup bazı çalışmalara göre yüksek olsa da Beata Jurecka-Lubieniecka ve arkadaşlarının yaptığı 709 hastayı kapsayan çalışmadaki ortalama 41,3 ± 14,27 yıl ile ve bazı başka çalışmalarla benzer bulunmuştur. 8,9 Tablo 1.…”

“…15 Sarfo-Kantanka ve ark., yaptığı 182 hastayı kapsayan bir çalışmada, çarpıntı, guatr ve nefes darlığı en sık saptanan başvuru semptomları olarak bildirilmiştir. 7 Lanas ve arkadaşlarının yaptığı başka bir çalışmada, katılan 257 hastanın %55'inin başvuru anında göz bulgusu olduğu belirtilmiştir. 9 Bizim çalışmamızda, başvuru anındaki kardiyovasküler, hipermetabolik ve göz bulgularına birçok çalışmadan farklı olarak bu kadar yüksek sıklıkta rastlanmadı, hastaların %39,76'sının asemptomatik olduğu görüldü.…”

“…1,7,10 Çalışmamızda, çoğu çalışmadan farklı olarak katılımcıların %51,81'inin erkek (oran:1.07:1.00) olduğu saptandı. Bu bulgunun hasta sayısının az olması ve ankete katılmaya gönüllü olanların daha çok erkek hastalar ile ilişkili olduğu düşünüldü.İyot eksikliğine bağlı yetersiz tiroid hormonu üretimi, büyüme ve gelişme üzerinde birçok olumsuz etkiye neden olmaktadır.…”