Thyrotoxicosis in Africa: a systematic review and meta-analysis of the clinical presentation

Abstract

Background Thyrotoxicosis is a common endocrine disorder. The clinical presentation is variable, and it is often misdiagnosed or diagnosed late in Africa. This study was aimed at collating and analyzing the clinical characteristics of the disease across the continent so as to enhance correct and timely diagnosis. Methods The study is a systematic review with a meta-analysis. Studies, done in Africa, which documented the clinical features of thyrotoxicosis were selected. African Journal Online (AJOL), PubMed, SCOPUS and Google Scholar, Research Square, SciELO, and medRxiv were systematically searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study quality was assessed using the Newcastle-Ottawa scale. Heterogeneity was determined using I2 statistic and Cochran’s Q test. LFK index and the symmetry of the Doi plot were used to assess publication bias. Results The eligible studies were 59 and the total sample size was 9592. The most common symptoms of thyrotoxicosis on the continent included palpitations (69%), weight loss (65%), heat intolerance (64%), tiredness (49%), increased appetite (49%), hyperhidrosis (48%), and insomnia (47%). The most common signs were thyromegaly (88%), tachycardia (67%), sweaty palms (54%), hand tremor (49%), and exophthalmos (49%). Atrial fibrillation, heart failure, and thyrotoxic heart disease were found in 9, 12, and 22% respectively. Other findings were hypertension (25%) and diabetes (9%). Conclusion Clinical presentation of thyrotoxicosis varies, and understanding these peculiarities would mitigate misdiagnosis and delayed diagnosis in Africa.

“It’s a Psychiatric Patient”: Misdiagnosing of Somatic Symptoms in Patients with Mental Disorders Due to Stigma and Inadequate Diagnostic Treatment

“…The patient's TSH levels were low, and serum total T3 and T4 were elevated, which is consistent with findings in the literature [16,18]. Symptoms and signs that may be associated with AIT and were present in our case report include confusion, dyspnoea, tachycardia, pretibial myxoedema, palpitations, subfebrile body temperature, fatigue, sialorrhea and speech difficulties [17][18][19][20][21]. These findings satisfy the Akamizu criteria, which our patient fulfils (elevated thyroid hormones, CNS symptoms, and at least one non-CNS manifestation), leading to a diagnosis of thyroid storm [18].…”

“…Similar results have been found by Anfinsen and Lima who describe suppressed TSH, high FT4 and high or normal FT3 [16]. The onset of thyrotoxicosis is usually sudden and explosive, and the symptoms are nonspecific, making the correct diagnosis difficult [12,19]. Symptoms such as weight loss, sweating, tremor, sinus tachycardia and worsening of the underlying heart disease can occur.…”

“…Other symptoms mentioned in literature include generalized weakness, fatigue, heat intolerance, diaphoresis, fever, palpitations, diarrhoea, hair loss, diplopia, eye irritation, pale skin, dyspnoea, tachycardia, pretibial myxoedema, atrial fibrillation, congestive heart failure, nausea, vomiting, hepatic failure, and hyperpyrexia. Psychiatric symptoms are also mentioned, most commonly confusion, agitation, anxiety, emotional liability, delirium, psychosis, stupor and coma [17,19,20]. An uncommon symptom of hyperthyroidism (specifically Graves' disease) is also sialorrhea, which can affect speech and cause drooling [21].…”

“…An uncommon symptom of hyperthyroidism (specifically Graves' disease) is also sialorrhea, which can affect speech and cause drooling [21]. A meta-analysis of studies in Africa showed that the most common symptoms of thyrotoxicosis are palpitations, weight loss, heat intolerance, fatigue, increased appetite, excessive sweating, insomnia, nervousness, dyspnoea, hyperdefaecation and so on [19]. The Akamizu diagnostic criteria can be used to identify whether a patient is experiencing a thyroid storm.…”

Role of Preoperative Vit D Administration in Decrease Incidence of Post Thyroidectomy Hypocalcemia

“…Tachycardia, exophthalmos and heat intolerance are more commonly associated with toxic goiter (3) . The surgical therapy of goiter may be accomplished by lobectomy, partial thyroidectomy, near-total thyroidectomy, or complete thyroidectomy (4) .The gold standard therapy for thyroid carcinoma, multi-nodular goiter, and grave's disease is a total thyroidectomy (5) , however there is a chance of postoperative complications (transient or permanent hypocalcemia and recurrent laryngeal nerve paralysis) (6) . Although there are few postoperative problems after a subtotal thyroidectomy, recurrence rates might reach 28% (7) .…”