Thyroid cancer in Yemen.

To evaluate the characteristics of thyroid cancer [TC] patients in regard to demographic distribution, histological variants, mode of presentation and modalities of diagnosis and treatment. We retrospectively audited the records of 97 consecutive cases with histologically proved thyroid cancer between 1997 and 2001 presenting to the Kuwait University Hospital, Sana'a, Yemen. Patients with TC in this study comprise 17.7% of goiter patients who were admitted at the same period. Females constituted 89.7% [n=87], and males 10.3% [n=10]. The average age of diagnosis was 38.4 years. More than two thirds were at the age of 40 and less. Among patients with goiter, the percentage of carcinoma was higher in the following groups, males [37.9% versus 16.6%, p=0.028], patients aged of 47 or more [25.8% versus 12.6%, p=0.001], patients with enlarged lymph nodes [9.3% versus 3.8%, p=0.020], and patients with recurrent disease after being operated for a presumably benign disease [8.2% versus 2.9%, p=0.012]. The average period since patients noticed the swelling until seeking medical help was 4 years. Most patients [90%] came from highland areas. Multinodular swelling was the most common clinical finding [43.3%], and hoarseness was the most common symptom [17.5%]. In histopathological examination, papillary carcinoma accounted for 93.8% of the cases and papillary microcarcinoma was found in 10 cases [10.3%]. The papillary/follicular carcinoma ratio was 22:1. Hormone assay and ultrasonic imaging were the most commonly used investigations. Sub total thyroidectomy was the most common procedure used in treatment [39%]. Not all histological variants of TC are represented in this study. Papillary carcinoma formed the bulk of TC cases. Salt iodization program might have an effect on the incidence of thyroid malignancy, and on the papillary/follicular carcinoma ratio. Better level of expertise is needed in the field of fine needle aspiration and ultrasonography. A consensus has to be reached, which is based on our environment and capabilities, where TC has to be managed aggressively by experienced surgeons. Yemen is in real need of a national cancer registry to assess the problem on a national level

epidemiology, pathology, and management of goitre in Yemen

Background: The total goitre rate in Yemen declined by half after the country adopted universal salt iodisation in 1995. We investigated the recent epidemiology, pathology, and management of goitre so as to evaluate changes since the initiation of the salt iodisation programme. We also sought to determine the effect of new diagnostic tools in the preoperative work-up of surgically treated patients

Methods: Data were collected from the records of 667 patients with goitre seen in Kuwait University Hospital between 1997 and 2001

Results: Females constituted 92.5% [n=617] of the series. The mean age of all patients was 35.2 +/- 11.58 years [range, 13 to 90 years]. Most patients [93%] came from highland areas with an average altitude of 2000 to 2600 meters above sea level. The average duration since patients noticed swelling until the diagnosis was made was about 4 years. Multinodular bilateral swelling was the most common clinical finding [44.9%], while solitary nodules constituted the least common [17.4%]. The most common associated symptom was dyspnoea [20.5%]. The most common histopathological finding was nodular and colloid goitre [62.8%], while malignancy accounted for 17.7%. Subtotal thyroidectomy was the most frequent procedure, and the most common postoperative complication was hypocalcaemia

Conclusion: Goitre is a national problem in Yemen. The late presentation, which may be important in malignant transformation of the thyroid gland, makes surgery imperative. The salt iodisation programme has been associated with a decrease in the malignancy rate. Yemen is in great need of experienced cytologists and radiologists to increase the efficacy of fine needle aspiration cytology and ultrasonography in the diagnosis of thyroid lesions. Patients need to be educated about the importance of post-operative follow up