Thyrotoxicosis in Ethiopian patients--a prospective study.

Forty-six cases of thyrotoxicosis, 8 males and 38 females, were seen over a period of two years from March 1979. There were 19 cases of toxic multinodular goitre, 22 of Graves' disease, four of toxic adenoma and one of subacute thyroiditis. The median age of those with toxic multinodular goitre was 49 and of those with Graves' disease was 30 years. The five most common symptoms were sweating/heat intolerance (82.6%), weight loss (82.6%), palpitations (82.6%), nervousness and irritability (73.9%) and insomnia (69.6%). Six of 24 non-pregnant females of child-bearing age had menstrual disturbances. The five most common signs were goitre (97.8%), tachycardia (100.0%), sweating (84.7%), and fine finger and tongue tremors (89.1%). Among the 22 cases of Graves' disease, 13 (59.1%) had exophthalmos and 4 (18.2%) had pretibial myxoedema. Treatment with propylthiouracil or carbimazole was effective in controlling the thyrotoxicosis. Granulocytopenia developed in two cases and skin allergy in one other, necessitating use of alternative treatment. Seven cases had subtotal thyroidectomy after preparation with antithyroid drugs or propranolol and Lugol's iodine.

Chloroquine in the treatment of porphyria cutanea tarda.

Porphyria cutanea tarda (PCT) is common in Ethiopia and invariably affects the liver. Treatment by abstension from alcohol and avoidance of direct sunlight often failed to achieve lasting improvement. Phlebotomy is unacceptable to most of our patients and impractical as a routine therapy. Chloroquine phosphate 500 mg (300 mg base) given daily for 10 days to 24 patients with confirmed PCT, was found to be uniformly effective. Both clinical and biochemical remissions were complete, The side effects of chloroquine include fever, nausea, vomiting and myalgia which predictably occur on the third day of therapy and subside within 72 hours. Since all other modes of therapy are ineffective or impractical and since the response to chloroquine is prompt, effective and reproducible and the side effects are brief, mild and do not cause permanent hepatic damage, it is suggested that this drug is currently the most practical treatment for PCT in areas where repeated phlebotomy is unacceptable and patient follow-up is unsatisfactory.

Porphyria cutanea tarda in Ethiopia.

The clinical, biochemical and histological features of 75 Ethiopians with porphyria cutanea tarda (PCT) are described. PCT in Ethiopia is definitely related to alcohol abuse and there is no clinical evidence for hereditary predisposition. Significant elevation of transaminases and bromsulphthalein retention, moderate to marked hepatic siderosis and inflammation with little or no fibrosis, suggestive of mild or likely reversible parenchymal changes, characterize the liver affection in these patients. A similar study of 18 patients with hyperpigmentation of the face and hands but without blisters, an unexplained but common feature of liver disease in Ethiopia, revealed that serum iron and urinary uroporphyrin levels were normal in eight but significantly elevated in ten (56%). Neither elevated serum iron and hepatic siderosis nor increased urinary uroporphyrin completely explains the hyperpigmentation in this group of patients.

Hyperpigmentation of the face and hands without blisters: porphyria cutanea tarda.

Hyperpigmentation of the face and hands without blisters and hypertrichosis in Ethiopian patients with liver disease represents an early or latent form of porphyria cutanea tarda.