GOITER
Although Aira is not an endemic area, the incidence of goiter is high. The vast majority are simple colloid goiters caused by iodine deficiency. The condition is totally preventable by adding sufficient iodine in the food or giving iodine capsules as prophylaxis during childhood. Iodized salt is available in the hospital pharmacy and the shops in own. People however prefer the much cheaper salt from the Red Sea, which is sold in the market in bars or as grains. It tastes better too!
(The salt is produced by evaporation of the salt Red Sea water in the extreme lowland, Danakil, and transported on camels to the high lands. As late as in the 1960’ies the salt bars were still in use as payment instead of printed money)
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The indications for thyroid surgery are:
1) Thyroid nodules, as they have a potential for malignant changes,
2) Hyperthyroidism with or without a goiter (toxic goiter), and
3) Large colloid goiters. Some colleagues do not perform goiter surgery as they consider it “cosmetic”. Those I advise to try walking around and sleeping with a bag containing 3 kilo potatoes attached to the neck.
Malignancy (cancer) is most often not considered for surgery. Usually the disease is already too advanced for a radical cure, and even if it is possible to remove the cancer by a total thyroidectomy (removal of the whole gland), the patient will succumb in hypothyroidism since lifelong substitution medication is not possible (it is not possible to secure a steady lifelong medication with thyroid hormone), even though the drug, thyroxin, is very cheap.
Small goiters and thyroid nodules are operated on daycare basis at 350 birr, large goiters as inpatient surgery at 400 birr. The goiters come in all sizes and forms. The huge ones need now and then a temporary tracheostomy post operatively.
During the first 6 months of this year 125 thyroid surgeries was done. In 5 years one postoperative death occurred due to complications.
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