A systematic review and meta-analysis on the aetiology and treatment patterns of thyrotoxicosis in Africa

Abstract Background Thyrotoxicosis is one of the most common endocrine disorders seen in clinical practice. This study aimed to determine the aetiologies and the treatment modalities of thyrotoxicosis in Africa. Methods The study design is a systematic review with a meta-analysis. Medical databases and the grey literature were systematically searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies done in Africa on the aetiology and treatment of thyrotoxicosis were selected. Meta-analysis was done with Meta XL an add-in software for Microsoft Excel using the DerSimonian Laird random effect. Study quality was determined with the Newcastle-Ottawa scale. Heterogeneity was determined using I 2 statistic and the Cochran’s Q test. Results Thirty-four studies met the eligibility criteria. The total sample size was 3995. The studies were carried out between 1982 and 2021. The pooled mean age in the selected studies was 38.6 years. The pooled female: male ratio of the participants was 7:1. Graves’ disease, toxic multinodular goitre, toxic adenoma, thyroiditis and other rare causes accounts for about 54% (95%CI: 41–67), 39% (95%CI: 28–50), 10% (95%CI: 6–14), 2% (95%CI: 1–3), and 1% (95%CI: 0.1-2) of thyrotoxicosis cases seen in Africa respectively. Thionamides, thyroidectomy and radioiodine therapy were received by 95%, 17% and 11% of individuals with thyrotoxicosis respectively. Discussion The most common causes of thyrotoxicosis in Africa are Graves’ disease, toxic multinodular goitre, solitary toxic adenoma and thyroiditis. The most common treatment modality adopted in Africa is thionamides, followed by surgery and radioiodine therapy respectively.