Presentation, Complication, Management, and Drug Adherence of Patients with Thyrotoxicosis in Developing Countries

Abstract

\n Background: Thyrotoxicosis is the state of thyroid hormone excess with a spectrum of disease ranging from mild to life-threatening complications like thyrotoxic cardiomyopathy and thyroid storm. This study aims to explore the pattern, clinical manifestation, complication, management, and drug adherence of patients with thyrotoxicosis in a tertiary hospital of Northern Ethiopia. Methods: An institution-based cross-sectional study was conducted in Ayder Comprehensive Specialized Hospital from 2017 to 2018. Data from a 200 thyrotoxicosis cases was collected using a structured questionnaire that includes Morisky Medication Adherence Scale questions. After describing variables, a logistic regression was conducted to identify independent predictors of dilated cardiomyopathy and drug adherence. Statistical significance was declared at p<0.05. Results: Mean age at presentation of thyrotoxicosis was 45 years and females accounted for 89% of the cases. As well, the most common symptom and sign were palpitation and goiter respectively. Thyroid storm occurred in 6% of the cases. Out of 89 patients subjected for echocardiography, 35 (39.3%) of them had dilated cardiomyopathy. And, the odds of dilated cardiomyopathy was higher in patients who had atrial fibrillation (AOR=15.95, 95% CI:5.89-38.16, p=0.001) and tachycardia (AOR=2.73, 95% CI:1.04-7.15, p=0.040). All patients took propylthiouracil and 13.0% of them experienced its side effects. Concerning β-blockers, propranolol was the most commonly (78.5% of the cases) used drug followed by atenolol (15.0%). Six patients underwent surgery. Lastly, drug non-adherence rate was 26% and it was significantly associated with illiteracy, side effect, lack of information and infrequent TSH follow-up. Conclusions: In developing countries like Ethiopia, patients with thyrotoxicosis have no access to methimazole which is the first-line anti-thyroid drug. In addition, they greatly suffer from dilated cardiomyopathy due to late presentation and side effects of propylthiouracil. Therefore, we recommend that patients should get adequate health information about thyrotoxicosis and anti-thyroid drugs including their side effects. Additionally, hospitals and other concerned bodies should also avail TSH test and methimazole at an affordable cost.