Follicular thyroid carcinoma in South Africa : insights from 103 cases

Abstract

BACKGROUND : Follicular thyroid carcinoma (FTC) accounts for approximately 17-20% of well-differentiated thyroid cancer (WDTC) worldwide. In South Africa (SA), FTC is more common than reported internationally, however, available SA studies included small patient numbers. This multi-institutional study comprehensively describes FTC patients who underwent surgery over a 5-year period, focusing on presentation, diagnosis, and management. METHODS : A retrospective review of all patients with FTC operated at 13 academic hospitals throughout SA between January 2015 and December 2019 was conducted. The Thyroid Cancer Group of South Africa collectively entered data on the presentation, diagnosis, management, and short-term outcomes of 464 thyroid cancer patients into a REDCap database. Descriptive statistical analysis was performed. RESULTS : Of 464 cases captured in the database, 103 (22.1%) were FTCs. WDTC was reported in 87.9% (408/464) of operations, with FTC comprising 25.2% (103/408). Of the 103 FTC patients, 82.5% (n = 85) were female and 16.5% (n = 17) male. The mean age was 51.8 years (SD 17.3). In cases where staging was reported, more than half (53.9%) presented with T3 tumours. Distant metastases were found in 12.6% of patients. Thyroid lobectomy was the most performed procedure (57.4%), followed by total thyroidectomy (37.6%). CONCLUSION : SA presents a multifaceted picture of FTC, with a higher incidence than in developed countries but lower than some other African nations. Patients are frequently symptomatic, which may predict worse outcomes. Standardised reporting and a national thyroid registry could assist in treatment planning and consistency of care.