A case report of graves’ disease in Liberia and surgical indication

Graves' disease is an autoimmune disease that may consist of hyperthyroidism, goiter, eye disease (orbitopathy), and pretibial or localized myxedema. The presence of thyrotropin-receptor antibodies (TRAb) in serum and orbitopathy on clinical examination distinguishes the disorder from other causes of hyperthyroidism. However, the diagnosis may be obvious on presentation; a patient with new-onset ophthalmopathy, a large non-nodular thyroid, and moderate to severe hyperthyroidism has Graves' disease. Because there is no consensus as to the "best" treatment, the American Thyroid Association (ATA) guidelines emphasize the importance of fully discussing the options with patients and considering their values and preferences before deciding on a treatment plan. Patients who are intolerant of antithyroid drug therapy and radioiodine ablation or who have active Graves orbitopathy are surgical candidates. Most experts now agree that total or near-total thyroidectomy is considered the optimal procedure. To date, there is no published data available on Graves’ disease in Liberia and the management options remain limited. Thereof, we present a 34-year-old Liberian female who underwent a near total thyroidectomy for Graves’ disease at the Eternal Love Winning Africa (ELWA) Hospital Monrovia, Liberia.