The root cause of MBD [metabolic bone disease] is considered to be inadequate calcium and phosphorus provision and to a lesser extent inadequate provision of vitamin D and magnesium."
Regional anaesthesia of the head in cattle is not new. Due to the cost of inhaled anaesthetic agents and the risk of aspiration pneumonia, general anaesthesia is rarely undertaken on adult bovines. With the exception of the cornual nerve block for disbudding and dehorning, techniques to desensitise areas of the head are generally not routinely undertaken by clinicians. These blocks can initially appear daunting but this article aims to assist by providing a practical guide on how to undertake the blocks and the pre and perioperative preparation so as to minimise the stress to both patient and surgeon.
Objective
To evaluate the prevalence and clinical significance of nonuniform technetium (99mTc) uptake among patients with Graves’ disease (GD).
Design, Patients and Measurements
Patients with GD, referred between July 2005 and March 2018, had Tc99‐ uptake scans and TSH‐receptor antibody (TRAb) measured before antithyroid drug (ATD) therapy. Risk of relapse after ATD cessation was monitored until June 2021 and compared between GD patients based on uptake patterns.
Results
Of the 276 GD patients (mean age, 49.8 years; 84% female), 25 (9.0%) had nonuniform Tc99 uptake. At diagnosis, individuals with nonuniform uptake were older (mean age of 61.8 vs. 48.5 years, p < .001), had lower mean thyroid hormone levels (free thyroxine: 36.3 vs. 45.4 pmol/L, p = .04 and free triiodothyronine: 10.0 vs. 17.8 pmol/L, p < .001) and median TRAb levels (4.2 vs. 6.6 U/L, p = .04) compared with those with a uniform uptake. Older age was a significant predictor for the presence of nonuniform uptake in GD patients; odds ratio (95% confidence intervals) of 1.07 (1.03 – 1.10). The risk of relapse was similar in both groups after a median (IQR) follow‐up of 41 (13–74) months after ATD cessation (56.0% vs. 46.3%, respectively); hazard ratio (95% confidence intervals) of 1.74 (0.96–3.15).
Conclusions
Nonuniform radio‐isotope uptake is seen in 1 in 11 patients with GD which could be misdiagnosed as toxic multinodular goitre if TRAb levels are not measured. Treatment of GD patients with nonuniform radio‐isotope uptake with ATD therapy as first‐line appears to be equally effective as compared with those with uniform uptake. TRAb testing should be the main diagnostic test for patients with suspected GD with radio‐labelled uptake scans being reserved for those who are TRAb negative.
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