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Lookup NU author(s): Nicholas Vennart, Dr Jolanta Weaver, Dr Salman Razvi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
Objective: To evaluate the prevalence and clinical significance of non-uniform technetium (Tc99) 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 prior to anti-thyroid 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 non-uniform Tc99 uptake. At diagnosis, individuals with non-uniform uptake were older (mean age of 61.8 vs 48.5 years, p<0.001), had lower mean thyroid hormone levels (free thyroxine: 36.3 vs 45.4 pmol/L, p=0.04 and free triiodothyronine: 10.0 vs 17.8 pmol/L, p<0.001) and median TRAb levels (4.2 vs 6.6 U/L, p=0.04) compared to those with a uniform uptake. Older age was a significant predictor for the presence of non-uniform 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: Non-uniform radio-isotope uptake is seen in one in eleven patients with GD which could be misdiagnosed as toxic multinodular goitre if TRAb levels are not measured. Treatment of GD patients with non-uniform radio-isotope uptake with ATD therapy as first-line appears to be equally effective as compared to 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.
Author(s): Abdalaziz A, Vanka R, Bartholomew P, Vennart N, Vernazza J, Stewart K, Tsatlidis V, Narayanan K, Weaver J, Razvi S
Publication type: Article
Publication status: Published
Journal: Clinical Endocrinology
Year: 2022
Volume: 97
Issue: 1
Pages: 100-105
Print publication date: 01/07/2022
Online publication date: 04/03/2022
Acceptance date: 18/02/2022
Date deposited: 18/02/2022
ISSN (print): 0300-0664
ISSN (electronic): 1365-2265
Publisher: Wiley-Blackwell Publishing Ltd
URL: https://doi.org/10.1111/cen.14709
DOI: 10.1111/cen.14709
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