Canine Hypothyroidism with Neurological Disorders

Background: Hypothyroidism is characterized by hypofunction of the thyroid gland. It results in deficient production of thyroid hormones. Neurological disorders resulting from hypothyroidism are rare, which highlights the importance of this study. This study reports a case of hypothyroidism in a dog with neurological clinical signs, that was treated at the Universidade Estadual de Santa Cruz’s Veterinary Hospital (HV-UESC).   Case: A 4-year-old male intact Dogo Argentino breed dog, weighing 64 kg, presenting obesity, anorexia, prostration, walking in circles, and chronic dermatopathy was presented at HV-UESC. Upon physical examination, the animal presented a deficit of proprioception in the 4 limbs, with preserved superficial and deep pain. No alteration was observed in the ears, that could explained the clinical signs. In terms of dermatopathy, the animal presented symmetrical alopecia in the lateral region of the thighs and tail. Blood samples were collected for a complete blood count and biochemical tests of urea, creatinine, ALT, AST and cholesterol. Imaging radiography and ultrasonography were performed, which ruled out thoracic and abdominal changes that could be related to the case. Prior to receiving the blood test results, idiopathic encephalitis was suspected and enrofloxacin and prednisone were prescribed for 7 days. During the medication period, previous exams were provided, which indicated only increased cholesterol (500 mg/dL). The animal showed no improvement with the prescribed medication. In view of the clinical signs presented by the patient and the results of the additional tests, hormonal disease was suspected, compatible with hypothyroidism. Thus, hormonal tests of total T4, free T4, and TSH were requested, leading to verification of reduced total T4 (0.3 ng/dL) and free T4 (0.15 ng/dL) levels, and confirming the dysfunction of the thyroid gland. The previous treatment was suspended and thyroid hormone replacement was initiated. After 3 days of treatment, the neurological signs regressed and the animal became more active; after 30 days, the areas of alopecia decreased. Although the patient did not receive the recommended clinical follow-up for such cases, it was possible to establish the ideal levothyroxine dosage for the dog after appropriate adjustments, which permitted thyroid hormone levels to return to normal. Discussion: This report refers to a case of hypothyroidism in a giant dog breed. The dog in the report showed clinical signs of a dermatological, metabolic, and neurological nature, which is consistent with a lack of thyroid hormone. The main signs presented by the animal were neurological, such as walking in circles and a deficit of proprioception in the four limbs. These clinical signs are rarely mentioned in the literature associated with hypothyroidism. Laboratory abnormalities are correlated with the severity and chronicity of the disease. The animal showed a decrease in total T4 and free T4, which is to be expected in a hypothyroid animal. As a result, levothyroxine replacement treatment was initiated. The dose used for the dog, which is the recommended dose in the literature, greatly increased its total T4 levels. As a result, the dose was readjusted after a new clinical evaluation. The rate of metabolism and absorption of levothyroxine varies widely and is independent of weight. The patient showed quickly improvement in neurological signs, activity level, and serum cholesterol rate. Regarding dermatological signs and body condition, there was a more gradual improvement. This corroborates what is mentioned in the literature, which indicates that improvements can take many months. Keywords:  hormonal Disease, hypothyroidism, neuropathy

Canine Hypothyroidism with Neurological Disorders

Background: Hypothyroidism is characterized by hypofunction of the thyroid gland. It results in deficient production of thyroid hormones. Neurological disorders resulting from hypothyroidism are rare, which highlights the importance of this study. This study reports a case of hypothyroidism in a dog with neurological clinical signs, that was treated at the Universidade Estadual de Santa Cruz’s Veterinary Hospital (HV-UESC).   Case: A 4-year-old male intact Dogo Argentino breed dog, weighing 64 kg, presenting obesity, anorexia, prostration, walking in circles, and chronic dermatopathy was presented at HV-UESC. Upon physical examination, the animal presented a deficit of proprioception in the 4 limbs, with preserved superficial and deep pain. No alteration was observed in the ears, that could explained the clinical signs. In terms of dermatopathy, the animal presented symmetrical alopecia in the lateral region of the thighs and tail. Blood samples were collected for a complete blood count and biochemical tests of urea, creatinine, ALT, AST and cholesterol. Imaging radiography and ultrasonography were performed, which ruled out thoracic and abdominal changes that could be related to the case. Prior to receiving the blood test results, idiopathic encephalitis was suspected and enrofloxacin and prednisone were prescribed for 7 days. During the medication period, previous exams were provided, which indicated only increased cholesterol (500 mg/dL). The animal showed no improvement with the prescribed medication. In view of the clinical signs presented by the patient and the results of the additional tests, hormonal disease was suspected, compatible with hypothyroidism. Thus, hormonal tests of total T4, free T4, and TSH were requested, leading to verification of reduced total T4 (0.3 ng/dL) and free T4 (0.15 ng/dL) levels, and confirming the dysfunction of the thyroid gland. The previous treatment was suspended and thyroid hormone replacement was initiated. After 3 days of treatment, the neurological signs regressed and the animal became more active; after 30 days, the areas of alopecia decreased. Although the patient did not receive the recommended clinical follow-up for such cases, it was possible to establish the ideal levothyroxine dosage for the dog after appropriate adjustments, which permitted thyroid hormone levels to return to normal. Discussion: This report refers to a case of hypothyroidism in a giant dog breed. The dog in the report showed clinical signs of a dermatological, metabolic, and neurological nature, which is consistent with a lack of thyroid hormone. The main signs presented by the animal were neurological, such as walking in circles and a deficit of proprioception in the four limbs. These clinical signs are rarely mentioned in the literature associated with hypothyroidism. Laboratory abnormalities are correlated with the severity and chronicity of the disease. The animal showed a decrease in total T4 and free T4, which is to be expected in a hypothyroid animal. As a result, levothyroxine replacement treatment was initiated. The dose used for the dog, which is the recommended dose in the literature, greatly increased its total T4 levels. As a result, the dose was readjusted after a new clinical evaluation. The rate of metabolism and absorption of levothyroxine varies widely and is independent of weight. The patient showed quickly improvement in neurological signs, activity level, and serum cholesterol rate. Regarding dermatological signs and body condition, there was a more gradual improvement. This corroborates what is mentioned in the literature, which indicates that improvements can take many months. Keywords:  hormonal Disease, hypothyroidism, neuropathy

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)