Hyperthyroid symptoms without hyperthyroidism...

Re: Hyperthyroid symptoms without hyperthyroidism...

Emily Nightingale — Sun, 07 Apr 2013 20:29:38 GMT

BTW great article in In Practice with the Vet Record this week. =)

Re: Hyperthyroid symptoms without hyperthyroidism...

Sara Ramsey — Sun, 07 Apr 2013 08:49:14 GMT

That sounds very useful! I have two old cats which are similar to the above case and hadn't thought about EPI. Always thought it was young dogs.

Re: Hyperthyroid symptoms without hyperthyroidism...

Kate Richardson — Fri, 05 Apr 2013 14:16:09 GMT

With unremarkable bloods and ruling out hyperthyroidism and diabetes, GIT disease and exocrine pancreatic insufficiency would be top of my list. GIT disease could range from inflammatory disease through to neoplasia; lymphoma tends to be more infiltrative cf adenocarcinoma which is more likely a discrete mass/thickening which is often palpable. FeLV unlikely in a cat of his age so unless very high incidence in your area wouldn't waste money on testing, think overall incidence in UK now less than 5% and usually young cats. FIV more common but wouldn't account for your symptoms alone. FIP not impossible but but very unlikely in cat of this age. Mild anaemia suggests chronic disease and monocytosis suggests chronic inflammation. Was potassium normal? thinking of causes of weakness. If cat goes outside, there may be vomiting or diarrhoea that is not known but not all cats with GIT disease have vom/dia. If you can get some idea of faeces consistency/colour can be very helpful though.

If cat is 'happy' otherwise, and you think IBD/lymphoma or EPI a possibility I would trial a pancreatic enzyme supplement fisrt- will do absolutely no harm and can give dramatic and quick improvement; ideally give B12 supplementation at same time, weekly injections fine, again will do harm whatsoever as cat will just pee out excess, but some EPI cases won't respond if they are B12 deficient.

If no response to EPI treatment, and further testing/ultrasound exam of abdo not an option, trial treatment for IBD (diet/pred/B12)

Hope that helps

Re: Hyperthyroid symptoms without hyperthyroidism...

Rob Loxley — Fri, 05 Apr 2013 13:45:50 GMT

In similar cases I'd be looking at primary GI pathology, and particularly IBD/lymphoma.

If further investigations aren't possible, maybe give the preds a go?

Re: Hyperthyroid symptoms without hyperthyroidism...

Martin Atkinson — Fri, 05 Apr 2013 11:00:18 GMT

[quote user="Tracy Arend"]So...where to go from here? I know running a FeLV snap test would be useful but money is an issue. Globulins werent raised as you might expect with FIP. Any thoughts?[/quote] You hands are tied if the owner can't/won't pay for further investigation, then if you make a diagnosis can they afford any treatment anyway. It ceases to be your problem so don't fret about it but you have to explain that you've just got to go through a progression of investigation if they want to find out about it. IMO retro-viruses and a survey X-ray would be minimum further things to do but don't totally exclude hyperthyroidism, I've see a few with normal values although if they're low admittedly its less likely. You say there may be a goitre determining if there is or if there is a lump of some other sort would be a huge step forward.

Re: Hyperthyroid symptoms without hyperthyroidism...

Andrew Kent — Fri, 05 Apr 2013 10:33:07 GMT

We're there any other biochemical abnormalities? As others have said if it isn't hyperthyroidism ( which I think is unlikely with your results ) then perhaps malabsorption? In which case I would probably look at running a TLI/folate/B12 and maybe some abdominal imaging if possible? We have seen cats with chronic pancreatitis that can present like this.

Andy

Re: Hyperthyroid symptoms without hyperthyroidism...

Tracy Arend — Fri, 05 Apr 2013 09:43:58 GMT

The free T4 and TT4 came back lower than references ranges so unlikely to be sick euthyroid syndrome. Heart rate is above 200. I also consider lymphoma on my differentials, but there is no lymphocytosis on the haematology.

In regards to defecating, there was no mention of diarrhoea. He was seen 2 months ago for his boosters. At that time the owners said his faeces were normal. He was on the skinny side then and I had discussed signs to look out for hyperthyroidism then.

Re: Hyperthyroid symptoms without hyperthyroidism...

Bob Russell — Fri, 05 Apr 2013 09:30:34 GMT

I do wonder whether these cats are 'hyperthyroid' but sick euthyroid syndrome at the same time (ie lab results not reflecting the true state of the cat! Not sure this is even possible but quite a lot of old cats seem to do this. What is the heart rate?

What has the lab said? I have never had the confidence to try these cats on medication.

I suspect most of these have other pathology such as lymphoma.

Re: Hyperthyroid symptoms without hyperthyroidism...

David Mills — Fri, 05 Apr 2013 09:17:09 GMT

Indoor/outdoor cat? (Do the owners see it sh*tting?)