Hyperthyroidism and raised liver enzymes in cats

Re: Hyperthyroidism and raised liver enzymes in cats

Michael Woodhouse — Thu, 10 Oct 2013 22:18:28 GMT

Idexx lab analyser range for cats

ALT (SGPT) 37°C U/L 5.0 - 60.0
Alk. Phosphatase 37°C U/L <= 60.0

Re: Hyperthyroidism and raised liver enzymes in cats

Michael Woodhouse — Thu, 10 Oct 2013 22:11:35 GMT

If it helps the Idexx lab report gives

ALT (SGPT) 37°C U/L 19.8 - 124.0
Alk. Phosphatase 37°C U/L <= 130.0

bugger - that's dogs.

Re: Hyperthyroidism and raised liver enzymes in cats

KathW — Thu, 10 Oct 2013 21:21:00 GMT

Same units are used Axiom labs give normal for ALT 0-20 u/l @37degrees C ALP 0-40u'l @37deg C

The other range is from our in house IDEX vet test machine where the range is given ALT 12-130 u/l ALP 14-111 u/l

I'm not sure why there is such a variation in the normal - a phone call to idex and /or Axiom tomorrow may be in order.

Re: Hyperthyroidism and raised liver enzymes in cats

Martin Atkinson — Thu, 10 Oct 2013 09:52:49 GMT

[quote user="KathW"]

n re checking the biochemistry the ALT is 90 (0-20) and Alp 59 (0-14).

Different values before treatment -( used a lab for the above and in house bloods at first) but then we had ALP 129 (14-111) and ALT 140 (12-130)

[/quote] These normal ranges seem widely disparate are you using the same units for each set of tests? IME liver enzymes are nearly always raised in hyperthyroidism, indeed it is the most common cause of this in an old cat and almost pathognomic but having said that we currently have a cat with nailed on symptoms of hyperthyroidism, a T4 of over 300nmol/l and normal liver enzymes! IME they usually go back to normal with good control on medication but I have little experience with YD. I wouldn't worry if they remained marginally above normal so long as the cat didn't have other symptoms and T4 was in normal range, but I may do Tbil and bile acids just to be sure. As the others suggest though, do keep an eye on renal function although in this case it seems normal.

Re: Hyperthyroidism and raised liver enzymes in cats

KathW — Wed, 09 Oct 2013 22:36:45 GMT

Thanks for all that. The cat is a stress head and so far we have visited as owner prefers it. We'd struggle to get a relevant blood pressure I think but will keep at the back of my mind.

As I said biochemistry was normal - However urea towards top end of range at 9 (6-10)

Creat 69 (60-170)

Phos not done -could request as add on.

USG is dilute 1.020 granular casts and raised UPC 0.9 (0-0.4)

Culture results now back Pseudomonas and coliform - probable E Coli or Klebsiella

So obviously we need to treat the UTI and then re chk urine culture UPC + do microscopy on sediment.

After that could also re chk liver enzymes and do bile acid stim if o willing. Don't think they'd want ultrasound too much stress for this cat.

Good point re YD and CRF thanks.

Thanks for everyone's input.

Re: Hyperthyroidism and raised liver enzymes in cats

Laurence Webb — Wed, 09 Oct 2013 09:33:38 GMT

I generally keep a closer eye on those on medication rather than on diet control but I would normally expect liver enzyme changes induced by hyperthyroidism to fall markedly when I recheck bloods 2-4 weeks after starting treatment. Many don't go back to normal, although how much of that is due to medication side effects I am uncertain.

Certainly those that do not show any improvement in liver enzyme levels to tend to raise concern that a seperate hepatopathy may be present, at which point I'd discuss furhter liver investigation such as bile acid stim and ultrasound +/- aspirates. Many people (most!) don't go for this and the cats seem to toddle on fairly well. The level of enzyme raise isn't massive but it does seem to be of a greater magnitude compared to the previous normal ranges so I'd certainly discuss bile acids at least with the owner.

If there is weight loss and a high UPC I'd certainly be interested in that. Have you checked for hypertension? Worth doing especially if there is an inactive sediment and culture is negative. What was the USG? If <1.035 then CRF may well be present even if urea/creatinine are normal. The IRIS guidelines are worth looking at for guidance here. Consider ACE inhibitors if you think there is CRF without significant hypertension. Also remember that y/d isn't a great diet if CRF is present.

Re: Hyperthyroidism and raised liver enzymes in cats

James Laidlaw — Wed, 09 Oct 2013 08:53:13 GMT

[quote user="KathW"]

I know that with untreated hyperthyroidism we often see raised ALT and ALP I think I read somewhere a possible reason for that but I can't remember what it was. Anyone now?

My question really is once the hyperthyroidism is well controlled do the ALT and ALP always go back to normal? It's not something I always check but I have a cat that is well controlled on Y/d TT4 22.5 (15-40) but on re checking the biochemistry the ALT is 90 (0-20) and Alp 59 (0-14).

Different values before treatment -( used a lab for the above and in house bloods at first) but then we had ALP 129 (14-111) and ALT 140 (12-130)

The cat has lost wt over 12 months since 1st tested ( o bought the food on the internet and came back for re check due to wt loss!) Rest of blood biochemistry normal. Poss UTI bacteria in urine (awaiting culture) and granular casts + UPC 0.9 (0-0.4)

[/quote]

What's the USG, UREA/CREA/PHOS?

Has the cat been losing weight while being stable? If so I'd be looking for something else. I think most cats go up 1-2 stages on the IRIS CKD scale when treating T4, so renal disease is possible, but if persistent raised liver enzymes perhaps a BAST or liver scan are in order to evaluate the liver further. Not a whole lot available to treat liver outside supplements though, and they're quite expensive so I always would discuss the outcome of diagnostics/diagnostic benefit first before plunging headfirst into scanning/biopsies etc

Re: Hyperthyroidism and raised liver enzymes in cats

Michael Woodhouse — Wed, 09 Oct 2013 00:58:57 GMT

Deep down in my mind, I had cats losing weight - liberate body fat - FFA to liver and degree of hepatic lipidosis.

They usually resolve with Tx, but not something I'll always check if cat doing ok and T4 normal (do check kidney parameters) especially when money is tight.