Fatty on thyroxine

Re: Fatty on thyroxine

John Flynn — Tue, 25 Mar 2014 15:31:18 GMT

Update:

reweighed and has lost 600g.

Hardly outstanding progress, but at least is not worsening given level of immobility etc.

Owners feel that dog is much better and brighter and they attribute this to the cessation of the thyroid meds, but I suspect this is purely their own mental association.

Plan to retest T4/TSH/fT4 at next weigh-in and really hope doesn't need to go back on thyroid supplement as owners likely to be much more on board with subsequent recommendations if that's the case... although I guess if is hypoT4 then weight should be easier to get under control from that point on...

Personally, I'm keeping an open mind. I've stopped thyroid meds and retested cases like this before to prove that they do need them.

Re: Fatty on thyroxine

Thomas Johnson — Thu, 27 Feb 2014 08:58:41 GMT

[quote user="Rob Davis"]

Yarvitan - it doesn't seem to be in the current Noah compendium, so assume it was withdrawn. Did anybody ever use it?

[/quote]

I've got vague memories of putting a dog on it once, the fact that I didn't do so again probably says something. It worked by binding dietary fat, so I'm not sure it would be much use if the dog is already on a low fat diet. Also I saw something on television about the human equivalents, and one of the possible side-effects is an oily anal discharge

Re: Fatty on thyroxine

Utlendigur — Tue, 25 Feb 2014 14:10:32 GMT

There was another one (Slentrol) - that still seems to be listed on the VMD database. Haven't used either or heard of anyone else using them.

Re: Fatty on thyroxine

Mark Hedberg — Tue, 25 Feb 2014 14:01:27 GMT

It was developed by Janssen, so I assume that Elanco took it on when Janssen got bought and they haven't gone ahead with producing it.

Re: Fatty on thyroxine

Rob Davis — Tue, 25 Feb 2014 13:30:12 GMT

[quote user="Robin Grimmer"]

Whwt ever happened to that weight loss pill for dogs that came out a few years ago?

[/quote]

Yarvitan - it doesn't seem to be in the current Noah compendium, so assume it was withdrawn. Did anybody ever use it?

Re: Fatty on thyroxine

Martin Atkinson — Tue, 25 Feb 2014 11:37:40 GMT

[quote user="Mark Hedberg"]It's an interesting suggestion - weren't there unpleasant side effects when they tried this on humans? (Genuinely don't know, just vaguely remember reading an article somewhere.)[/quote] One of my daughters suffers from hyperthyroidism (Graves disease) which caused her to have anxiety attacks, insomnia. palpitations, hot and cold flushes, and suicidal thoughts. Thankfully it was controlled with carbimazole and is now in long term remission - it is very common in young women, tends to be stress related and lot do grow out of it. However, you don't really have to look past hyperthyroid cats to see the symptoms really!

Re: Fatty on thyroxine

Robin Grimmer — Tue, 25 Feb 2014 10:25:58 GMT

Whwt ever happened to that weight loss pill for dogs that came out a few years ago?

Re: Fatty on thyroxine

Elisabeth Knappett — Tue, 25 Feb 2014 09:59:26 GMT

[quote user="John Flynn"]

[quote user="Elisabeth Knappett"]I don't think you have to wait too long off supplementation to retest so I would definitely want to confirm the diagnosis.[/quote]

I was thinking 6 to 8 weeks? I thought the cost of retesting would be worth it if turned out not the be hypothyroid, but I've done this before simply to confirm a case of hypthyroidism which is always frustrating for everyone. Equally, I'm sure thyroid supplementation is likely to help with weight loss irrespective, so not totally sure I'm doing the right thing, but I did ask them to stop as I just like things to be a bit more black and white.

[/quote]

Just doubled checked - our lab (London Vet Diag) suggest only 10 days off treatment to allow accurate interpretation. May speed the process up slightly! As for repairing the cruciates, I was always told that extracapsular repair would fail if done on heavy dogs (>30kg) so was a waste of money. Happy to stand corrected!

Re: Fatty on thyroxine

Thomas Johnson — Mon, 24 Feb 2014 15:21:32 GMT

[quote user="Mark Hedberg"]

[quote user="David Mills"]

In a more philosophical frame of mind, what about increasing thyroid meds to encourage weight loss as a quick fix for this dog (thereby increasing mobility, chances of recovery from CCL sx etc etc).

[/quote]

It's an interesting suggestion - weren't there unpleasant side effects when they tried this on humans? (Genuinely don't know, just vaguely remember reading an article somewhere.)

[/quote]

Mightn't you end up with all of the problems you'd normally associate with an uncontrolled hyperthyroid cat?

Re: Fatty on thyroxine

Utlendigur — Mon, 24 Feb 2014 14:38:56 GMT

[quote user="Mark Hedberg"]

[quote user="David Mills"]

In a more philosophical frame of mind, what about increasing thyroid meds to encourage weight loss as a quick fix for this dog (thereby increasing mobility, chances of recovery from CCL sx etc etc).

[/quote]

It's an interesting suggestion - weren't there unpleasant side effects when they tried this on humans? (Genuinely don't know, just vaguely remember reading an article somewhere.)

[/quote]

I had a case recently of an obese corgi with intermittent pyoderma diagnosed as hypothyroid on a single, just below normal T4 (yet again - hence the on previous post). Had been on soloxine for several months during which time the soloxine had done bugger all for its weight but had caused it to pant constantly, become tachycardic and also seemed very sensitive to discomfort. I think the T4 level was something like 118 .

Re: Fatty on thyroxine

Mark Hedberg — Mon, 24 Feb 2014 10:47:06 GMT

[quote user="David Mills"]

In a more philosophical frame of mind, what about increasing thyroid meds to encourage weight loss as a quick fix for this dog (thereby increasing mobility, chances of recovery from CCL sx etc etc).

[/quote]

It's an interesting suggestion - weren't there unpleasant side effects when they tried this on humans? (Genuinely don't know, just vaguely remember reading an article somewhere.)

Re: Fatty on thyroxine

David Mills — Sun, 23 Feb 2014 23:13:29 GMT

No more to add than others, except yes I would question the hypot4 dx. IME it's rare.

In a more philosophical frame of mind, what about increasing thyroid meds to encourage weight loss as a quick fix for this dog (thereby increasing mobility, chances of recovery from CCL sx etc etc).

Re: Fatty on thyroxine

Rob Loxley — Sun, 23 Feb 2014 20:38:28 GMT

[quote user="John Flynn"] Ultimately any surgical intervention will be unrewarding if the patient doesn't lose weight long-term, so perhaps trying that a bit more first to gauge likely success of post-op aims could save a costly and unrewarding surgical intervention.[/quote]

and if the owners stretch financially for surgery and the dog doesn't do well because of poor compliance and lack of weight loss, I'm sure I know whose fault it will be :)

how about some more pain relief to get the dog moving?

Re: Fatty on thyroxine

Mark Hedberg — Sun, 23 Feb 2014 20:35:22 GMT

I have to admit that the dog seems to me to be a poor surgical risk. Partly because of the weight, but also because of you comment that owners don't want to come back in less than a month. Major orthopedic surgery requires motivated owners and if you talk them into an ortho op that fails because they weren't willing to do the pre and post op rehabilitation? Well, it's just going to end badly all around.

That said, is there a hydrotherapy practitioner in the area? Failing that, a nice big pond? Take some of the weight off and get the dog moving is critical here. 20 minutes exercise sounds like a lot but the dog probably goes out for 5 minutes twice a day to do his business so he's halfway there already. I'm not asking the dog to run, i'm asking the dog to move. any speed is better than no speed.

You have my every sympathy, I had a patient the same way (fat lab); owner swore blind he was doing exactly what we said and the dog just got fatter and fatter and fatter. Euthanized due to pressure sores developing because he was sitting around all day.

Re: Fatty on thyroxine

John Flynn — Sun, 23 Feb 2014 19:06:20 GMT

Some good tips on dieting there - thanks guys!

[quote user="Mark Hedberg"]Ex-er-cise. 20 minutes a day walking to start, moving up to an hour a day that I guarantee the dog isn't getting.[/quote]

[quote user="robloxley"]I'd consider it if it was stopping the dog exercising, but not purely based on a tibial thrust result. And it sounds like finances are limited. And I wonder how much could be achieved with dietary/exercise/phamacological management?[/quote]

I wasn't clear enough on the dog's ability to exercise... it can't. Indeed I would be concerned that it could reach the stage of not being able to stand unaided within a couple of months, which is why I'm concerned about getting the initial course of action "right".

[quote user="robloxley"]Sounds rather low for SID (Leventa suggests 20mcg/kg SID; Thyforon 10mcg/kg BID), if it is truly hypothyroid[/quote]

My thoughts exactly (though I do need to double-check with client that I had the frequency of dosing correct), and (while I have recommended stopping the meds until retest) I do wonder if increasing thyroid supplement was the way to go at least initially. Stopping the thryroid-supplement can only lead to more weight gain, increasing it is likely to do no harm (other than to the client's wallet, which is a big factor in my decision-making).

[quote user="robloxley"]

[quote user="John Flynn"]Do some cruciate surgery[/quote]

I'd consider it if it was stopping the dog exercising, but not purely based on a tibial thrust result.

[/quote]

I suspect the cruciate disease is the main factor in the dog's lack of mobility. I personally would like to see weight loss first before contemplating surgery, firstly because I would like to see how much better the dog was as a leaner version prior to costly interventions, but secondly because I'd be more worried about significant post-op complications in the heavier version of this dog than post-dieting.

On the flip side, a cynic might say that this dog is unlikely to lose significant weight given the timescale and interventions of the previous vets, and therefore a change of tactic such as trying to improve mobility through surgery might be considered sooner. It would seem unlikely (to me) that the dog will be of a lean body weight in the next 6 months.

I think a successful TTA done at this stage, even in one leg, could be a big boost to getting this dog going again quite quickly, but I would run the risk of making matters worse to the point of euthanasia should I get a serious post-op complication and I do wonder if wanting a dog in a catabolic state and to be exhibiting bone healing is not a little conflicted. An extracapsular repair would be "safer", but might be less rewarding in the short-term and I do think this patient could be stretching my extracapsular technique a little, possibly to breaking point Ultimately any surgical intervention will be unrewarding if the patient doesn't lose weight long-term, so perhaps trying that a bit more first to gauge likely success of post-op aims could save a costly and unrewarding surgical intervention.

[quote user="robloxley"]

[quote user="John Flynn"]not sure can maintain current level of food/drug spend much longer[/quote]

Stop the meds; cut back the food!?

[/quote]

I meant the cost of the metabolic diet food, even if they feed less of this it is rather expensive - considerably more than "standard" dog foods.

[quote user="robloxley"]Do you have a good local vet physio?[/quote]

Nope. I guess hydrotherapy might be of some use here though suspect could end up costly for the level of benefit.

Loving all the ideas - making me think - so please keep them coming. Really good to hear how others would approach the case and poll results are interesting as I didn't expect to be in such a clear majority (though I guess the way I word the case might have an unconscious bias).

Re: Fatty on thyroxine

Rob Loxley — Sun, 23 Feb 2014 17:53:08 GMT

[quote user="John Flynn"]Has been on thyroxine almost 3 years varying between 0.5mg and 0.8mg once* daily[/quote]

Sounds rather low for SID (Leventa suggests 20mcg/kg SID; Thyforon 10mcg/kg BID), if it is truly hypothyroid

[quote user="John Flynn"]Stop thyroxine, leave a while and then retest T4/TSH/free T4 by equilibrium dialysis to confirm a diagnosis of hypoT4, while maintaining diet attempts[/quote]

That'd be my thought if the original diagnosis is in question (no TSH etc.)
How common is true hypothyroidism at 1 year old??

[quote user="John Flynn"]Do some cruciate surgery[/quote]

I'd consider it if it was stopping the dog exercising, but not purely based on a tibial thrust result. And it sounds like finances are limited. And I wonder how much could be achieved with dietary/exercise/phamacological management?

[quote user="John Flynn"]not sure can maintain current level of food/drug spend much longer[/quote]

Stop the meds; cut back the food!?

Do you have a good local vet physio?

Re: Fatty on thyroxine

Michael Woodhouse — Sat, 22 Feb 2014 21:59:20 GMT

I'd take the dog off the thyroxine and fix its knees. You need to get the dog moving to shift the weight. Check the T4 after a couple of weeks.

Re: Fatty on thyroxine

Jenny Smith — Sat, 22 Feb 2014 21:09:07 GMT

Trying to increase owner compliance with weighing food is hard... a good tip I picked up is to get them to weigh the food out for a week in advance. Either into food bags, tupperware, basically anything they want. Then each meal they can just tip the food into the bowl, but it's already been weighed.

Also helpful for those dogs who 'cannot live without' some treats on their walk - just tell the owner to take them from the meal baggie and no extra calories creeping in. Don't forget to ask about dentastix/joint chews - most owners don't count these as treats but they have huge amounts of calories. Works out as equivalant to a big mac for an average dog...

Jenny

(can you tell I used to get geeky about weight clinics?!)

Re: Fatty on thyroxine

Mark Hedberg — Sat, 22 Feb 2014 20:43:45 GMT

Bet you a large sum of venezuelan bolivars that the dog gets the food slopped in the bowl (hey, that handful looks like the 100 grams written on the bag!) and the owners not really interested in compliance.

I recommend owners get a cheap kitchen scale to measure food; 99% of them have absolutely no idea how much food to feed and their idea of portion control is 'fill 'er up!'. Often quite eye opening to them to see exactly how much food a certain number of grams is.

Last practice I worked in offered free weigh-ins; there was a big scale in the waiting room and clients were free to walk in anytime they liked to just jump on the scale for a quick check. Quite popular that one, good positive reinforcement when even a little bit came off. (note: not a free vet appointment, just a pop on the scale and the receptionist could add the weight onto the clinical file.)

Ex-er-cise. 20 minutes a day walking to start, moving up to an hour a day that I guarantee the dog isn't getting.

Good luck - until the owners get on board with this one, you'll have a hard one with this!

Re: Fatty on thyroxine

John Flynn — Sat, 22 Feb 2014 18:45:46 GMT

[quote user="Utlendigur"]Could you work out what weight of food she is being fed from the previous vet's records, if you know what size bag + often it was ordered[/quote]

That's a clever idea - I think I could and will. Might be helpful.

[quote user="Utlendigur"]Maybe it's time for TV to do a veterinary version of "Secret Eaters".[/quote]

Hehe. I think (hope!) I get better compliance these days, but remember well as a recent grad being befuddled by a dog gaining weight in spite of the owner feeding nothing but the diet food and water - I'd checked on all the usuals on a number of visits and spent a good 25 mins discussing these again; about 30 secs after uttering the words "and definitely no treats of any kind" to which the owner swore on her life, I said "well I guess we should weigh her again then" and a bag of doggy treats were produced from her pocket and used to coax the dog on to the scales right in front of my eyes. My jaw dropped and I was rendered genuinely speachless [I thought at the time it would have made hilarious documentary viewing, but perhaps you had to be there]

Re: Fatty on thyroxine

Utlendigur — Sat, 22 Feb 2014 18:28:02 GMT

[quote user="John Flynn"]

[quote user="Utlendigur"]Was TSH measured initially, or just diagnosed on basis of slightly low T4 alone?[/quote]

Just the T4 as far as I could see on print out of previous notes.

[/quote]

I've usually taken them off supplement for 4wks then retested with T4, cTSH +/- free T4 in situations like that.

To me it sounds suspiciously like the dog has simply been fed into obesity and disability, and owners like that are very good at trying to divert responsibility onto something other than themselves. Maybe it's time for TV to do a veterinary version of "Secret Eaters". Could you work out what weight of food she is being fed from the previous vet's records, if you know what size bag + often it was ordered - obviously wouldn't include any treats though.

Re: Fatty on thyroxine

John Flynn — Sat, 22 Feb 2014 16:38:31 GMT

[quote user="Utlendigur"]Was TSH measured initially, or just diagnosed on basis of slightly low T4 alone?[/quote]

Just the T4 as far as I could see on print out of previous notes.

[quote user="Elisabeth Knappett"]I don't think you have to wait too long off supplementation to retest so I would definitely want to confirm the diagnosis.[/quote]

[quote user="Elisabeth Knappett"]Has she lost weight on the diet?[/quote]

Owners don't think so, but I suspect at the very least she has not gained any further weight which would suggest some progress to me. Last recorded weight on lcinical notes I received was 18mths ago at exactly the same weight as is now (52kg), but I get impression may have been heavier for part of intervening period.

[quote user="Elisabeth Knappett"]Is she really on the diet?[/quote]

Well, she's definitely eating the diet food (records of purchase from previous vets on clinical notes); she could of course be eating other things. Diet food was not been weighed daily, just scooped etc. Have had a chat and reweighing in 4wks (quite a struggle to get her in a car and owners didn't wish to return any sooner than that).

[quote user="Elisabeth Knappett"]What about Cushings....weird presentation I know.......but I think there's a link between this and cruciate rupture (but the fatness may have something to do with that!)[/quote]

Nothing about the dog screams cushings to me, but I'm sure is a possibility. I suspect the cruciates were failing for quite some time (indeed with hindsight this could have been the initial presentation of lethargy in theory) and the lack of activity has at least partly contributed to the weight in a vicious cycle of inactivity and obesity, although I suspect obesity did come first.

Keep the ideas coming

Re: Fatty on thyroxine

Elisabeth Knappett — Sat, 22 Feb 2014 15:23:28 GMT

I don't think you have to wait too long off supplementation to retest so I would definitely want to confirm the diagnosis. Has she lost weight on the diet? Is she really on the diet? What about Cushings....weird presentation I know.......but I think there's a link between this and cruciate rupture (but the fatness may have something to do with that!)

Re: Fatty on thyroxine

Utlendigur — Sat, 22 Feb 2014 15:18:46 GMT

Was TSH measured initially, or just diagnosed on basis of slightly low T4 alone?