Zuri's Thyroid Results - Hypothyroid?

[NeylasMom]

So Zuri's thyroid results came in while I was away this weekend and my vet thinks he is hypothyroid. Mainly because his TSH is within normal range I just wanted to post his results here and get your input. Also, does anyone know what QNS means?

 

Here are the results (values my vet felt were concerning in bold):

 

Endocrinology results from IDEXX VetLab In­clinic Laboratory

Test Result Reference Range

T4 = 5 L 11 ­ 60

T3 = 1.0 0.8 ­ 2.1

FREE T4 = 4 L 9 ­ 39

FREE T3 = QNS 1.2 ­ 8.2

T4 A.A.B = 10 0 ­ 20

T3 A.A.B. = 6 0 ­ 10

TSH = 10 0 ­ 30

THY.GLOB.A = 11 0 ­ 35

 

I think given that he does have issues that could certainly be symptoms of a thyroid problem (history here) we should try supplementing, but I'm also interested in input on whether her dosage recommendation is a good starting point. She wants to start him on 0.4 of Soloxine BID.

 

Feeback/input welcome. Thanks!

Edited August 19, 2014 by NeylasMom

[seeh2o]

How much does he weigh?

[NeylasMom]

How much does he weigh?

That's actually a good question. I'm going to have to guess, but I'd say upper 60's? He used to weigh 70-75 lbs, but with this LS he's lost a lot of muscle. No less than 65 lbs though.

[seeh2o]

Doodles weighs 65 - 67, gets .6mg, Carl weighed 72 - 75lbs and got .7mg.

 

One half in the am, one half in the pm, 1 hour before a meal or 3 hours after.

[NeylasMom]

So those dosages are total? So Doodles gets .3 mg 2x/day and Carl got .35 2x/day?

 

My vet is recommending the .4 2x/day so .8 total. I had .7 in my head as a sort of standard starting dose (that often turns out to be too high for ghs), but I couldn't remember if that was .7 daily or twice daily. I would like to start with a conservative dose. The last thing I need is a hyperthryoid dog!

[seeh2o]

Yes, greyhounds don't need large doses of meds for thyroid. Their blood work was/is always perfect. Also, my vet initially put them on a generic, results were poor after 3 months, I had her switch them to Soloxine and that made a huge difference. Doodles is still on it and doing great.

 

For Zuri's weight, that seems like too much.

Edited August 18, 2014 by seeh2o

[tbhounds]

Doesn't look hypoT too me. Looks like sighthound results.

Edited to add---qns = quantity not sufficient

Edited August 18, 2014 by tbhounds

[NeylasMom]

Doesn't look hypoT too me. Looks like sighthound results.

Edited to add---qns = quantity not sufficient

Even with the presence of his symptoms? I would definitely agree with you - it does concern me that his TSH isn't even in the higher end of the range - if he weren't symptomatic. Also, what little I could find on T3 in greyhounds seems to indicate their T3 values typically run toward the higher end. I'm really on the fence - I don't want to fall into the trap of going with supplementation because it would be the easy explanation of all of these things going on, but at the same time, I don't want to ignore it if it could help him. My only thought is that I could try to get into the dermatologist for a consult sooner than I had planned to get another opinion, but my vet said he often has a really long wait.

 

I did look more closely at dosage information and think at the very least I'll ask the vet to drop the starting dosage even further - maybe 0.3 2x/day to start based on this from Greythealth:

 

Dr. Jim Gannon, author of Care of the Racing Greyhound and probably the most knowledgeable greyhound vet on the planet recommends .1 to .2 mg per greyhound twice daily. The standard dog dose is .1 mg/lO# twice daily. The above-mentioned Veterinary Medicine article goes with this dose. The new 2000 Ettinger's Textbook of Veterinary Internal Medicine ("the bible") says that once clinical signs resolve, you can often drop to once daily. I split the difference and give greyhounds half the standard dog dose (.1 mg/20#) twice daily.

 

Unfortunately I checked care of the racing greyhounds and while they give a schedule for dosing, they don't actually give a dosage recommendation.

[tbhounds]

Your hounds symptoms could all be allergy related. My boy always dealt with allergies to some extent until this year. He became so bad we saw a derm vet and had intradermal testing done. Turns out he's allergic to a zillion environmental allergens.

His skin was horrible back in a March/April-to the point where he was ulcerating his skin. Thankfully, his allergies are being managed with frequent baths, apoquel and his sublingual allergen drops. I only mention this because he had typical sighthound thyroid results--the derm vet rewiewed the results and we both agreed he was not hypoT (she had a gh so was familiar with reading sighthound parameters). Here's what he looked like just a few months ago...

[greyhead]

It's not unusual, with humans as well as dogs, to start higher -- to rectify the deficit faster -- and then monitor every 6 weeks and lower the dose as appropriate. If you're not comfortable with the dosage, tell the vet you want to start lower. In general, GH's get half the dose of other canines.

 

ETA: Spencer, at 77 lbs., started at .5 Soloxine twice a day.

Edited August 19, 2014 by greyhead

[NeylasMom]

Does anyone else have thoughts on whether these values + symptoms warrant trying supplementing with Soloxine or whether there are other things we should explore first?

[duncan41]

In cases like this, I always remember what Dr. Couto said when I heard him speak in Jekyll Island, GA years ago. When asked about hypothyroidism, he said, "I treat dogs, not blood test results."

 

Have you considered getting an opinion from Dr. Dodds?

 

I am not up-to-date on Zuri's issues/symptoms, but could it be euthyroid sick syndrome - as a result of "something else" going on?

[greyhead]

You don't really want to try the soloxine, do you, Jen?

[Batmom]

I'm not clear on what symptoms he has, that haven't cleared up either with abx or all by themselves.

[NeylasMom]

You don't really want to try the soloxine, do you, Jen?

I just want to be fairly sure that's really the issue before I medicate him.

 

I'm not clear on what symptoms he has, that haven't cleared up either with abx or all by themselves.

In a nutshell:

-hair loss (he still looks like he's blowing his coat, but that is definitely NOT what's going on as its been months; you can pull clumps of dull fur out constantly, grooming doesn't help)

-skin/wounds that are slow to heal

-bacterial skin infection (that did not resolve with 2 different ABs, although we did not culture)

-increased aggression

 

Entirely possible he just got a skin infection somehow that needs some special AB with no underlying reason (or some reason other than the thyroid) and the grumpiness is just because he's not feeling well, but these sypmtoms do all fit with hypothyroidism.

 

Our options as I see them are:

-try the Soloxine

-try the antibacterial/anti-fungal shampoo and see if the issues resolve

-see the dermatologist

 

The shampoo was supposed to be an "in the meantime" thing to try out, but it only just arrived and you're supposed to treat with it for 3-4 wks and I'm hesitant to wait that long so just doing that is pretty low on my list. I'd just do the derm consult, but there's likely a long wait there as well (they require a referral and my vet said the wait is often a month or two). I'm going to get the ball rolling on that in the morning and see - my schedule is flexible so I can hope for a last minute cancellation.

 

So I guess the choices really are, get the ball rolling on the derm consult and shampoo in the meantime or try the Soloxine.

[Batmom]

I'd see the dermatologist, or at least do a culture. Keep in mind that for skin infections, it can take 2-3 months of oral antibiotics to clear them. Depending on the infection, medicated baths/topicals can speed that up some.

 

Aggression isn't a usual symptom of hypothyroidism.

 

The coat thing sounds totally ordinary to me. It's what dogs do in a "long shedding season" year.

[greyhead]

Jen, I'm just going to wish you luck and leave the conversation. I feel like I've said everything I can about hypothyroidism already, and you've been around long enough to have seen it.

[tbhounds]

I'd see the dermatologist, or at least do a culture. Keep in mind that for skin infections, it can take 2-3 months of oral antibiotics to clear them. Depending on the infection, medicated baths/topicals can speed that up some.

 

Aggression isn't a usual symptom of hypothyroidism.

 

The coat thing sounds totally ordinary to me. It's what dogs do in a "long shedding season" year.

This :-)

[BauersMom]

I've had two dogs respond well to thyroid supplement as a resolution for aggressive behaviors that seemingly came out of nowhere. One was a clear case of hypothyroid, one was borderline but we felt the supplementation was worth trying. Rest of the bloodwork was normal.

[krissn333]

I've had dogs respond well to supplementation as a resolution for aggressive behaviors too.

 

Jen, I think if I were in the same boat (and the aggression he is displaying is not putting your girls or Cisco in a dangerous position...sounds to me like he is just crabbier than usual?), I'd start with the shampoo and get the ball rolling with the dermatologist and get him in to have the skin stuff looked at. Since Zuri can be a grumpy gus anyway (and granted I do not KNOW him, but just from what you've told us over the years about him...), if he were mine I'd be inclined to believe increased grumpiness is a result of him not feeling well (and maybe his skin is just itchy and pulling a little bit and he's just crabby?).

 

Maybe right now just to begin with, get a few treatments in with the shampoo and see if the skin improves, and if, as it starts to improve, he is less crabby. That might help you better gauge where to go from there. And as you said, your schedule is flexible so there's also the hope that the dermatologist can see you soon.

 

You know him best, though. Go with your gut.