Hypothyroid And Murmur

[Guest bernadette]

I had the vet fax me the lab results.

Free T4 (ng/dl) is at .4 with a reference range of .5-3.7

Free T4 (pmol/L) shows 5.1 with a ref range of 7.7-47.6

cTSH shows 4.3 with a ref range of .05-.42

What I just noticed though ...is that on the CBC comprehensive, it says WBC 4.3 with a ref range of 5.7-16.3 and Eosinophil 1 with a ref range of 2-10%.

Absolute Lymphocyte 731, ref range 1000-4500 and Absolute Essinophil 43 with a ref range of 100-1250.

[Guest bernadette]

I did consult with Dr. Jean Dodds, a grey specialist at HemoPet in California. She is on vacation in Italy but responded to my email quite quickly and was extemely helpful. After looking over Vinnie's test results, she did recommend that he start on Soloxine. I would highly, highly recommend her.

[Batmom]

Did you mean .43 for the TSH?

 

The free T4 isn't low but the high TSH does suggest that supplementing might be worthwhile.

 

Your WBCs and eosinophils are fine. Greyhound WBCs run low, and it's fine for eosinophils to be below the reference range.

 

If your vet is unfamiliar with these things, it might be worthwhile for him/her to consult with OSU's Greyhound Health and Wellness Program. The doctors there are true experts in endocrinology, hematology, and many other disciplines.

[tbhounds]

I questioned the cTSH results too-- wondered if it was meant to say 0.43???? If it's truly is 4.3 that is crazy high and I would supplement too. The ft4 seems like normal gh values to me as does the WBC.

[Guest bernadette]

Oh geez. Yes, that's supposed to be .43, sorry! Long last few days...

My vet told me that his workup was all normal aside from his thyroid. After the murmur debacle however, I wanted a specialists confirmation. Dr. Dodds is qualified enough, I feel confident in her suggestion that Vinnie be treated. I don't know that this will solve everything that has been going on, but it's a start.

[tbhounds]

0.43?? Well, let's say I disagree with Dodds and I'll leave it that.

I would encourage you to consult with OSU just for another opinion.

[Guest bernadette]

Per Dr. Dodds:

 

The lowest acceptable limit for T4 in greys is 0. 9 ug/dL (Vinnie is .4)and for free T4 is 0.65 ng/dl (8 pmol/L) (Vinnie is 5.1). His levels were lower for both values and his TSH level was high, as would be expected for primary hypothyroidism.

 

The important point now is to make sure that he is not overdosed with thyroxine medication, as the dose for sight hounds should be about half that given to dogs of other breed types.

 

Sight hounds require 0. 1 mg of thyroxine per 20 pounds of optimum weight twice daily – i.e. about 0. 4 mg twice daily for a male. Also, thyroxine binds to calcium and soy in foods, so it should always be given at least an hour before or three hours after these foods, to ensure absorption – your veterinarian may not have been taught this fact.

 

I did contact OSU with his bloodwork and am waiting to hear back.

 

In other news... I reached out to an animal communicator last night in a desperate attempt to find out what he has seemingly been in so much pain. The thought was, a nerve issue and the suggestion of acupuncture (sp?). What an interesting experience that was...

Edited May 31, 2012 by bernadette

[greyhead]

I think you're going about this very well, and I'm hoping that a little thyroxine will make lots of things much better for Vinnie, including the pain. Hypothyroid conditions can give rise to widespread pain. Before I was diagnosed, I got to where I couldn't pick up a mug of coffee some days because of the pain in my forearms. It's likely that OSU will say that Vinnie is in the normal range for a greyhound. As I've argued before, individual differences are very important, and what's possibly a normal range for many or most greyhounds isn't necessarily optimal for each individual greyhound. Good luck to you and Vinnie, and I hope you'll let us know how it works out.

[Guest bernadette]

Thank you for the encouraging words. As I've said before, if he weren't so symptomatic then I would not be so concerned.

[Batmom]

Per Dr. Dodds:

 

The lowest acceptable limit for T4 in greys is 0. 9 ug/dL (Vinnie is .4)and for free T4 is 0.65 ng/dl (8 pmol/L) (Vinnie is 5.1). His levels were lower for both values and his TSH level was high, as would be expected for primary hypothyroidism.

 

 

That isn't correct. The low limit for T4/free T4 depends on the lab that did the assay -- there is no global low limit as Dr. Dodds claims.

 

Per the scientific research, the low limit for greyhounds is actually 0 -- the assays aren't capable of measuring very small amounts, which is what greyhounds can normally have.

 

It is worth consulting OSU because a greyhound can show your pattern of results -- entirely normal T4 / free T4 but slightly elevated TSH -- due to nonthyroidal illness. Given the dog's symptoms, some vets would recommend a trial of thyroxine and some would recommend retesting later since there is evidence that currently, your dog's thyroid is able to respond to TSH.

[Guest bernadette]

So, my Soloxine arrived from the vet. The instructions: 0.8mg twice a day.

 

My head is spinning. Who can you trust?????

[Guest bernadette]

It's so frustrating... one specialist can be so highly regarded by patient A and couldn't be thought less of by patient B. What is a person supposed to do?

 

 

 

Per Dr. Dodds:

 

The lowest acceptable limit for T4 in greys is 0. 9 ug/dL (Vinnie is .4)and for free T4 is 0.65 ng/dl (8 pmol/L) (Vinnie is 5.1). His levels were lower for both values and his TSH level was high, as would be expected for primary hypothyroidism.

 

 

That isn't correct. The low limit for T4/free T4 depends on the lab that did the assay -- there is no global low limit as Dr. Dodds claims.

 

Per the scientific research, the low limit for greyhounds is actually 0 -- the assays aren't capable of measuring very small amounts, which is what greyhounds can normally have.

 

It is worth consulting OSU because a greyhound can show your pattern of results -- entirely normal T4 / free T4 but slightly elevated TSH -- due to nonthyroidal illness. Given the dog's symptoms, some vets would recommend a trial of thyroxine and some would recommend retesting later since there is evidence that currently, your dog's thyroid is able to respond to TSH.

[greyhead]

Bernadette, I know from experience that Dr. Dodds would probably not approve that big a dosage for a greyhound. I take it she was unaware what your vet was proposing for the dosage? Does your vet know that greys should get half the dose any other dog of comparable age and size but non-sighthound would get?

 

Our Spencer is a tall and large male, approx 85 lbs at that time, and was on .5 or .6 of thyroxine. When we changed vets, the new vet retested and submitted the results to Dr. Dodds. She said that was a large dose for a greyhound but that his blood levels of everything were good so it didn't need to be changed. (Nobody told her anything about his size, and that dose was good for him until recently when we retested and reduced it.)

 

I would not start with a dose anywhere near .8, especially not with Vince's issues. I'd think something like .4 would be more appropriate. Perhaps the vet would agree that you should just break those tablets in half.

 

ETA: The problem of competing experts has arisen before, regarding thyroid, IBD, and other serious medical issues. The best we can do is research enough to be educated about the issues and know our individual dog very well. The final decision about what to do or not do for our animals is always ours, after all.

Edited June 1, 2012 by greyhead

[Guest bernadette]

Hi Grey,

 

Dr. Dodds believes that Vinnie is truly hypothyroid as his T4's are low and his TSH high (of course this is all up for debate, depending on who you talk to). She said to make sure that he is not overdosed, that greys get about half the dosage of other dog breeds. She recommended .1mg per every 20 pounds of optimum weight, twice daily. About .4 twice a day for Vinnie. She was talking about Thyroxine and my vet sent Soloxine... would there be a difference in dosage?

 

What my vet sent was twice Dr. Dodds recommendation (if there is no difference between thyroxine and soloxine dosages).

 

Of course then you have those opinions like Batmom (above), and I don't know what to think. I emailed OSU and have yet to hear back. If he needs these meds, I am anxious to get him going.

[tbhounds]

Vinnies cTSH IMO is not high and his T4 and FT4 values are very very common with Ghs (see Mary-I didn't say normal).

Take for example. I do in fact have a truly hypothyroid hound. Actually, I made her that way-- she had a thyroidectomy recently (thyroid carcinoma). When I tested her cTSH it was 4.75----not 0.43. Can you appreciate the difference??

Here's a question-- when you contacted Dr Dodds did you mistakenly give her the wrong TSH #??? I just can't believe even she would feel that 0.43 is a high value.

[greyhead]

Theoretically there's no dosing different between Soloxine and other forms of thyroxine, but Soloxine is widely believed to be better absorbed. Therefore, it's potentially stronger than the others. It sounds like .4 is the place to start for Vinnie and your regular vet just isn't aware that sighthounds should get half the regular dose.

 

In all likelihood OSU will say Vinnie's numbers are normal for a greyhound. You're going to have to decide what you want to do. I didn't ask OSU or Dr. Dodds either to start with, just relying on my own instincts about the numbers in consultation with my vet, who did know about greyhound dosing.

 

ETA: I was writing while tbhounds, whom I dearly love, was posting. She refers to the extended discussion we've had on GT -- and I'm glad we have -- about what's common for greyhounds in general and what's normal for any particular individual dog. There are those who believe (like Batmom, OSU, and MSU) that a greyhound can get along fine with no detectable T4. I'm not going to rehash that argument here because it about killed me the first time. I'll just say that what's possible for a three-year-old intact racer may not be the same as what's optimal for a neutered older hound. In the end it's still up to you and your vets to decide what's possible and best for your dog.

 

Further editing: If you're a glutton for punishment, we can probably give you links to our GT arguments about hypothyroidism. If I were you, though, I'd break the pill in half, give .4 mg, and tell your vet about it tomorrow. But that's me, and I'm not a vet.

Edited June 1, 2012 by greyhead

[tbhounds]

Bernadette- have you considered changing vets??

The two most misdiagnosed conditions in Ghs are cardiac disease and hypothyroidism. Two strikes againist your current vet. (even if you do decide to supplement your hound- which I hope you don't- he didn't even get the soloxine dose correctly.

Lastly, how is Vinnie feeling today?

[Guest bernadette]

No, I did not give Dr. Dodds the wrong information. I sent her a .pdf of his lab results, sent the same to OSU.

 

Of course I am looking for a new vet. Clearly this one, unfortunately, isn't familiar enough with the breed- I can't trust his judgement. I am waiting still to hear from OSU and hope that I do, soon. I understand the difference between .43 and 4.75.....

 

Vinnie had a better day today, thankfully. If you had asked me this morning or yesterday, I would have been leaning towards treatment with Soloxine as he has been DRAGGING and so symptomatic. He did eat today and seemed a LITTLE bit more energized on our walk this evening... so I am not leaning one way or the other at this exact moment. I'd like to see how he does over the next couple of days while I wait to hear from OSU (hopefully before the weekend).

 

Grey- thank you for clarifying about the obvious debate. Thank you for the offer, but I am hesitant to read the previous back and forth...! I understand that everyone has an opinion and that's ok as long as topics can be discussed without crossing any lines. RIght now though my concern is Vin and if he continues showing symptoms, I will consider treatment- certainly not at the dosage my current vet has suggested however. I am anxious to find a capable vet so that our questions can maybe be answered.

[45MPHK9]

Have you searched the recommended vet list pinned at the top of this forum? Again, Linda Lyman, president of GFNJ, is a tremendous resource. I would not hesitate to contact her for a vet recommendation in New Jersey.

 

So glad to hear that Vinnie had a better day today.

[tbhounds]

Glad Vinnie is having a better day :-)

Didn't mean to come across as disrespectful when

mentioned my girls TSH #-- I just wanted you to see a truly high TSH #. As you can see hypothriodism in ghs is and most likely will always be a hot topic here. For the most part we all play well in the sandbox but, some subjects become pretty heated-sorry you became caught up in it. Actually, we all mean well. I'm in Northern NJ- perhaps I can I assist you in finding a new veterinary clinic-- just need to ask!

[Guest bernadette]

Yes, 45, thank you I did. I contacted one today from work and will make more calls tomorrow. I contacted Dr. Tsai (sp?) office (Companion Animal Hospital). They were nice enough but I am hesitant of anyplace that can't even give you a ballpark estimate for something like xrays or a dental without extractions.

 

TB, thank you! I am in Bedminster, are you far? What vet do you use? My current vet I also use for my horse, I am going to have to rethink that as well.

Maybe if you're not far then a doggie play date in the future.

 

I remember picking up on this debate years ago... I never thought I'd have to participate. Vinnie is having a better day, yes. I hope this continues... I would definitely prefer acupuncture over any pain medication, I'll have to look into that also if Vinnie continues to appear uncomfortable. Although I was hesitant, I am glad that I spoke with that communicator last night... I'll take a stab at almost anything to find out what has been bothering him.

[Guest bernadette]

OSU says... Vinnies thryoid panel is normal for a greyhound.

[tbhounds]

OSU says... Vinnies thryoid panel is normal for a greyhound.

I'm glad they replied. I have to say--think its obvious but, I totally agree. How's your boy today--still improving?

Asking because--did you ever have him tested for lyme disease or other Vector borne (tick) diseases??

That would be my next step if he's still feeling out of it--well, that plus a new vet.

[Guest bernadette]

He ate last night and was not as sluggish on our walk.. this morning he almost had a new 'pep' in his step. I am THANKFUL and as long as he continues to not go backwards, I will not treat. Again... I am left just as confused as to what caused all of this. Last weekend I thought I was going to have to let him go! So many ups and downs.

[tbhounds]

Yea!! Glad to hear he's better!!!