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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 24439
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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my cat has all of the symptoms of hyperthyroidism and been

Customer Question

my cat has all of the symptoms of hyperthyroidism and been tested for t4 hormone levels and found to be low. His blood has been tested for kidney problems and liver problems and all appear to be normal. I asked the vet if it was a good idea to test for t3 due to his symptoms but he said he wanted to test his urine first. The thing that worries me is the cat is getting worse each day and I am concerned that we may run out of time to treat whatever the problem is.
Submitted: 2 years ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 2 years ago.
Aloha! You're speaking with Dr. Michael Salkin
Do you recall what the total T4 value was? Was a free T4 (fT4) performed as well? Can you upload a copy of his test results to our conversation? I understand that you might not have a copy of the results at home but his vet should be able to give you one which you could scan into your computer and give me the link or you can photograph the page(s) and upload the images by using the paperclip icon in the toolbar above your message box (not if you're using the chrome browser) or by using an external app such as imgur.com or dropbox.com

Please note that total T4 is preferable as a screening test for hyperthyroidism because although total T3 concentrations are highly correlated to total T4, 25-30% of hyperthyroid cats have serum total T3 within the reference range.

I'll await your reply.
Customer: replied 2 years ago.

here are all the tests he has had at the vets.

Maison Dieu Veterinary Centre
Dover
20 October 2014
Consultation Detail
Date:
76-77 Maison Dieu Road
Dover
Kent
CT16 1RE
Telephone: 01304 201617
Fax: 01304 210660
Email: *****@******.***
Species:
Mr Sheather Animal:
40 Shavaia Road
Dover
CT17 9PG
For:
Date:
Alfie
Cat
15/10/2014 Employee: Stuart Dymov Maison Dieu Veterinary Centre
Clinical Notes: urine was collected from carier, > Sg -1.035, Blood + leuc. on Microscope not seen any crystals
Blood Results
IP 1.21 (0.7-2.1)
T-CHO 5.81 (0.9-6.5)
ALB 26 (26-42)
T-BIL 11 (0-10)***HI***
TP 84 (56-81)
GLU 9.3 (3.8-7.6)***HI***
GGT 6 (3-14)
CREA 51 (44-194)
Ca 2.37 (1.6-3)
BUN 7.74 (6.10-12.5)
GPT 100 (18-77)***HI***
ALP 44 (11-67)
Na 154 (140-157)
K 3.7 (3.4-5.6)
Cl 120 (111-129)
WBC 12.8 (5.5-19.5)
LYM 0.6 (1-7)
MONO 0.5 (0.2-1)
GRAN 11.7 (2.8-13)
LYM% 4.9 (0-99.9)
MON% 4 (0-99.9)
GRA% 91.1 (0-99.9)
HGB 9.5 (8-15)
HCT 25.1 (25-45)
RBC 5.7 (5-11)
MCV 44.1 (39-50)
MCH 16.7 (12.5-17.5)
MCHC 37.8 (31-38.5)
RDW% 19.3 (14-18.5)***HI***
RDW 27.9 (20-43)
PLT 126 (200-500)***LO***
MPV 9.1 (8-12)
Item
Work:
Net VAT Total
1.00 x Lab in-hse urine SG only 12.84 2.57 15.41
1.00 x Lab in-hse urine dipstick only 16.03 3.21 19.24
1.00 x Fi Total T4 (feline) Top Up 15.80 3.16 18.96
Printed By: Flick Parry Page 1 of 2 Using RoboVet(TM) From Veterinary Solutions Limited
Date: Stuart Dymov Stuart Dy Maison Dieu Veterinary Centre
Item
Work:
Net VAT Total
Total Price 44.67 8.94 53.61
Printed By: Flick Parry Page 2 of 2 Using RoboVet(TM) From Veterinary Solutions Limited

Maison Dieu Veterinary Centre
Dover
20 October 2014
Consultation Detail
Date:
76-77 Maison Dieu Road
Dover
Kent
CT16 1RE
Telephone: 01304 201617
Fax: 01304 210660
Email: *****@******.***
Species:
Mr Sheather Animal:
40 Shavaia Road
Dover
CT17 9PG
For:
Date:
Alfie
Cat
20/10/2014 Employee: Michelle Bartlett Maison Dieu Veterinary Centre
Clinical Notes: *****@******.***
Patient:
SHEATHER Alfie
Stuart
Access Number:
14101769139
CVS (UK) LTD (DVR)
ID:
Maison Dieu 76-77 Maison Dieu Road
ASG:
13 Years 3 Months | Cat (Feline - Domestic) (Domestic Short Hair) | MaleNeutered
DOVER
Report Date:
17/10/2014
KENT
Request Date:
17/10/2014
CT16 1RE
Test Results
Total T4
L
5.2
nmol/L
7.5 - 55.0
Item
Work:
Discount inc. VAT Net VAT Total
Total Price
Printed By: Flick Parry Page 2 of 2 Using RoboVet(TM) From Veterinary Solutions Limited

Expert:  Dr. Michael Salkin replied 2 years ago.
Thank you! The mildly elevated GPT (ALT) is consistent with hyperthyroidism. The total T4 needs to be repeated and a free T4 (fT4) performed. The blood will need to be sent to a reference lab for the fT4 to be performed. Alfie's blood work is remarkably normal for a cat of his age.

Please review for me what symptoms you're seeing in Alfie.
Customer: replied 2 years ago.

Thankyou

He is not very active and has lost a considerable amount of weight. He never seems to settle and sleep and usually gets up to wander every hour or so and nearly always visits his food bowl when he does. He doesn't like to be touched or stroked and is quite wobbly as he has lost a lot of muscle mass from his hind quarters. He seems to be urinating excessively but only poos once a day.

Just to clarify by poos i mean bowel movement.

Expert:  Dr. Michael Salkin replied 2 years ago.
Thank you for the additional information. 10% of hyperthyroid cats will act as if they were hypothyroid - inactive - but Alfie is also agitated and restless as well as polyphagic (increased hunger). I suspect that he's also polydipsic (increased thirst) because you're noticing polyuria (increased volume of urine) and these symptoms are seen in 35% of hyperthyroid cats. It's imperative to have the total T4 and a free T4 run by an outside lab. We need to consider the two main difficulties in diagnosing hyperthyrodism...

1) Fluctuation of T4 concentrations in and out of the normal range. T4 has been shown to fluctuate considerably over time in hyperthyroid cats. This is relevant where a fluctuation downward can lower T4 to within the reference range. It is also important to note that any geriatric cat with a T4 of 2.0ng/dL (25.7pmol/L) or higher is likely to be hyperthyroid even though those values are within the reference range.

2) Suppression of serum T4 concentrations into the normal range because of concurrent nonthyroidal illness. Diseases that suppress T4 include chronic renal disease, diabetes mellitus, neoplasia, gastrointestinal disorders, and primary hepatic disease. In Alfie's case, neoplasia, gastrointestinal disorders and primary hepatic disease haven't been ruled out. Although the GPT elevation is expected in hyperthyroidism, it's also consistent with any cause of hepatic damage. Note that his bilirubin is slightly elevated as well which is worrisome for primary hepatic disease.

Please continue our conversation if you wish.
Customer: replied 2 years ago.

Thankyou

I will be seeing the vet tomorrow and will ask him to do the total t4 and free t4 test.

Would the fact that the blood was taken after fasting for approx 13hrs have any effect on the test? Also he was taking prednisolone 4 days before the blood was taken.

He was also initially treated with veraflox suspecting a gastro problem at the start of this ilness approx 2.5 months ago with no signs of improvement.

Expert:  Dr. Michael Salkin replied 2 years ago.
Fasting isn't necessary for this testing but shouldn't have any effect. Prednisolone, however, can suppress the T4 and fT4 - even if administration were stopped four days earlier. It's best to wait a couple of weeks post-glucocorticoid (prednisolone, e.g.) administration when performing the T4 and fT4.

The Veraflox administered so long ago shouldn't have any effect. Thank you for the additional information.
Customer: replied 2 years ago.

Thankyou

To be honest I don't think he would survive another two weeks to wait to test again for t4 if he continues to deteriorate at this pace.

When you say suppress the t4 do you mean the same as the hyperthyroid medication would, or just the detection of it. As if its the former would that not rule out hyperthyroidism as he hasn't improved while on steroids.

Expert:  Dr. Michael Salkin replied 2 years ago.
I understand. If he's deteriorating as you describe, I must suspect that there's a disorder underlying his hyperthyroidism - if, indeed, hyperthyroidism is present. A malignancy should be considered - particularly in his gastrointestinal tract for which blood/urine tests aren't very helpful. GI lymphoma would top my differential list because you've also mentioned a "gastro problem" arising 2.5 months ago.

Yes, the T4 is suppressed by glucocorticoids just as the methimazole does. Methimazole, however, is far more effective in doing so. (Glucocorticoids can be helpful when addressing a lymphoma but the positive effect tends to wane by 30 days post-institution of the steroid.)

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