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nekovet
nekovet, Veterinarian
Category: Dog
Satisfied Customers: 18251
Experience:  Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
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Back in March 2015 my male (now 8 year old) castrated pedigree

Customer Question

Back in March 2015 my male (now 8 year old) castrated pedigree Staffordshire Bull Terrier was diagnosed with low thyroid (hypothyroidism). All other blood work came out OK. He started on 1 tablet of thyroxine (soloxine) a day.
His dad was clear of L-2-HGA, his mum not checked (results on certificate).
He was displaying signs of lack of activity, trouble on his walks moving freely (dragging front legs etc), dandruff, frequent eye infections etc. Drunk looking.
Since then he improved slightly over the summer, but never really got back to the 'old' him, he was disinterested in other dogs and didn't chase his ball like he used to. The tablets didn’t transform him like hoped or read. It didn’t seem like it was just low thyroid at play.
Within the last few months he is gradually deteriorating. Around that time we switched tablets to Thyforon (due to supply issues of Soloxine). He started to get lethargic again, but most of all started moaning/whining on occasion, when he was just lying on his bed. He was re-tested and his thyroid was slightly high. Confirming with the Vet we cut his dose and eventually split the tablet into 2 and gave him half in the morning and half at night. He has lost some weight (28 to 27 kg).
The whining has got progressively worse and he moans a lot now, most of the time that he is awake. It doesn’t matter if you try to comfort him, he continues. He doesn’t do it at night (we've moved his bed into our bedroom now) or on walks, but does when he wakes in the morning. Lethargic to get up. He is becoming more vocal, we tried painkiller from vet but no effect... it doesn’t seem to be pain therefore?, just general confusion, when no-one is in the room, or when he want food or toilet. It's almost a howl. But he also does it if petted around head area.
During the night he seems to have a build-up of saliva (noticeable because he clacks his mouth a lot), his nose is wetter than normally during day too, definite increase in fluid coming out. He started to show tendencies to turn left and become very flighty at any sounds on walks, checking behind him to the left and also hiding head in bushes (to the left). Generally very anxious all the time.
Now his circling to the left has got progressively worse and he does this at home now and seldom turns right. He can walk in a straight line and does (just shout the word ‘dinner’!). He is very lethargic and has stated to growl and snap if you try and coax him from his bed (to go to the toilet for example). He has no difficulty actually defecating etc and it appears fine, but doesn’t mark his territory on walks and hasn’t done so for probably a year, tends to go in the garden (in the same place) if he can, if out on a walk in one place usually the same each day. He looks drunk most of the time, heavy head, no real head tilt though, there haven’t been any seizures that we have witnessed. He doesn’t tend to respond to his name so much anymore and forgets where he is and gets trapped under the table (although he could reverse) and shows signs of head pressing (but just hiding his head rather than pushing it) behind sofas. He tends to stand by his dish and forget he has just had a drink. No problem eating but swallowing seems to be more difficult and drinking slowly. Strangely he seems to speed up and after going to the toilet and run back into the house. He doesn’t go to toilet in the house.
He has episodes of fast breathing and this is when the vocalisation comes. He can be on my lap (well half of him!) calm and then he suddenly starts breathing harder, raises his head confused and vocalises. He seems to have anxiety attacks for no reason.
He has been back to the vet and checked bloodwork and liver - thyroid (T4) normal scale and liver clear and general bloods OK. Weight stable (27kg).
We have been advised to lower the thyroxine to 1 every other day and next would be to test for L-2-HGA. But it seems the vet is best guessing now? I'm thinking to switch back to Soloxine as a last resort (would this really make a difference?) but feel there is probably something else neurological but since his symptoms have been for nearly a year now not sure what? Advised MRI but been down that route before with another dog and won't be doing that. Any help greatly appreciated!
Submitted: 1 year ago.
Category: Dog
Expert:  nekovet replied 1 year ago.
Hello & welcome, I am Dr. B, a licensed veterinarian & I would like to help you with your wee one today.
First, I would not have L-2 HGA at the top of my differential list for James. Typically that condition causes epileptic seizures, "wobbly" gait, tremors, muscle stiffness after exercise or excitement and altered behaviour. Some of the signs do fit, but quite a few of the important ones do not.
Instead, I have to say that his behaviour changes (attitude, disorientation, mental depression), circling, and head pressing (which doesn't have to be hard or a true press) all are very suspicious of a brain based issue. And if he involuntarily goes to the left, we'd be concerned about a left sided focal lesion in the brain. This can be a variety of lesion types (ie bleeds, soft tissue swelling, focal infections, parasitic cysts, protozoal disease, or tumors). As well, I do have to note that if we have an issue in the brain that is then putting pressure on the pituitary (which secretes the thyroid precursor hormone) that could also be part of the lack of great response he has had to treatment.
With all this in mind, it is a shame that MRI isn't an option for James. This is because it is still the best diagnostic too to see past the skull and into the brain. Still, if that isn't an option, you could speak to his vet about a spinal tap to rule out infectious brain issues. If that is clear, then consider an anti-inflammatory to reduce any brain swelling or any lesion putting pressure on the brain. As well, you could also try him back on the Soloxine (we do see varied responses between the brands) but that is likely a minor issue given all the signs he is showing.
Overall, these signs raise real concern of a brain lesion lurking here. Therefore, we do need to tread with care and consider at least medical management if advanced imaging isn't an option here with James.
All the best, *****
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Customer: replied 1 year ago.
Thanks for your response.So does it sound like the Hypothyroidism he has is probably secondary ie the cause resides in the pituitary gland?From what I have read the causes of pituitary hypothyroidism include:- congenital malformation
- neoplastic invasion/destruction
- non-thyroidal illnesses (especially Cushing's Disease...Hyperadrenocorticism) - Cushing's doesn't seem to have symptoms like head pressing and circling?
- malnutrition (not applicable)
- certain drugs (especially with chronic corticosteroid use) (not applicable).So if there is a growth in there it could be a pituitary tumor: benign, slow-growing tumors that arise from cells in the pituitary gland. Could this be why symptoms have been going on for some time? I noted pituitary tumors are common in brachycephalic breeds like him.
Expert:  nekovet replied 1 year ago.
You are very welcome,
I would suspect so (this being secondary and chronic) with the other signs he is showing. As well, Cushing's doesn't tend to cause those signs on its own. So, we would be highly suspicious of brain based issues triggering secondary hormonal ones.
Furthermore, while pituitary based masses are a concern, we have that extra complication that any swelling in the brain anywhere compressing the brain (in that limited skull space) could compress the pituitary on the bottom. So, it could be a direct pituitary mass or any of those aforementioned brain lesions putting pressure on the brain and therefore onto the pituitary too.
Take care
Dr. B.
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*Please remember to rate my service once you have all the information you need as this is how I am credited for assisting you today. Thank you! : )
Customer: replied 1 year ago.
Thank-you. What sort of medical management is best (particularly to reduce the inflammation for pain relief)?
We have some loxicom left (but dose of bodyweight in mg didn't seem to make much of a difference).
Also, assume we should continue with the thyroxine or not?
Expert:  nekovet replied 1 year ago.
You are very welcome,
Now without an MRI, we can only speculate on what was present and therefore what it'd likely respond to. Though with his signs being most suggestive of a focal mass, we could try steroids. This would have better nervous system and brain penetration then a non-steroidal anti-inflammatory drugs like Loxicom.
Otherwise, continued treatment with the should be based on the thyroid levels just as a view to try to keep those stable and him comfortable. But if he hasn't responded well to the alternative brand, then we'd be best to go back to his original one if we continue that for him.
All the best,
Dr. B.
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* Please remember to rate my service once you have all the information you need as this is how I am credited for assisting you today. Thank you! : )
Customer: replied 1 year ago.
Thanks, ***** ***** an MRI scan show that could be different to using steroids as a solution?
Expert:  nekovet replied 1 year ago.
You are very welcome,
An MRI is just the only way we can look past the skull and into the brain to pinpoint the cause for all of James's signs. It lets us definitively know what we are fighting and thus confirm we are on the right track with treatment.
Otherwise, we are to a degree treating blind. Of course, his vet's diagnostics and treatments have ruled some things out. And his signs have made other issues less likely. Still, we do have to appreciate that there will be some issues that won't respond to steroids. So, if we try them and they work --grand! If they don't, then without an MRI we don't know why or what we should do next to try to address that mystery brain lesion.
So, its just a case of whether we try and see if he responds to steroids. Or if we use an MRI to see what is there and thus can make a treatment plan based on those findings.
All the best,
Dr. B.
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* Please remember to rate my service once you have all the information you need as this is how I am credited for assisting you today. Thank you! : )
Customer: replied 1 year ago.
I've booked him in for a steroid injection with the vet today, do you think one injection will be enough to see an improvement to confirm continued steroids will work? Also what is the best steroid for the injection (and whether it should be short or longer duration)?
I've read that steroids can cause thyroid hormone suppression so I guess we'll have to monitor that as it's a current issue.
Expert:  nekovet replied 1 year ago.
Hi again,I agree that does need to be watched, but our treatments are always based on balances for our patients.Now the number of injections until treatment response does depend on what duration of action the steroid injection has. A long acting one would be better from the angle of giving the steroids time to work. That said, a short acting one would be fine if you were able to continue tablets after that wears off. Generally speaking, we'd want to try him on treatment for at least a week to see if we can get some reduction in his current signs.Take care,Dr. B.-----------------------------------------------------------------------------------------------------------------* Please remember to rate my service once you have all the information you need as this is how I am credited for assisting you today. Thank you! : )
Customer: replied 1 year ago.
He was administered 1.5ml dexadreson at 11am and now 6 hours later no difference in anything.
Expert:  nekovet replied 1 year ago.
Hi again,
I am glad to hear they treated him but you need to give this at least 48 hours to work. Six hours is much too soon to ask the drug to already be reducing significant levels of brain inflammation. So, its early days and we need to see how we go with this.
Take care,
Dr. B.
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****Please remember to rate my service once you have all the information you need as this is how I am credited for assisting you today. Leaving feedback doesn't close the question and you will still be able to reply to me as needed. Thank you! : )
nekovet, Veterinarian
Category: Dog
Satisfied Customers: 18251
Experience: Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
nekovet and other Dog Specialists are ready to help you
Customer: replied 1 year ago.
Well last night was not good all in all. The fact we had a child's birthday party probably didn't help as there were quite a few family around (no strangers though) but the dog was not happy and he was really sounding off (moaning very loud/howling) and very stressed generally. We had to take him out of the house a few times. The steroid injection seemed to turbo-charge his current symptoms, more circling, more moaning, more head hiding, he was hiding his head under my arm. He was more energetic on his walks when we did take him out to get him away but he was still turning left and circling and no urination on the walk. He calmed down later on at night and although breathing quickly was silent all night. I have a print out of his bloods and his cholesterol is 11.87 (high). Lymphocytes (absolute) 1.29 (low). He has only had Total t4 taken, no free t4 and that's at 45.8. This morning back to how he was before injection, has also been moaning from 10.30 for an hour in 10 min intervals. Slow on walk. I had read that there is one theory that links hypothyroidism with problems with the hypothalamic-pituitary-adrenal (HPA) axis, a major part of the neuroendocrine system that controls reactions to stress. "Some hypothyroid patients have chronically elevated levels of cortisol, the stress hormone, which would chemically mimic a state of constant stress" and this is what he is doing. "The continual high level of cortisol could suppress pituitary function and decrease the production of thyroid stimulating hormone (TSH), resulting in reduced production of thyroid hormones." I'm therefore not sure if the additional steroid would have further exaggerated that being cortisol based. He's off to the vet tonight but not sure another injection or tablets is the way forward.
Expert:  nekovet replied 1 year ago.
Hello again,
We wouldn’t have expected to see worsening of signs with the steroids. The increase signs and the effects of the drugs just are at odds with one another. As well, if his vet used a long acting preparation, then if the effects had been secondary to the injection they’d not have worn off as quickly as it sounds like it has.
Therefore, I would be more suspicious of stress elevating his blood pressure and that could contribute to the worsening of signs (especially if the underlying issue has any associated bleeds on the brain)).
As well, we don’t usually see effects of high cortisol clinically in thyroid dogs. Instead, if we are concerned about that they we’d be more suspicious of a lurking Cushing’s disease afterall (and that could spike the cholesterol levels and could also be affected since it too is pituitary based). Therefore, I am glad that you are having him reassessed and you want to speak to his vet about Cushing’s disease and Addison’s (which is low cortisol, but is a disease that can be a “great pretender” and thus always worth adding to our list of concerns with weird turns in hormonal conditions) potentially playing a role here +/- consider having those tested for. But even so, as those are pituitary based, we still have that overriding concern that something is affecting that tissue or compressing it. And that may make treating any of these complicated.
Please take care,
Dr. B.

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