CIMDA

Hello, newbie here. I was recommended this site by a lovely Facebook group.
My vet suspects my dog has got Laryngeal paralysis but not confirmed. The vet wanted to try anti-inflammatorys (Loxicom) and do a full blood test before doing any invasive investigations.
The only thing that the vet was slightly concerned about was Buffys T4  level of 13.8, only just in range.
From personal experience, I know a level this low in range can sometimes cause symptoms even though it is classed as normal.
Also, on the results, the MCHC is low at 325 g/l , however the vet didn't show any concern (I've not yet googled what MCHC is!)
So, Buffy has been on the Loxicom a few days and yesterday I noticed Buffy had two large lumps just below her jaw/neck one side is significantly larger than the other and today the vet took a biopsy right away because she doesn't believe it is an infection.
Sorry, I'm waffling but Buffy is extremely precious to me. I was preparing to eventually let Buffy have a tie back surgery for her Lar Par and was also going to discuss a low dose of thyroid medication to see if raising her level helped her fatigue and energy level. But now, it's looking like something else more serious is going on and I don't know what to do.
Biopsy results will come back in 5-7 days. Do I just hang on for now and see what the biopsy shows or is there another route I can go down?
Help please!

I am wondering if it all (or some of  it) could be to do with Hypothyroidism. Buffy's low T4, plus her fatigue and even megaoesophagus can be symptoms of it. Your vet needs to do a fuller thyroid panel - FreeT4, TSH and TgAb to find a more accurate result. See here for more information: http://cimda.co.uk/smf/index.php/topic,18.0.html

Were the lumps on her neck lymph nodes or could they indeed have just been swollen? I would wait to see what the biopsy results are before thinking of her having surgery. I would also keep an eye on any other symptoms like loss of appetite, pale gums. I assume her red blood cells are okay.

Thanks for your reply Catherine.
Our next step was going to be a full thyroid panel, if the Loxicom didn't help. But then the lumps appeared.
I believe they are swollen lymph nodes but the vet doesn't think it's down to infection but something more sinister.
I have googled MCHC and I see it is linked to iron deficiency.
Buffy is on a raw meat diet so I cannot see how she could be iron deficient.
I have a print out of her last blood test that I could upload if that's of any use?
In the meantime, wait and see what the biopsy results show.

Yes that would be a good idea to put the blood tests results on here. Sometimes the levels can be in the "normal" range but may be of concern.

Obviously I do not want to throw out false/alarming scenarios but it was just that (amongst other problems) swollen neck lymph gland(s) can be a symptom of auto-immune - it happened with my AIHA dog although I did not link it at the time. Your vet may be right with the idea of cancer, but it could also be something less.

Ive tried uploading Buffys results but I can't make the file size small enough. Any ideas?
If not, I'll type them instead at the weekend.

Sorry, have no idea how to upload.

Hi and welcome

I am sorry Buffy may have Laryngeal paralysis.   Some breeds of dog are predisposed to primary LP, is Buffy one of those breeds?

Does Buffy have other clinical signs? 

Having a full thyroid check is very important because some drugs and also some conditions can artificially lower the thyroid hormones.  If the vet doesn't think the swollen lymph nodes are due to an infection then it is not necessarily due to something more sinister but  likely due to inflammatory disease, such as an autoimmune disease.  Is there any chance Buffy could see a specialist?  Primary LP should be confirmed before surgery is undertaken.   

I hope the results point to a diagnosis.

Jo


Below is some interesting information:   

https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/laryngeal-paralysis
Acquired: Idiopathic

An acquired idiopathic laryngeal paralysis occurs in older large-breed dogs without other significant signs of neuromuscular disease. It is common in Labrador retrievers, Saint Bernards, Newfoundlands, and Chesapeake Bay retrievers. Many of these dogs suffer from chronic hypothyroidism and some may improve when treated for their hypothyroidism. Most require laryngeal surgery to improve their inspiration and ability to exercise. The relationship between the chronic hypothyroidism and the laryngeal paralysis is not well understood. Both myopathy and neuropathy occur with this endocrine disorder in humans. Other cranial nerve and even brainstem signs have been associated with hypothyroidism solely on the basis of some response to therapy. No adequate pathologic studies have been performed in these dogs (see previous discussion with idiopathic facial neuropathy-neuritis). Occasionally, the dogs with this laryngeal paralysis also have megaesophagus. Until we understand this disorder better, these dogs should be evaluated for their thyroid status and the possibility of focal myasthenia gravis by evaluating their serum for antibodies against acetylcholine receptors.

Hypothyroidism

J. Catharine Scott-Moncrieff, in Canine and Feline Endocrinology (Fourth Edition), 2015
Other Neurologic Disorders

Laryngeal paralysis and megaesophagus may both occur in association with hypothyroidism; however, a causal relationship has not been established, and treatment of hypothyroidism does not consistently result in improvement of clinical signs of either disorder (MacPhail and Monnet, 2001; Gaynor et al, 1997). Myasthenia gravis has been identified in dogs with hypothyroidism (Dewey et al, 1995) and is a well-recognized cause of acquired megaesophagus in the dog. Concurrent hypothyroidism may exacerbate clinical signs of myasthenia gravis, such as muscle weakness and megaesophagus. In human beings, there is a link between autoimmune thyroiditis and acquired myasthenia gravis, and myasthenia gravis is a recognized component of polyglandular autoimmune syndrome type II. Presumably a common abnormality in immune function allows development of autoimmune attack on both the thyroid gland and acetylcholine receptors. Myasthenia gravis was documented in only 1 of 162 dogs with hypothyroidism reviewed by Panciera (2001), implying that hypothyroidism is rarely associated with myasthenia gravis. A causal relation between hypothyroidism and myasthenia gravis remains to be established.

I am sorry but at the moment I don't think it is possible to upload any results because the capacity is full.

Sorry

Jo

This is another excellent website:


http://veterinarycalendar.dvm360.com/managing-laryngeal-and-tracheal-problems-proceedings?id=&pageID=1&sk=&date=

Thankyou Jo.
Buffy is a Bearded Collie (working type)
She generally seems lethargic on walks and starts panting easily even in cool weather. Just jumping on or off a chair will make her pant. This is why the vet suggested anti-inflammatorys first in case a bit of arthritis was causing her pain and so making her pant and making her breathing more difficult.
The vet wanted to try less invasive treatment before going down the surgery route.
Buffys appetite is fine although she looks as if she feels uncomfortable swallowing and her drinking is normal. Pre and poo fine. Difficulty loosing weight over the last few years which is now even more difficult with her lack of energy.
I will attempt to type her test results here in the next few days.
Thankyou Jo.

Something else I've just remembered that the vet pointed out, along with low T4 is high cholesterol at 6.64
Is that down to her diet or possibly related to thyroid?
I've also been giving Buffy a spoonful of Manuka honey twice a day in the hope it will soothe her throat. Is that recommended or too high in sugar?

Hi

Even though Buffy is a working beardie I have not known LP in the breed, so given that she is lethargic, has put on weight, has high cholesterol (which is usual in hypothyroidism), lethargic and with lack of energy, I feel this points more likely  to hypothyroidism than LP and the difficulty in swallowing could be due to megaosoephagus and not LP.  If Buffy has hypoT, and as a result has megaO,  then the sooner you get a diagnosis and start treatment the better because MegaO isn't reversible but by early treatment you can halt the disease process.   If the TSH is high and the FreeT4 is low then this confirms HypoT.

Jo


Below is an extract from my seminar notes:

Hypothyroidism – An underactive thyroid gland
'More than 95% of cases of canine hypothyroidism are believed to be due to acquired primary hypothyroidism. Destruction of the thyroid gland can result from lymphocytic thyroiditis, idiopathic thyroid atrophy or rarely neoplastic invasion.'  Canine Medicine and Therapeutics by Neil Gorman.
Hypothyroidism or under-active thyroid glands, is the most common autoimmune disease in the dog and is probably evident in most breeds, although the incidence appears to be higher in some breeds than others. This disease is usually a slow process resulting in the destruction of the thyroid glands by antibodies directed against the thyroid (lymphocytic thyroiditis).  As the body only needs less than 20% thyroid production to function, clinical signs of this disease often develop over a lengthy period of time and are so gradual that the owner is not always aware that the dog is slowing down.  The body will cope very well with diminishing thyroid glands, but when the glands have been more than 80% destroyed then clinical signs become more obvious. 

The thyroid is essential to life; it circulates thyroid hormones to all parts of the body. If replacement therapy is not given to a hypothyroid dog it will die.  Usually the clinical signs show well before this time and a thyroid blood test should confirm a diagnosis. Thyroid disease is not always simple to diagnose but usually a low TT4 (total thyroid hormone) confirmed by a low FreeT4 (thyroid hormone measurement without protein) and a high TSH (Thyroid Stimulating Hormone) is considered to be diagnostic of hypothyroidism.  (In addition, tests to assess thyroid dysfunction may include: TT3, FT3, autoantibody, TSH and TRH response tests).

Measuring TT4 alone is not enough to make a definitive diagnosis as the dog could be suffering from a non-thyroidal illness (NTI), that is an illness affecting the amount of thyroid hormone within the circulation, rather than a primary autoimmune destruction of the glands.  Non-thyroidal illness should be suspected if the dog has a low TT4 and a low TSH. Whippets and other sighthounds have a naturally lower TT4 than many other breeds but the FT4 is within normal limits.

Note: Several drugs, including prednisolone and diseases such as Cushing's syndrome, will lower the circulating TT4 levels and this should be taken into account when evaluating the results.  Hypothyroidism is both over and under diagnosed.

Some clinical signs of hypothyroidism are:
Lethargy, mental dullness, unwillingness to exercise,  stiffness in gait – limping, weight gain (obesity), dry scaly skin or greasy skin, excessive pigmentation (hyperpigmentation),  skin lesions, on-going ear problems, coat texture and colour changes, loss of hair particularly on the tail and bilateral, symmetrical  hair loss, signs of premature ageing, irregular seasons - poor infertility and libido, depression (tragic expression), irritability or aggression, intolerance to cold, seizures, voice change (pitch of bark),  muscle weakness, megaoesophagus (weakness of muscles in the throat causing difficulty in swallowing).

On examination your vet may also find that a hypothyroid dog has a slow heart beat (bradycardia), eye abnormalities such as corneal lipid deposits or ulceration: dysfunction of the central nervous system (CNS), such as tilting of head, circling, unsteady gait (ataxia):  Blood analysis may also reveal anaemia and high cholesterol.

The prognosis for dogs with hypothyroidism is excellent, although life-long daily treatment with hormone replacement, Levothyroxine, is required. Giving half the daily hormone replacement dose every twelve hours provides a more balanced level of thyroid hormone throughout a 24 hour period and avoids peaks and troughs. (BSAVA Small Animal Endocrinology)  "Levothyroxine is better absorbed on an empty stomach".  Canine Medicine & Therapeutics by Neil Gorman

Note: Sometimes dogs with hypothyroidism are prone to other autoimmune diseases.

That's interesting Jo, thankyou.
Buffy has very gradually slowed down over the last 2 years but I've obviously wrongly assumed it was down to old age.
I'm thinking I won't wait for the biopsy results and request a full thyroid panel done asap. I feel I've already left it much to long to help her.
Thankyou,
Julie

How old is Buffy?

Elevated cholesterol can be an indicator of Hypothyroidism.

Is Buffy spayed? If she is still entire than the ideal time for her to get a more accurate thyroid test result is during her anestrus. Quote from CANINE THYROID DIAGNOSTIC TESTING, INTERPRETATION AND DOSING -  W. Jean Dodds, DVM : " The interpretation of results from baseline thyroid profiles in intact females is more reliable when they are tested in anestrus. Thus, testing for health screening is best performed at 12 -16 weeks following the onset of the previous heat.  "

But as this is more urgent it will probably be best not to wait for that period.

Hi. Thanks for your help so far.
Buffy is nearly 13yrs and was speyed at age 10yrs.
Buffys biopsy results came back inconclusive, so vet now wants to try antibiotics to get the lymph nodes swelling down and therefore wants to withhold the thyroid blood test because infection can alter the thyroid results.
Is that true?
Buffy had blood taken yesterday for the thyroid test and they now want to discard it.

There could be a couple of things going on but at 13 years old Buffy's thyroid could be wearing out anyway. It could be non-thyroidal illness but that is why a FreeT4 test and a TSH test are done along with the T4.

How is Buffy now, any more symptoms?

Buffy is still lethargic and pants alot on walks and in the evenings.
Is it true that an infection can affect the thyroid results?
I wanted her thyroid checked asap but vet now wants to discard the blood they took yesterday and put her on a 1 week course of antibiotics instead, saying that if the lymph nodes are swollen due to infection, it could affect the thyroid results.

I do not know if an infection will affect the results. But I thought that is why the extra tests are done to help diagnose Hypothyroidism or a non-thyroidal illness, an infection say. Taken from Jo's earlier post: "Measuring TT4 alone is not enough to make a definitive diagnosis as the dog could be suffering from a non-thyroidal illness (NTI), that is an illness affecting the amount of thyroid hormone within the circulation, rather than a primary autoimmune destruction of the glands.  Non-thyroidal illness should be suspected if the dog has a low TT4 and a low TSH."

This chart and information may explain it better: https://www.veterinarypracticenews.com/how-to-test-interpret-thyroid-function/

I would still go ahead and test the thyroid with the blood taken. Try to avoid potentiated sulphonamide antibiotics as they have been known to make some dogs very ill.

Ok, thanks.
If the vet hasn't already thrown the blood I'll ask them to send it for testing anyway.
I'm picking up the antibiotics tomorrow. Don't know what they are called.

Hi

I don't know that 'infections' can cause alteration in thyroid hormones but illness can and so can many drugs including some antibiotics.

Jo

Ok, so Buffys full thyroid test came back showing she is hypo but the vet wants to finish the course of antibiotics before putting her on medication.
If Buffys lymph nodes aren't back to normal after the antibiotics, the vet will consider investigating the lymph nodes further before starting thyroid medication.
Does that sound like the right way to go?

Did the vet give a reason for delaying starting thyroid medication? It seems to me that if Buffy is hypothyroid then the sooner she starts on the medication the sooner some of her symptoms may improve. Delaying, surely only increases the risk of more problems?

How is Buffy?

Something about possibly another underlying condition other than thyroid affecting the lymph nodes and if there is another underlying condition it might give false thyroid results.
Even though the biopsy results came back inconclusive they still haven't ruled out cancer for some reason.
The lymph nodes have reduced slightly but not sure they will be back to normal after the antibiotics.

I thought that was the reason for having the extra tests to get a more accurate result. Was the TSH high? What cancer are they talking about?

I assume they think cancer of the lymph nodes. Not that I've ever heard of that before.
I don't know what the TSH is just that the FT4 is low.
I'll be getting a print out of the full results at our next appointment on Wednesday.
Buffy has become less tolerant of exercise so it looks like the anti-inflammatorys aren't helping and maybe the antibiotics are making her feel groggy too.

Hi

I don't know of any good reason why if the FT4 and TT4 is low that a vet wouldn't treat with thyroid replacement hormone. 

Buffy has clinical signs of hypoT and now the lab results to back up a diagnosis of hypothyroidism.  If there is underlying problem then replacement thyroid hormones when a dog isn't able to produce them can only do good.  The thyroid  hormone is essential to every part of the body.

I would ask for her to be treated and if your vet refuses then find another vet.
Good luck
Jo

Here is an assessment chart from Hemopet that might help:
http://www.hemopet.org/clients/14145/images/Hemopet-magnet5-4-2014-blue_(1).jpg

If the anti-inflammatories are not helping I would stop them as they could cause more problems. What is the name of the antibiotics?

I agree with Jo that as the clinical signs and test results point to Hypothyroidism then the sooner Buffy starts treatment the better.

Hi.
The antibiotics are called Noroclav (Amoxicillin and Clavulanic acid)
We've got one more days worth of these antibiotics and Buffys left lymph node has reduced and feels normal but her right side still feels very hard, although it doesn't feel like it's surrounded by squidgy/fluid anymore but the actual lump has not reduced at all. This is also the side they took the very first blood sample from that they had real trouble getting the needle in the vein and were, in her words, jabbing in the dark.
This is also the side they took the biopsy from.
I'm guessing the vet will want to open Buffy up and have a look at her lymph node next. I'm not sure about that given her age.
So you suggest I stop the anti-inflammatorys? They don't appear to of helped in any way.
I'll have more info on the thyroid results on Wednesday.
Thanks

Those antibiotics should be fine.

I do not know Buffy so I shall just throw out a few things. The right hand lump - has it reduced any, do you remember the size before Buffy started having problems?. It is probably not something that is noticed until a dog is unwell, but could the right hand lymph node have always been bigger than the other one?

If the anti-inflammatories are not helping why give them to her? You can always start again with them if you really think they will help.

Can you remind me of Buffy's symptoms again please?

I would not be rushing to have her undergo an operation and anaesthetic at her age unless it was life saving. I would certainly want to try her on the thyroid medication first if you do go down the exploratory operation route because if her thyroid is not working so well it could affect other parts of her body and make things riskier. I would also want to know what the vet was thinking it could be and whether she could be cured. If not, why put her through an operation just to get a diagnosis? If the lump has not become bigger or there are severe problems for Buffy it would be a good idea to "wait and see" before any operations.

I do know how difficult it can be to go against a vet's advice. That is why it helps to find out as much as possible and your options and also to go by your own gut feeling. Perhaps you can compromise with the vet. If you really think it would help to have a trial of thyroid medication then I can not see why your vet would not be amenable to that. After all your vet was not keen on the thyroid test and look what that showed!

Another route would be to take Buffy to see a specialist.

I've no idea what size her lymph nodes were before. All I noticed when I was fussing her is that I've never felt lumps there before! I noticed them about 1 week after she had her first blood test but I don't often touch her in that particular area so I'm not 100% sure how long theyve been inflamed.

Buffys symptoms are, mainly, lethargic on walks with very little energy and pants early in to our walk with a slight raspy noise in her throat. Also pants at home in the evenings for no apparent reason but without the raspy noise.
She does become alert when I've got her toy and if she sees a rabbit but she soon returns to looking lethargic.
Appears to be in a bit of discomfort when swallowing but that has improved slightly while on antibiotics.
Her appetite is good and water intake normal. Pee and poo fine although I think the antibiotics have upset her a little.

Good old Google! Lymphoma, I think, might be what the vet is thinking, although the biopsy came back inconclusive. If it lymphoma, it looks like it would need urgent treatment.
Would lymphoma affect the thyroid results?
Maybe the vet thinks it would give a false thyroid reading.

There are certainly quite a  few symptoms going on. Reading back through your thread I find it rather worrying about the various diagnoses. I realize it is not always easy to make a firm diagnosis but at the beginning Laryngeal paralysis was muted and to have surgery for that, then arthritis, then infection, then lymphoma.

I would think lymphoma would be classed as a non thyroidal disease and the T4 and FT4 would be elevated rather than lower but I am not sure of that. Hopefully someone else will know more.

Hi

Even if there is an underlying problem with Buffy, if her complete thyroid panel is diagnostic of hypothyroidism then she should be treated for it anyway.

Symptoms may resolve if the thyroid hormone is adequate or it may allow other clinical signs to become apparent and an underlying condition diagnosed.

Lymph nodes can be enlarged for many different reasons, not just Lymphoma, and it is often just an indicator that there is inflammation or infection within the body.   https://www.petmd.com/dog/conditions/cancer/c_multi_lymphadenopathy

Jo

Thankyou Caroline and Jo.
I've just come out the vets and she agrees Buffys lymph nodes have reduced in size. Cancer isn't such a concern now and trying another 7 days of antibiotics.
Buffys thyroid results...
On 29th September her Total T4 was 13.8 mmol,
On 16th October Total T4 was 11.1 
I guess the drop in those levels would explain why Buffy is a little more lethargic the last couple of weeks.
Is the drop in such a short space of time anything to worry about?

Haemolysis Index: slight haemolysis

Free T4  3.9 pmol
TSH 0.09 Ng/ml

Thyroglobulin Autoantibody Negative.

The vet has given me Thyforon 400mcg, I give Buffy half a tablet every 12 hours and go back for blood test in two weeks.
Is that a good dose to start and is a two week test the norm for dogs? (It was initially 6 weeks for me!)

Thanks,
Julie

That is sounding more positive that it is not lymphoma.

I think like most blood test results, the levels can vary from hour to hour, day to day, but if left untreated the thyroid levels will continue to drop.

Dogs are usually started on a low dose of thyroid medication so that probably sounds right. Also the absorption of the medication can be affected by food so it is best to give the medication 1 hour before OR 3 hours after feeding.

Two weeks does sound a bit soon, I thought it was usually about a month. Perhaps your vet wants to do other blood tests though to keep an eye on Buffy. Remember, when going for the thyroid test to have it done 4 -6 hours after giving Buffy her tablet.

Hopefully you will soon see an improvement in Buffy.

The vet wants to do two blood tests in two weeks time. One before Buffy has her first tablet of the day and another 6 hours  later/after taking her tablet.
Admittedly, I'm not sure on the competence of this young vet. She is the one that dismissed my thoughts of Buffys lymph nodes swelling due to infection and was fairly insistent it was something more sinister. She also said food would not affect absorption like it does in humans.
This is why I'm so glad I can come here for a second opinion. I just want my old girl to be happy!
If you think two weeks is too soon, I will raise my concern with one of the more experienced vets at the practice.

Can you not ask to see another vet (try to be diplomatic, maybe say you both have different ideas of the way forward for Buffy and that another vet may be more compatible with you)?

With regard to giving the tablet with food. If your vet will not accept the weight of opinion, where is the harm in going ahead and NOT giving the tablet with food/ within the times of feeding? It is not like it has to be with food, so err on the side of caution. Also the thyroid tablets are usually tasty and the dogs will eat them as they are.

As regards the two weeks, I  can find no reference to that amount of time but plenty for the 4 - 6 weeks after starting thyroid medication. With regard to the 2 blood tests before and after dosing, I have never heard of that - it has always been 4 - 6 hours post pill. (Also Buffy may need a few blood tests before her medication is the correct amount so why put Buffy through TWO tests each time if ONE is sufficient?) Are you in the USA? I HAVE found a reference to the "two blood tests", apparently the first is called "trough". I have copied an excerpt below. Maybe in the USA it is normally done that way?

"Four to six weeks after initiating treatment, either the peak or trough T4 level (or both) is determined. The choice of peak or trough sampling is dependent on the client's and veterinarian's schedule. The desired post-pill thyroid hormone level(s) will depend on the timing of the blood sample. Serum for peak levels is drawn 4 to 6 hours after thyroxine administration, whereas serum for trough levels is drawn immediately prior to the next dose. Peak levels should be high-normal to slightly increased and trough levels should be low - normal." Advanced Endocrinology: Thyroid Diagnostics, Monitoring and Treatment
Peter P. Kintzer DVM, Dipl. ACVIM IDEXX Lab
[/b]

Hi

This is good news and you should see a slight improvement in Buffy within a few days and significant improvement within 7 days. She will certainly be feeling better.

Your vet wants to do a pre pill or 'trough' measurement and according to the BSAVA Manual of Canine and Feline Endocrinology, 3rd Edition, '

'The pre test is to ensure that T4 values do not fall substantially beneath the reference range however maintenance of reference range concentrations is not essential due to the long biological half life of T4 compared with its circulating half life. Given the clinical studies which have correlated clinical resolution with peak T4 values there seems to be little value in continuing to perform tough T4 measurements'.  [/i]

Also, dosing twice a day give a better and more even distribution of the T4 hormone and this avoids peaks and troughs. 

Usually, for monitoring blood is taken 4-6 hours post pill.   I notice that some labs say 3 hours.   It sometimes depends on whether a dog is being medicated only once or twice a day - or in rare cases three times a day. 

2-4 weeks is the usual time for taking bloods after starting treatment but 2 weeks will give time for lots of the clinical signs of hypoT to resolve and if there are other issues this may be evident at this time.

This is an informative link.

http://thehormonelab.com/handbook/thyroid-function/canine-hypothyroidism

and another:

http://the-vet.net/DVMWiz/Vetlibrary/End-%20Monitoring%20Treatment%20for%20Hypothyroidism.htm


This is good news.

Jo

So if,  in 2 weeks time, Buffys "trough" level is too low or her "peak" level is too high, that is likely to be reflected in her behaviour?
Buffy is with me pretty much all day so I will be able to monitor her.
If I'm concerned about Buffys behaviour in 2 weeks, I will go ahead with the blood tests but if I feel she is doing ok I think I'll ask for the test to be done at 4-5 weeks. That seems more realistic to me.

Buffy has been started on a low dose of Thyforon so I would not expect the medication to cause "overdose" symptoms. The only thing I can see could happen is that the dose is not high enough. With this you would hopefully see some improvement with her symptoms but they may not be as much.

I think that is a good idea you mention. Basically monitor her and if she seems to be okay then you can wait a further few weeks rather than the two. I also would just have the one post pill test but that is obviously your choice.

When Buffy has the next thyroid test(s) are you planning on getting her to have the full blood test as well - haematology, biochemistry and electrolytes? That way you can monitor her other results. Hopefully the slight anaemia will be back to normal and also the cholesterol should go down again.

Clinical signs should reflect the blood results, and with dogs that are receiving replacement thyroid hormone therapy the aim is to arrive at the optimum dose that produces normal behaviour and wellness. 

You should see some improvement and, along with the resolution of clinical signs, the blood test results will indicate if the Thyforon dose needs to be raised or adjusted.

Jo

It's been almost 2 weeks on Thyforon and I've not noticed any improvement in Buffys energy level on walks.
Im still thinking 2 weeks is too soon to retest but is the ft4 level likely to rise much more if I wait another 2 weeks?
I spoke to my vet and she is adamant Buffy should be retested now so that the dose can be increased, if needed.
My concern is that if the dose is increased too soon, Buffy could turn hyper.

How is Buffy - have her other symptoms - the swallowing problem and raised glands resolved?

If you have her thyroid tested this week then I would also get her blood tested for haematology, biochemistry and electrolytes just to make sure everything is okay.

Buffys glands feel back to normal but she does still appear to be slightly uncomfortable swallowing, not as bad. Her teeth were checked by the vet and all good there.
She had her bloods done in September which showed MCHC low at 325g/L and Cholesterol high at 6.64 mmol.
Everything else within normal range.

Hi

"My concern is that if the dose is increased too soon, Buffy could turn hyper."

This is very unlikely because the initial dose is usually low and this is gradually increased, based on blood results, until the optimum dose is reached and clinical signs have resolved.

Buffy may have megaosoephagus or an ulcerated throat etc.

In addition to the thyroid panel perhaps you should have a full biochemistry and a complete blood count to put your mind at rest. 

Jo