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Author Topic: Undiagnosed condition  (Read 3093 times)

Julie Beardieye

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Re: Undiagnosed condition
« Reply #30 on: October 22, 2018, 06:47:00 PM »

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.




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Catherine

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Re: Undiagnosed condition
« Reply #31 on: October 22, 2018, 09:50:52 PM »

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.
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Jo CIMDA

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Re: Undiagnosed condition
« Reply #32 on: October 24, 2018, 03:35:25 PM »

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
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Julie Beardieye

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Re: Undiagnosed condition
« Reply #33 on: October 24, 2018, 05:39:48 PM »

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
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Catherine

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Re: Undiagnosed condition
« Reply #34 on: October 24, 2018, 08:15:37 PM »

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.




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Julie Beardieye

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Re: Undiagnosed condition
« Reply #35 on: October 24, 2018, 09:11:21 PM »

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.

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Catherine

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Re: Undiagnosed condition
« Reply #36 on: October 25, 2018, 09:27:49 AM »

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]
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Jo CIMDA

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Re: Undiagnosed condition
« Reply #37 on: October 25, 2018, 10:09:05 AM »

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
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Julie Beardieye

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Re: Undiagnosed condition
« Reply #38 on: October 25, 2018, 04:05:02 PM »

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.
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Catherine

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Re: Undiagnosed condition
« Reply #39 on: October 25, 2018, 04:42:49 PM »

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.
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Jo CIMDA

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Re: Undiagnosed condition
« Reply #40 on: October 27, 2018, 11:58:26 AM »

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
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Julie Beardieye

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Re: Undiagnosed condition
« Reply #41 on: November 05, 2018, 06:27:41 PM »

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.

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Catherine

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Re: Undiagnosed condition
« Reply #42 on: November 05, 2018, 08:18:28 PM »

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.

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Julie Beardieye

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Re: Undiagnosed condition
« Reply #43 on: November 05, 2018, 09:51:24 PM »

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.
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Jo CIMDA

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Re: Undiagnosed condition
« Reply #44 on: November 07, 2018, 09:16:17 AM »

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
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