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Author Topic: Undiagnosed condition  (Read 125 times)

Julie Beardieye

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Undiagnosed condition
« on: October 10, 2018, 09:21:10 PM »

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!
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Catherine

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Re: Undiagnosed condition
« Reply #1 on: October 10, 2018, 10:21:29 PM »

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.

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Julie Beardieye

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Re: Undiagnosed condition
« Reply #2 on: October 11, 2018, 01:12:31 PM »

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.
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Catherine

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Re: Undiagnosed condition
« Reply #3 on: October 11, 2018, 01:52:50 PM »

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.

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Julie Beardieye

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Re: Undiagnosed condition
« Reply #4 on: October 11, 2018, 08:04:19 PM »

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.
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Catherine

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Re: Undiagnosed condition
« Reply #5 on: October 11, 2018, 09:17:07 PM »

Sorry, have no idea how to upload.
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Jo CIMDA

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Re: Undiagnosed condition
« Reply #6 on: October 11, 2018, 09:52:05 PM »

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.
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Jo CIMDA

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Re: Undiagnosed condition
« Reply #7 on: October 11, 2018, 09:53:40 PM »

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
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Jo CIMDA

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Julie Beardieye

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Re: Undiagnosed condition
« Reply #9 on: October 11, 2018, 10:23:16 PM »

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.
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Julie Beardieye

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Re: Undiagnosed condition
« Reply #10 on: October 11, 2018, 10:28:05 PM »

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?
« Last Edit: October 12, 2018, 07:40:44 AM by Julie Beardieye »
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Jo CIMDA

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Re: Undiagnosed condition
« Reply #11 on: October 12, 2018, 10:53:23 AM »

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.

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Julie Beardieye

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Re: Undiagnosed condition
« Reply #12 on: October 12, 2018, 11:50:29 AM »

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
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Catherine

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Re: Undiagnosed condition
« Reply #13 on: October 12, 2018, 01:03:51 PM »

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.
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Julie Beardieye

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Re: Undiagnosed condition
« Reply #14 on: October 16, 2018, 04:08:50 PM »

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.
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