Cushing's questions from a new member

[westcoastflea1]

declan has been off vetoryl completely for about 3 months. currently his meds have been 0.05 mg of cabergoline 2 times a week and dermal thyroid meds 2 times a day i have not tested cortisol levels but will be doing so in the next couple of weeks to determine what adjustments if any are needed in cabergoline dose

[westcoastflea1]

so glad that declan is finally on thryoid medication. That was found last july right, so glad it is being addressed. YES HE HAD THE TEST and the vet would not prescribe the meds needed since dr dodds said thyroid was normal i had to find another vet to prescribe thyroid and cabergoline.

Yes to clarify, declan is not on vetroyl now he is on cabergoline.RIGHT i can't remember if you had an mri to verify the location of the pituitary tumor,NO
but it is interesting that he is having such a good response to the cabergoline. I believe you are our first to try this for cushings, so we are all going to be super interesting in how he is doing on it and any follow up testing to verify cortisol levels.WILL KEEP EVERYONE POSTED WHEN UCCR IS DONE

i wonder if the reason that he has a prolonged reaction to the acth test is because his of his unaddressed thyroid issues at that time? I think i mentioned at the time that normally the spaz situation resolves within about 48 hours and cortisol goes back to normal, but for declan the spaz response went on for almost 2 weeks wasn't it? HIGH CORTISOL LEVELS mess with thyroid stimulating hormones so possible that thyroid wasnt producing what it should and led to symptoms worsening
but not sure what thyroid does in terms of appetite water consumption gas etc

i call it spaz as that was how i felt my molly reacted. But it's an increase in all cushings systems until the cortisol that is dumped in the body by the acth test works it way to normal levels.

yes declan didnt go back down stayed higher which caused me to have to increase vetoryl

[westcoastflea1]

[quote=lauries;200081]i am also very interested in your experience with cabergoline. I have mostly the same questions as carole posted. My charlotte couldnt tolerate vetoryl and has been off of it for a couple of months and some of her cushings symptoms (exessive hunger and pu/pd) have not returned. Her current symtoms are lethargy, tremoring, pacing, cc, anorexia and now she wont drink on her own.HAS HER THYROID BEEN CHECKED?? AND IF SO WHAT WERE THE TEST RESULTS? ? THEY MAY SAY THYROID IS FINE BUT IF ACTUAL LEVELS ARE BELOW NORMAL I WOULD PUT ON THYROID MEDS THEY CANT HURT AND MAY VERY WELL HELP . HAVE YOU HAD A GALL BLADDER ULTRASOUND? DECLAN WAS THROWING UP YELLOW BILE SOME MORNINGS HIS GALL BLADDER WAS SLUDGY PUT ON MEDS AND CLEARED IT OUT IF NOT DONE IT CAN BURST.
THYROID MEDS SHOULD HELP WITH APPETITE, LETHARGY AND NOT DRINKING, GET DERMAL THYROID SINCE GETTING A PILL INTO A DOG WITH ANOREXIA IS IMPOSSIBLE, COMPOUNDING PHARMACY CHARGES ME 50.00 A MONTH FOR IT we suspect a pit macro tumor but havent had a mri to confirm. I DONT SUPPOSE IT MATTERS IF YOU HAVE AN MRI OR NOT IF VETORYL IS NOT WORKING TRY CABERGOLINE IF THAT DOESNT WORK GO WITH ANOTHER DOPAMINE AGONIST NONE OF THE DRUGS HURT YOUR DOG OR CAUSE ANY NEGATIVE EFFECTS, AND IF THEY DO WORK THEY CAN SHRINK A PIT TUMOR he is day to day at this point. We have her on prednisone and several holistic supplements to reduce inflammation and boost immune system. STEROIDS FOR POSSIBLE PIT TUMOR REDUCTION? Yesterday was a good day, today not so good. I would love to feel like there is some hope as she is only 7 years old. But i also dont want to treat her like an "experiment" and need to think of her quality of life.YOU AND YOUR DOG HAVE NOTHING TO LOSE BY STARTING CABERGOLINE AND POSSIBLY THYROID MEDS. NO NEGATIVE SIDE EFFECTS WITH EITHER THEY ARE NOT HARMFUL LIKE THE OTHER CUSHINGS DRUGS THERE IS HOPE! YOUR DOG IS STILL YOUNG CHANCES ARE GOOD THAT ORGAN DAMAGE IS NOT EXTENSIVE THE SOONER YOU START THE BETTER YOUR DOG MAY FEEL
i anxiously await your answers to some of carole's questions. Thanks for sharing all your experiences with declan.

[LaurieS]

Thanks for your response and yes we have checked Charlotte's thyroid. Although they don't feel there is anything wrong I do know it's a very misdiagnosed problem in people so I suppose she could be having thyroid issues that we aren't treating. I don't have her test results in front of me right now but I will ask my vet again about it. Also, it doesn't seem like we have much to lose trying the cabergoline. Even without a mri it's pretty apparent she has a pit tumor that has enlarged and is putting pressure on the hypothalamus which is what controls hunger, thirst, blood pressure and so many other things. I'm so glad Declan is doing better and I sure hope the cabergoline will work for other dogs on this forum.

Laurie

[LaurieS]

One more question for you. How long did it take you to see the cabergoline start to work?

Laurie

[westcoastflea1]

[QUOTE=LaurieS;200130]Thanks for your response and yes we have checked Charlotte's thyroid. Although they don't feel there is anything wrong I do know it's a very misdiagnosed problem in people so I suppose she could be having thyroid issues that we aren't treating. I don't have her test results in front of me right now but I will ask my vet again about it.I WOULD HAVE YOUR VET EMAIL TEST RESULTS TO YOU, THAT WAY YOU CAN SEE WHAT THE LEVELS ARE ON T3 T4 TSH ETC .MY VET SAID THYROID WAS FINE DR DODDS SAID THYROID IS FINE, BUT UNTIL YOU SEE ACTUAL LEVELS T3 T4 AND TSH LEVELS YOURSELF YOU WONT KNOW. HAVE YOU HAD RECENT BLOOD WORK DONE? SO YOU KNOW ORGAN FUNCTION IS GOOD OR BAD WHITE BLOOD CELL COUNT ETC ETC AND HAVE YOU THOUGHT ABOUT ADDISONS DISEASE? WHEN WAS THE LAST TIME YOU HAD CORTISOL LEVELS CHECKED? I WOULD HAVE CORTISOL LEVELS CHECKED BEFORE STARTING CABERGOLINE TO MAKE SURE YOUR DOG HASNT GONE ADDISONS DUE TO VETORYL SHE WAS TAKING Also, it doesn't seem like we have much to lose trying the cabergoline. Even without a mri it's pretty apparent she has a pit tumor that has enlarged and is putting pressure on the hypothalamus which is what controls hunger, thirst, blood pressure and so many other things. I'm so glad Declan is doing better and I sure hope the cabergoline will work for other dogs on this forum.

[westcoastflea1]

one more question for you. How long did it take you to see the cabergoline start to work?

Laurie

i took declan off vetoryl 3 months ago, as far as beginning to work i dont have an answer for you. All i can say is that no symptoms of cushings have returned.when i get a uccr done that will tell me if he is still testing as a non cushings dog which is where he was at after last test. Then i will know meds are definitely working or if we need to increase his dose. Again if i were you i would have blood work done cortisol levels tested and get copy of THYROID test results showing where all the levels are at if you are below normal or low normal for most levels then you know that thyroid meds might be good . And again addisons has most of the symptoms your dog is showing so super important to get cortisol levels asap IS YOUR DOG ON MEDS FOR BLOOD PRESSURE?

[labblab]

OK, per my note posted elsewhere, I wanted to return to your thread to try to clarify thyroid recommendations. I do not disagree at all with urging folks to request complete thyroid panels for their Cushpups in order to explore the likelihood that low thyroid readings are a primary problem in their own right, vs. being secondary to the Cushing's ("sick euthyroid syndrome"). I would also agree with giving thyroid supplementation to any dog for whom hypothyroidism is judged to be a primary problem. But I think you are also recommending that supplementation be started for any Cushpup with a low thyroid reading, even if the thyroid abnormality is thought to be secondary to the Cushing's. Am I right about that, or am I misunderstanding you?

In that situation, I believe most specialists recommend against starting thyroid supplementation prior to having the opportunity to gauge whether thyroid results normalize once cortisol levels have been therapeutically lowered with Cushing's treatment.

Here are some excerpts from Michigan State University's veterinary thyroid testing page. It addresses a pattern of results that may commonly occur in Cushpups.

My patient has low thyroid hormone concentrations, but thyroid stimulating hormone is not elevated. What does this mean?

Depending on the clinical presentation, one of two main possibilities is likely.

The more common explanation is that T4 values often decline in animals with non-thyroidal illness and in animals receiving certain drug therapies (some glucocorticoids or anticonvulsants). Non-thyroidal illness may suppress TSH release from the pituitary via glucocorticoid-mediated inhibition or lower T4 concentrations by altering serum protein binding affinities...

...With this pattern of test results, a trial with T4 supplementation is suggested only if there is a strong clinical presentation consistent with hypothyroidism and if no non-thyroidal illness can be detected...

...While the administration of thyroid hormone to animals which do not have hypothyroidism is generally considered to have minimal risk, large scale studies in human medicine have shown detrimental effects of such treatment in patients that have decreases in serum thyroid hormone concentrations due to non thyroidal illness. (Brent GA and Hershman JM. Thyroxine therapy in patients with severe non-thyroidal illness and low serum thyroxine concentrations. J Clin Endocrinology and Metabolism. 1986, 63:1)

https://www.dcpah.msu.edu/sections/e..._Canine.php#19

As I say, I may be misunderstanding your recommendations, so I wanted us to have a chance to clarify further.

Marianne

[westcoastflea1]

a thyroid test may show that the thyroid is normal BUT the problem is that the thyroid stimulating hormone is suppressed by high cortisol which keeps it from putting out what it needs to put out, which causes many of the symptoms you see in both cushing and hypothyroidism.
THIS is why you need to see the entire thyroid panel not just listen to your vet tell you the thyroid is normal. until cortisol is under control you have a thyroid that tests as normal but is in actuality not working correctly so you have hair loss, skin infections, etc etc i put declan on thyroid meds and within a month all hair had grown in no more skin infections, he had more energy, he was playful, when i took him off thyroid meds for 2 weeks he got grumpier and grumpier until he bit me. I got dermal thyroid meds and he is fine now SO the point im making is you need to see entire panel and if all numbers are low except t4 you should put on thyroid meds. when cortisol levels are under control then have thyroid panel taken again and see where numbers, then make decision as to whether or not to continue or discontinue it took a year to get declan on the right dose of vetoryl 300mg so that is a year in which skin infections were happening every day hair was falling out he was grumpy, his immune system was weak.HPA axis is complicated so getting thyroid levels where they should be might help with other issues there is just no point in not putting on thyroid meds if numbers are for the most part low until cortisol levels are under control

[westcoastflea1]

declans thyroid panel was low with the exception of free t4 which was 80 range is 70 -1.70. so they said thyroid was good whats funny is both thyroid tests he had one like 4 years ago and this one said possible non thyroidal illness but the vet never mentioned it or suggest exploring what else could be wrong needless to say i have a new vet now that test showed low normal so in 4 years he went from low normal to below normal makes you wonder what we could have done 4 years ago if we acted on the non thyroidal aspect