Dog got diagnosed with Cushing's - Chuck has passed

[lulusmom]

Very interesting about hypothyroidism! I googled the symptoms and can see how they would get confused. If my dog has had an acth stim test, would that definitively rule out his symptoms as being cushings? Just curious! Will call my vet about it tomorrow!

I copied this post from another member's thread so that we keep Chuck's information here.

Clinical symptoms, as well as lab abnormalities, commonly associated with cushing's overlap with those of dogs with primary hypothyroidism. A very large number of cushingoid dogs will have a low T4 at the time of the cushing's diagnosis but this is most often sick euthyroid instead of primary hypothyroidism. Non-thyroidal illness, and most certainly cushing's, can cause a transient decrease in T4 which corrects itself once the underlying cause is treated. That is why most cushing's savvy vets will treat the cushing's first and once the dog has been stabilized, recheck the T4 to see if it has returned to normal. I am not really sure what question you are asking but if Chuck symptoms are commonly associated with cushing's, his lab abnormalities are consistent with cushing's and a diagnostic test, such as the acth stim test is consistent with cushing's, I would say his symptoms are probably caused by cushing's. However, if Chuck's T4 is also low, you can't rule out primary low thyroid until a recheck of the T4 after he's stable on an appropriate dose of Vetoryl. I hope that makes sense.

Glynda

[randomguy]

That does make sense, i think, thank you! Man oh man, are you a vet? You have an incredible amount of knowledge! I guess I was just wondering if its possible it's not cushings but instead hypothyroid. I called and left a message asking the vet; hopefully they'll know more.

[lulusmom]

No, I'm not a vet. I'm an insurance professional by trade. I, like many of our staff and members, have spent a good bit of time researching and trying to keep up with the latest developments. I have cared for multiple cushingoid dogs, my own and rescued. Plus I have been involved in small senior and special needs dog rescue for most of the last 25 years and have rehabilitated or provided hospice care for scores of little dogs with any number of medical issues.

If your vet did a thorough job of diagnosing Chuck with cushing's, then I don't believe you are dealing with a misdiagnosis. Cushing's is second only to hypothyroidism in canine diseases that are frequently misdiagnosed so we like to look over a vet's shoulder. The key to determining that possibility will be the results of the original acth stimulation test that was done to confirm the cushing's diagnosis. If the post stimulated cortisol on that test is greater than 22 ug/dL, I think the diagnosis is probably correct; however, it would have been optimum had your vet done differentiating test to determine whether Chuck has adrenal or pituitary dependent cushing's. Did your vet discuss the type of cushing's Chuch has? When you call your vet's office tomorrow, please ask them to tell you the results of the original stim test. There are only two number, the pre and post so you can easily jot them down and post them here.

[randomguy]

He told me that 85% or so cases are pituitary and that his gut feeling is that it's pituitary. But unless I get an LDDS test (i think thats it) he won't know for sure. I can't afford that test in addition to the last one ($~250) so I elected to not do it. He said that adrenal is not treatable or not as easily treatable (i don't remember!). He is definitely a thorough vet, so I'm assuming he's correct, but he sometimes has to work around my budget, which makes things more difficult. I'll definitely get those numbers for you. Thank you for helping me with your breadth of knowledge! And bless you for taking care of dogs in need!

[randomguy]

Ok, got the pre and post acth results and spoke to the doctor. She said she really doubts it's hypothyroid based on the results. The pre was 4.4 ug/dl and the post was 23.5 ug/dl. The testing sheet says there can be false positives due to stress so the results must be interpreted with symptoms in mind and I feel like we've done that. Hope that makes sense and thanks!

[lulusmom]

It makes perfect sense. Thank you for sharing those results. A post stimulated cortisol of 23.5 ug/dL is definitely a result that is consistent with cushing's. In case I confused you in my previous posts, I want to clarify that I am more concerned about a primary hypothyroid misdiagnosis in a dog with suspected cushing's than the other way around. I would not suspect that low T4 thyroid hormone would cause enough stress to yield a false positive on an acth stimulation test.

Glynda

[randomguy]

Thanks for replying and checking everything out Glynda! So far, day 2, he seems to be tolerating the medication well so I guess that's a good sign. I guess we'll see how his levels are doing at the 2 week test...I'm gonna be optimistic!

[flynnandian]

http://www.tipper-squirtcushingfund.org/apply.html here you can apply for help with your medical bills.

[randomguy]

Thank you very much! I think I will be able to make due without that generous organization, but am definitely very happy it's there! I would love to donate to it someday.

Does anyone know where the cheapest place to get Vetoryl is? So far it seems like california pet pharmacy. Day 3, my dog is doing fine on the Vetoryl, which is nice. It may be me imagining things, but he seems to be wanting to play more than usual lol.

[molly muffin]

California Pet Pharmacy and Diamondback are both pharmacies that members here have used with success.