My big boy Gable - sweet Gabe is now at peace

[Joan2517]

Oh Joan, sorry I don't usually read these posts so I didn't realize all this was happening to poor Gable! And poor you gosh I hope you get to the bottom of all this soon. And if it is Cushings, everyone is here by your side supporting you. Plus you have so much knowledge about this and will be a great advocate for Gable. Huge hugs and love to you all.
Annie

I'm not really, Annie...I still don't know what it all means. We'll try the meds and see if it works. My cute vet thinks it is just this, but did say that if he doesn't start to improve, we will go further. He knows what i'm afraid of...

[labblab]

What was Gable's T4 on this new panel, and how far out of range was it?

From looking back in your thread, I see that Glynda talked earlier about the difference between a regular T4 and free T4 analysis. Do you know which T4 level was tested this time around? It might be worth the effort to have an advanced, complete thyroid panel performed before you start thyroid supplementation. I know some folks here favor using Dr. Jean Dodds; I personally favor using a specialized service such as Michigan State University's vet school lab. But either way, an advanced panel may indicate whether a low T4 reading is associated with primary hypothyroidism, or whether it is likely secondary to some other condition (such as Cushing's), for which you might want to keep pursuing some additional diagnostics right now.

I know the prospect of Cushing's is so very scary for you. But I suspect that, in the back of your mind, you're going to continue to worry about it anyway . So perhaps it would be better to go ahead and pursue a more definitive diagnosis now, so that you can truly put together the very best treatment plan for Gable.

Marianne

[Joan2517]

The first part of the test showed low, I can't remember what he said, but it was lower than the last time when it was low normal. I'll call them and have them send that to me. He said we'd wait for the second part of the test to come back with the other values, and the ones I posted were the only ones out of range.

I think that for now, Marianne, I am just going to treat him for this and see if he gets better. Dr. Cutie did say that we would look further if he doesn't respond. He hasn't peed in the house since that day, so it could've been a combination of not going out again before I left and me being late.

I can deal with hypothyroidism...my husband and I both had Thyroid Cancer, had our thyroids removed, and take Synthroid.
Must be a family trait...

[labblab]

OK, Joan. We'll surely hope you'll see improvement, then, with the thyroid supplementation. In good conscience, though, I need to point out that excessive thirst and urination are not typical of hypothyroidism. In fact, in terms of thyroid function, it's the reverse: hyperthyroidism is associated with elevated thirst/urination.

I'm particularly sensitive to this issue because my own Cushpup, Barkis, was initially misdiagnosed for several months as simply being hypothyroid. He suffered from significant hair thinning on his flanks and haunches (which could have been just thyroid), but also from excessive thirst and urination (which I now know was not likely to be thyroid). Also, unlike hypothyroid dogs who are cold and seek out warm spots, my Barkis was always panting and seeking out cool spots. We ended up seeing a specialist for a liver biopsy due to his chronically elevated ALKP, but as soon as the IMS heard my description of his symptoms, he cancelled the biopsy and instead tested for Cushing's. After that, it became clear that Cushing's was the central diagnosis, and the low thyroid reading was likely just a consequence.

So if Gable's excessive thirst doesn't resolve or even worsens with supplementation, I do think you'd need to look beyond the thyroid. Please, please bear in mind that even if Gable were to have Cushing's, his situation is probably quite different from Lena's. She was an elderly dog who suffered from heart and respiratory issues that may not even have been related to the Cushing's at all. Plus, her Cushing's was due to an adrenal tumor (as opposed to the more common pituitary tumor) and that may also have complicated the overall picture for her. If Gable were to have Cushing's, he would be traveling his own treatment path, with every reason to believe that his cortisol could be effectively controlled and his behavior and appearance normalized.

But I realize I'm putting the cart ahead of the horse! So we can just table this conversation, and only return to it if we need to (which hopefully we won't!).

[Joan2517]

Thanks, Marianne...The T4 numbers were on the bottom of the page and I didn't notice them. I'll keep paying attention to his drinking...

T4: 0.5, ref range 0.8 - 3.5

T4: (Equilibrium Dialysis) 6, ref range 8 - 40

[labblab]

I know I said I was shelving my discussion, but I do want to mention one more thing. Once you start thyroid supplementation, any further thyroid diagnostics will be skewed. So if you did have any interest at all in having an extended thyroid panel done, you ought to have the blood drawn for that now. Otherwise, you have to wait until supplementation has been halted for about six weeks or so before you could accurately assess native thyroid function again.

This info may not have any bearing on your own decision right now, especially since it looks as though Gable's T4 was re-analyzed using equilibrium dialysis. But I just wanted to add it for other readers who may be following this thread and are considering thyroid testing for their own dogs.

[Joan2517]

Gable is going for the LDDST test on Monday. Even though his thyroid levels are normal after being on Soloxine for a few months, he's still drinking/peeing a lot. No more accidents in the house after that one time, but his panting has increased to the point where it is unbearable to watch. So, i am biting the bullet and having him tested.

They said he can have a light breakfast. I just want to check with all of you to make sure that is okay.

[Harley PoMMom]

With the LDDS test, fasting is usually preferred, however if this makes Gable have undue stress than a light breakfast should be ok. Wishing you both luck with the testing and let us know how it goes.

Hugs, Lori

[Joan2517]

Thanks, Lori. I thought I had remembered something about fasting. I might just give him a little something with his Soloxine.

[Joan2517]

Gabe's results are in and according to the vet, no Cushing's. I put his blood work in his album, but here they are anyway.

Sample 1: 4.2 ref range: 1.0 - 5.0
Sample 2 Dex: 0.8 ref range: 0.0 - 1.4
Sample 3 Dex: 1.3 ref range: 0.0 - 1.4

What do you think?

He even called their Internal Medicine guy because he was worried about the closeness of Sample 3, but was told that was okay.

The IMS thinks that the panting could be from Pulmonary Hypertension. We'll take an x-ray next, but I'm wondering if it could be Pancreatitis.