Cushings and Hypothyroidism

[MacMajor01]

Cowboy's story. Cowboy is 12 1/2. One evening out of the blue he began excessive panting. I thought he had been poisoned somehow. I went and bought him pedialyte and replaced his water with that; he went through 2 bottles. That did not correct his panting, but I figured if he had been poisoned, it would have flushed his system well enough with that amount. It wasn't long before his excessive drinking began, so much so, that he would have an occasional accident overnight, so I began covering his water bowl at night. I thought I screwed up his system somehow w/too much pedialyte, because now he is consuming water like crazy! He has always had skin issues and had been on Apoquel in the past. Just a little hair thinning and dandruff, nothing really new to him that shampoo and Apoquel couldn't correct. I took him to the Vet thinking that would be the outcome again, but this time they said he has Hypothyroidism. I did not believe it, but started his dose of Thyroid Tabs 0.7 2x day. His follow-up blood work showed no change and they up-ed his dose to 0.8 2x day. So now he has put on excessive weight, is always hungry and his hair is really thinning! All of this is new, and the previous symptoms remained... excessive panting and excessive drinking. At this point I am frustrated and want him off the Thyroid Tabs, because it is not correcting any symptoms and only creating more!!! I share my concerns with the Vet, and they decide to do an ACTH (I think is the name of the Cushing's test). They first tell me that Cushing's Disease can effect the thyroid (so I am thinking false-positive?). The diagnoses comes back that he does have Cushings, and is now on day 6 of Vetoryl 120mg Once Daily. Nothing has improved. The Vet said it was fine for him to remain on both meds... but I am still thinking that Cushing's Disease has effected his Thyroid, and I want him off that medicine anyway because he must've have put on 5-10 lbs. since starting the meds... and also, when they retested his thyroid, they didn't test within the time window of him taking his dose of Thyro Tabs (I had read that his thyroid should be tested 4 hours after the dose?) Anyway, I went against what they suggested and 4 days ago I lowered his Thyroid Tab dose of 0.8 2x day down to 1x daily. I am scared to stop it altogether... I still have some of the 0.7 Thyroid Tabs, so I figure I will switch to that lower dose in a couple of days, one daily for a few days, and then stop them from there. I believe he was misdiagnosed for Hypothyroidism all along and it is just Cushing's Disease all along throwing off the thyroid levels, I don't know! So today will be his 6th dose (this evening) of Vetoryl, and I am not seeing any improvement. I don't know how long it takes... but any sound he hears, he thinks it is food! He is still drinking 2 liters of water a day, or more... his tail is looking like a rat tail... and ALL of this is NEW! It's either creating news signs and symptoms and/or not correcting the symptoms that started a few months ago. I am at a loss!

Is it safe to just stop these thyroid pills... I thought for sure they would tell me he didn't need them anymore since they found the right diagnosis.

And how long does it take for the Vetoryl to show signs of improvement? I am wondering if the Thyroid Tabs is stopping the Vetoryl from working correctly?

Other than a few easily manageable skin issues, Cowboy has been healthy his whole life! What the heck? Should I get a 2nd opinion? Should I at least ask for copies of his blood work? Will they give them to me?

Cowboy weighed 86 lbs prior to starting the thyroid tabs.... he's gotta be pushing 100 now... and all it appears to be in his stomach! This is NOT good... cannot be healthy. These darn thyroid tabs did this to him!

Thank You!
Tracy & Cowboy!

[Squirt's Mom]

Hi Tracy,

Welcome to you and Cowboy!

Yes, Cushing's can cause a condition called Euthyroid Sick Syndrome which usually clears up once the cortisol is in a more normal range. If the pup is truly hypothyroid then taking meds for both conditions is fine - the do not counteract with each other. Weight gain is caused by Cushing's as well as low thyroid so that cannot be used to determine the effectiveness of the thyroid treatment. Only a thyroid assay can tell you if the med is helping or now. The pot belly is a hallmark sign of Cushing's.

I am a bit concerned about the dose of Vetoryl Cowboy has started on in spite of the continuing signs you are seeing. The starting dose for dogs of his weight is 0.05mg/lb. Recent studies have shown that larger dogs (60 lbs+) are very often much more sensitive to this drug than smaller dogs and need a much smaller starting dose as a result. However you don't mention any of the signs of over dose - loss of appetite, loose stools/diarrhea, nausea/vomiting, or lethargy - so I am not panicked just yet. The concern is that the cortisol can suddenly drop too low so please keep an eye on your sweet boy for the signs I mentioned. If you see ANY of them, stop the Vetoryl immediately and call the vet for another ACTH and electrolyte check. Low cortisol is a life threaten situation so don't take any chances. Cowboy is six days into treatment so you could see signs of improvement or danger at any time so watch him closely the next few days.

I am assuming he is scheduled for either an ACTH or PVC monitoring test next week? This should be done 10-14 days after starting treatment, another at 30 days after starting treatment, then every 90 days thereafter IF the results are within range and signs are improved. This testing schedule starts all over at the 2 week mark with any dose change. So if he is not scheduled, please call his vet Mon and get this set up. Ask which test the vet will be using - ACTH or PVC - to monitor as they are handled differently and you will need to do different things before the test is given. So you want to be sure which one is used so you know what you are supposed to do.

Would you mind getting a copy of all the testing done to diagnose the Cushing's - the ACTH you mentioned plus any labs that show things like BUN, CHOL, ALP plus the test called the CBC? They should be glad to give them to you. (It is the perfect time to start the habit of asking for test result from now on so you can keep them in a file at home.) If you would post the abnormal results, too high or too low, from those tests it would help us to give you more meaningful feedback. I am also a bit concerned about the diagnosis because you say these signs started suddenly. Cushing's does not come on suddenly but very slowly, snail's pace slow, over years. In fact most people just think their dog is getting older and don't realize a disease is present. Cushing's is one of, if not THE, most difficult canine disease to correctly diagnose because so many other conditions share the same signs and can cause false positives on the tests for Cushing's. This happened to two of my babies - misdiagnosed because of other conditions/health issues that were present. A tumor on the spleen in one and multiple issues including COPD in the other. So the fact that you say this started suddenly causes me to wonder about the diagnosis. Was an abdominal ultrasound done? If not I highly recommend having this done if at all feasible. You want it performed on a high resolution machine which most GP vets don't have so you may need a referral to get this test done. It is well worth it tho as it will tell you a great deal about his organs and will also help determine if Cowboy has Cushing's and if so which form - adrenal or pituitary.

I'm glad you found us and look forward to seeing those test results soon!
Hugs,
Leslie

[MacMajor01]

loose stools, yes... that has just begun... likely since the vetoryl.

lethargy, yes. He has always been one to lay around, he is 12 1/2. However, he always gets up and follows me, or use to... now it's like he doesn't even know I left the room... sometimes I have to call his name several times to get him to 'wake up'... he lays and looks asleep, but a lot of times his eyes are open like he's in a trance. These two signs are since Vetoryl began.

Tracy & Cowboy

[MacMajor01]

I am not seeing my reply, so I hope this does not duplicate.

In response to loose stools and lethargy, yes to both since the start of Vetoryl. He is has gotten lazier and almost trance like.... sometimes he lays there as if asleep, but with his eyes open. Sometimes I have to call him a few times to 'wake' him up and/or snap it out of it. He has always been one to follow me everywhere, but now he mostly doesn't even hear me get up and leave the room. His stools have become loose, and sometimes seem very loose. All since the start of the Vetoryl.

I want to say thank you for your in-depth response. You have enlightened me in many, many ways! I am going to take your advice on everything and I will update with the lab work once I receive it!

I will say that I have noticed.... for quite some time now... one of his back legs slipping.... as if it glides behind him when he walks a little further than it should... or as if it is going to slip out from under him. Hope that makes sense. Most likely for a few good months or year. I thought perhaps hip dysplasia was setting in with age... but perhaps it was Cushing's setting in??? The laziness has been the norm for a long time... he is older... but it has never been an issue. I sit around, he sits around... I jump up, he jumps up... he has always followed suite... more of a mental stimulated dog... active when he needs to be. But NOW, way more less active... trance like, as I mentioned, since starting the Cushing's medicine. But again, the excessive panting and excessive drinking did happen in a days time. That morning, fine as usual, that afternoon... panting.... as I said, I gave him a lot of pedialyte, and that's when the excessive drinking began; neither have gone back to normal. In fact, I would say that his breathing has gotten more intense or off beat since Vetoryl!

THANK YOU from Tracy & Cowboy!

[Harley PoMMom]

Diarrhea and lethargy are signs that cortisol may have dropped too low so my recommendation is to have his cortisol checked. How is his appetite?

[Squirt's Mom]

Sorry for the delay in replies! A few years ago I fell and tore my rotator cuff then recently have had several more falls that injured it again. Asa result my computer time is limited for now. PT is helping thankfully and I hope to be back in full swing soon.

I agree with Lori - if you are still seeing the diarrhea and lethargy I would want an ACTH done to check the cortisol. Especially if Cowboy's appetite is waning too.