Spontaneous primary hypothyroidism in 7 adult cats

Clinical hypothyroidism in a cat associated with sulfonamide administration for the management of intracranial nocardiosis

A 2-year-old cat was referred for suspected generalised seizure activity and reclusive behaviour, with a history of non-resolving facial abscess. Magnetic resonance imaging (MRI) revealed a contrast enhancing lesion occupying the left calvarium and adjacent peripheral tissues. The intracranial lesion was causing significant mass effect, with oedema and transtentorial herniation. Nocardia nova was isolated from the lesion and identified by DNA sequencing. Treatment consisted of debridement via craniotomy and ventral bulla osteotomy, and combination antibiotic therapy with clarithromycin, amoxycillin and trimethoprim-sulfonamide (sulfadoxine parenterally, then sulfadiazine orally). After several weeks of antibiotic therapy, the cat developed weakness, bicavitary effusion, myxoedema, non-regenerative anaemia and azotaemia. Total thyroxine (TT4) was below the detectable limit and canine thyroid stimulating hormone (cTSH) assay was markedly elevated at 7.53 ng/mL (reference interval 0.15-0.3 ng/mL). Discontinuation of sulfonamides and administration of levothyroxine resulted in resolution of clinical signs. The cat was subsequently able to discontinue levothyroxine, with recovery of euthyroid state. To the authors' knowledge, this is the first report of clinical hypothyroidism in a cat treated with sulfonamide antibiotics and may influence antimicrobial selection and monitoring during therapy. This report also described the management of an atypical presentation of nocardiosis with intracranial extension.

Thyroid lesions in a population of domestic cats submitted to necropsy without clinical suspicion of thyroid disease

Although hyperthyroidism is the most common endocrine disorder in elderly cats, systematic studies investigating the prevalence of thyroid lesions in feline animals are scarce. Our objective was to evaluate morphological changes in the thyroid glands of 61 cats submitted to necropsy without clinical suspicion of hyperthyroidism. Thirteen (13/61 [21.3%]) cats had thyroid enlargement and 54/61 (88.5%) had some histological thyroid changes. Proliferative lesions were histologically seen in 33/61 (54%) cats while non-proliferative lesions were observed in 48/61 (78.7%) cats. Thyroid hyperplasia (18/33 [54.5%]) and cystic adenoma (6/33 [18.2%]) were the most prevalent proliferative changes and lesions with little or no clinical significance (37/61 [60.6%]), degenerative (31/61 [50.8%]) and inflammatory changes (12/61 [19.7%]) were the most common non-proliferative changes. Among cats with proliferative lesions, 16/33 (48.4%) had a proliferation grade ≥A4, a grade previously associated with clinical hyperthyroidism. Although the cats from this study did not have any clinical diagnosis of thyroid disease, it is possible that one or more had some degree of clinically unnoticed thyroid dysfunction. The high prevalence of follicular lesions in this study highlights the importance of a more careful clinical and pathological investigation regarding thyroid diseases in mature and elderly cats.

Signalment and laboratory findings in cats with diabetes mellitus in Germany: a retrospective review of laboratory submissions of 129,505 cats

OBJECTIVES

The aims of this study were to compare signalment and laboratory parameters between diabetic (D) and non-diabetic (ND) cats and poorly-controlled diabetic (PD) and well-controlled diabetic (WD) cats in Germany.

METHODS

Laboratory data from Antech Lab Germany between 2015 and 2018 were retrospectively analysed. Age, sex, red blood cell count (RBC), creatinine (CREA), alkaline phosphatase (AP), alanine aminotransferase (ALT), bilirubin (BILI), cholesterol (CHOL), triglycerides (TRI), glucose (GLU) and total thyroxine (TT4) were compared between D (fructosamine ⩾340 µmol/l) and ND cats, and PD (fructosamine >500 µmol/l) and WD (fructosamine 340-500 µmol/l) cats. The proportion of cats with anaemia (RBC ⩽4.21 ×1012/l), CREA >250 µmol/l, ALT >455 U/l, AP >315 U/l, BILI ⩾35 µmol/l and TT4 > reference interval (RI) was compared between PD and WD cats. Data are presented as median and interquartile range (IQR) and analysed using non-parametric tests. Significance was P<0.05, and effect size was assessed by Cramér V or r.

RESULTS

In total, 129,505 cats were included (D: n = 9334 [prevalence 7.2%], WD: n = 5670/9334 [60.7%]). The median age of D and ND cats was 12 years (IQR D 9-14; ND 9-15); there was no difference in sex. A significant difference was found between groups (D vs ND; PD vs WD) for all parameters studied. Considering the effect sizes and medians outside the RI, the only relevant difference was higher CHOL, TRI, AP and GLU in PD compared with WD (CHOL: PD 7.46 [5.85-9.32] vs WD 5.44 [4.32-6.97] mmol/l, P<0.001, r = 0.39; TRI: PD 1.44 [0.84-3.66] vs WD 0.78 [0.5-1.35] mmol/l, P <0.001, r = 0.35; AP: PD 66 [47-92] vs WD 35 [23-59] U/l, P <0.001, r = 0.39; GLU: PD 23.7 [20.15-27.3] vs WD 6.89 [5-11.31] mmol/l, P <0.001, r = 0.69).

CONCLUSIONS AND RELEVANCE

Laboratory changes in diabetic cats were mild and mainly associated with lipid derangements.

Feline congenital hypothyroidism: a case report

We report a two-month-old male cat weighing 630 grams with congenital hypothyroidism. The main complaints were difficulty defecating for more than three days and prostration. Physical examination revealed a broad, flat face, a short neck, enlarged submandibular lymph nodes, chemosis, mild bilateral mucopurulent ocular discharge, seborrheic coat, with gingival thickening around the upper and lower deciduous incisor teeth with partial eruption. The abdomen was distended due to constipation and right unilateral cryptorchidism. Based on this, feline congenital hypothyroidism was suspected. Hormonal tests (free T4 by equilibrium dialysis of 0.06 ng/dl, total T4 of 0.1 ng/ml and TSH of 4.7 ng/ml) confirmed this. Treatment was started with levothyroxine sodium (5-32.2 µg/kg/day). After 120 days of treatment, there was clinical stabilization. Then the patient underwent orchiectomy of the left and of the right ectopic testicles, and at 380 days of treatment, the thyroid scintigraphy showed intense uptake of the radiopharmaceutical by both thyroid lobes and a significant increase in volume. Clinical evaluation showed weight gain (2.6 kilograms during treatment), improvement in the shape of the skull, and a notable increase in body size. At 17 months of age, hormone values were within the reference limits after administration of levothyroxine sodium (32.2µg/kg/day).

2023 AAHA Selected Endocrinopathies of Dogs and Cats Guidelines

Canine and feline endocrinopathies reflect an endocrine gland disease or dysfunction with resulting hormonal abnormali ties that can variably affect the patient's wellbeing, quality of life, and life expectancy. These guidelines provide consensus recommendations for diagnosis and treatment of four canine and feline endocrinopathies commonly encountered in clini cal practice: canine hypothyroidism, canine hypercortisolism (Cushing's syndrome), canine hypoadrenocorticism (Addi son's disease), and feline hyperthyroidism. To aid the general practitioner in navigating these common diseases, a stepwise diagnosis and treatment algorithm and relevant background information is provided for managing each of these diseases. The guidelines also describe, in lesser detail, the diagnosis and treatment of three relatively less common endo crinopathies of cats: feline hyperaldosteronism, feline hypothyroidism, and feline hyperadrenocorticism. Additionally, the guidelines present tips on effective veterinary team utilization and client communication when discussing endocrine cases.

Infertility In Queens: Clinical approach, experiences and challenges

CLINICAL CHALLENGES

It is not easy for a veterinarian to determine the cause of infertility in a queen. The simplest method is to start by investigating the most common causes and then progress by successive elimination to the less common causes. For example, mating problems are commonly responsible for reproductive failure, and owners should be particularly vigilant in checking that the mating is progressing satisfactorily. Frequently, a veterinarian may have to determine, among other things, if there is a uterine or hormonal disorder or if an infectious pathology may be involved. In the case of a queen that is not cycling, it is important to differentiate a lack of onset of puberty in a young queen from a lack of cyclicity in an adult queen.

AIM

This review sets out a practical, step-by-step approach that veterinarians can follow, starting with the most common causes of infertility in queens and moving towards more rare or specific causes.

EQUIPMENT AND TECHNICAL SKILLS

Simple techniques such as vaginal smears are essential to determine if a queen that is ready to be mated is in full oestrus, if a queen is cycling or not and to diagnose inflammation of the genital tract. Veterinarians should be familiar with the peculiarities of the swabbing technique in cats, as well as the interpretation of feline vaginal cytology. Progesterone assays are useful on many occasions in the diagnosis pathway. A laboratory capable of performing karyotypes should ideally be available. Finally, it is important to be able to perform an ultrasound examination of the ovaries and uterus in a queen.

EVIDENCE BASE

Although it appears that infertility is a problem among purebred queens, there is a lack of knowledge in this area and too few published studies. Some causes of feline infertility remain poorly investigated.

Hyperthyroid cats and their kidneys: a literature review

Hyperthyroidism and chronic kidney disease (CKD) are common diseases of geriatric cats, and often occur concurrently. Thus, a thorough understanding of the influence of thyroid function on renal function is of significant value for all feline practitioners. Among other effects, hyperthyroidism causes protein catabolism and increases renal blood flow and glomerular filtration rate (GFR). These effects render traditional renal markers insensitive for the detection of CKD in cats with uncontrolled hyperthyroidism. Furthermore, the development of iatrogenic hypothyroidism with over treatment of hyperthyroidism can be detrimental to renal function and may negatively affect long-term survival. This review discusses important diagnostic considerations of feline hyperthyroidism, as well as key treatment modalities, with an emphasis on the use of radioiodine and the importance of post treatment monitoring of thyroid and renal parameters. In Australia, a common curative treatment for cats with benign hyperthyroidism (i.e. thyroid hyperplasia or adenoma) is a fixed dose of orally administered radioiodine, regardless of the serum total thyroxine concentration at the time of diagnosis. This review discusses the long term outcomes of this standard of care in comparison with current, relevant research literature from around the world. Finally, this review explores the use of symmetric dimethylarginine (SDMA) in assessing renal function before and after treatment in hyperthyroid cats. SDMA correlates well with GFR and creatinine in non-hyperthyroid cats, but our understanding of its performance in hyperthyroid cats remains in its infancy.

Case Report: Cytologic Description of Somatotroph Pituitary Adenoma in a Cat

This case report describes for the first time the cytologic characteristics of a hormonally secreting pituitary adenoma in a cat. An 8-year-old female spayed domestic long-haired cat was referred with a previous diagnosis of hypersomatotropism and secondary diabetes mellitus 7 months prior. Clinical signs included weight loss, polyphagia, polyuria, and polydipsia. Serum insulin-like growth factor-1 was 340 nmol/L (RI: 12-92), and CT scan revealed a hypophyseal mass, and a presumptive diagnosis of acromegaly was made. A transsphenoidal hypophysectomy was performed. A fragment of the pituitary gland was subjected to a squash preparation and cytology revealed a neuroendocrine neoplasm characterized by anisokaryosis and prominent nucleoli. Additional cytologic findings included cell cohesiveness, indistinct cytoplasmic borders, nuclear crowding, molding, and fragmentation. A diagnosis of adenoma was based on a lack of histopathologic or imaging evidence of invasion. A week later, during post-surgical hospitalization, the patient worsened and died. Histopathology from a necropsy procedure revealed fibrinosuppurative meningitis as a post-surgical complication. Pituitary adenomas might have an aggressive cytologic appearance, despite a lack of histopathologic invasion or dissemination.

Utility of a canine TSH assay for diagnosis and monitoring of feline hyperthyroidism

OBJECTIVE

This retrospective study was initiated to evaluate the utility of TSH measurements using a common canine TSH assay to diagnose and monitor feline hyperthyroidism after radioiodine or thyreostatic drug treatment.

MATERIAL AND METHODS

The electronic database of the University of Veterinary Medicine Vienna was searched for combined TSH and T4 measurements. 217 pairs of TSH and T4 from 136 cats with possible hyperthyroidism were assigned to group A (untreated; n = 24) and B (treated; n = 193). Measurements in group B were then subcategorized according to T4 concentrations (reference range 15-50 nmol/L): group B1 = elevated T4 (n = 46), group B2 = normal T4 (n = 84) and group B3 = decreased T4 (n = 63). Group B2 was further divided into cats with low normal (group B2a; n = 35), medium normal (group B2b; n = 29) and high normal (group B2c; n = 20) T4 concentrations.

RESULTS

TSH was detectable in 4 (17 %) of the 24 untreated cats (group A) and did not return to normal despite seemingly successful therapy in two. Increased TSH concentrations were observed in 3.6 % of the treated cats in group B2 and 2.9 %, 6.9 %, and 0 % in subgroups B2a, B2b and B2c, respectively. Forty-four percent of the treated cats with a decreased T4 (group B3) had an increased TSH concentration. TSH correlated with treatment length (r = 0.358, p = 0.004) and was significantly higher in cats treated for more than 3 months (p = 0.008).

CONCLUSION

TSH was detectable in a significant number of untreated hyperthyroid cats and thus this parameter should not be used to definitively rule out feline hyperthyroidism. Furthermore, the very low prevalence of increased TSH concentrations in treated hyperthyroid cats with a normal T4 and cost benefit calculations do not support the routine measurement of TSH in these cats. The fact that TSH correlated with time since treatment start and 56 % of the cats with a decreased T4 had TSH concentrations within the reference limits, suggests delayed recovery of the pituitary thyrotrophs which might explain the low prevalence of subclinical hypothyroidism in the present study.

CLINICAL RELEVANCE

TSH measurement in cats with suspected or treated hyperthyroidism using a canine assay lacks diagnostic sensitivity and can only complement therapeutic decision-making.

Association of recessive c.430G>A (p.(Gly144Arg)) thyroid peroxidase variant with primary congenital hypothyroidism in cats

BACKGROUND

Primary congenital hypothyroidism (CH) is a rare endocrine disorder in cats with a largely unknown genetic cause.

OBJECTIVES

Describe the clinical presentation of CH in 11 affected cats and identify the causal genetic variant.

ANIMALS

Eleven CH-cats from 10 unrelated families, 11 CH-free family members, 21 unrelated CH-free cats, and 155 unrelated nondiagnosed cats from different breeds.

METHODS

Case control study of CH-cats and their siblings (2019-2021). Diagnosis was based on low to low-normal serum thyroxine (T4) concentrations, high thyroid-stimulating hormone (TSH) concentrations and clinical signs compatible with CH. We identified the causal variant using Sanger sequencing, genotyping via PCR-RFLP and variant interpretation using ACMG/AMP guidelines.

RESULTS

All CH-cats (5 weeks-8 years) had disproportionate dwarfism. A goiter was not palpable in all. Thyroid scintigraphy with radiopertechnetate showed abnormally high uptake by thyroid glands, whereas scintigraphy with radioiodine showed abnormally low uptake, compatible with a defect in iodine organification by thyroid peroxidase (TPO). All cases were homozygous for TPO variant XM_006930524.4:c.430G>A(p.(Gly144Arg)), while none of the CH-free cats were. All sampled parents were heterozygous for this recessive variant. This variant was found in 15 cat breeds with an estimated allele frequency of 9%.

CONCLUSIONS AND CLINICAL IMPORTANCE

Disproportionate dwarfism, abnormally high TSH and abnormally low to low-normal T4 concentrations are diagnostic for CH in cats. All cases had dyshormonogenesis demonstrated by thyroid scintigraphy. This novel TPO missense variant (not described in humans) causes CH in cats and awareness of it can assist in diagnosis and breeding.

Serum thyroxine and thyrotropin concentrations decrease with severity of nonthyroidal illness in cats and predict 30-day survival outcome

Background

In cats, nonthyroidal illness affects serum thyroid hormone concentrations. Serum thyroxine (T₄) and triiodothyronine (T₃) concentrations commonly decrease, whereas free T₄ (fT₄) concentrations vary unpredictably. Limited information exists regarding effects on serum thyrotropin (thyroid‐stimulating hormone [TSH]) concentrations in cats with nonthyroidal illness syndrome (NTIS).

Objectives

To characterize alterations in thyroid function that develop in cats with NTIS and to correlate these alterations with severity and outcome of the nonthyroidal illness.

Animals

Two hundred and twenty‐two cats with NTIS and 380 clinically normal cats of similar age and sex.

Methods

Prospective, cross‐sectional study. All cats had serum T₄, T₃, free T₄, and TSH concentrations measured. Cats were grouped based on illness severity and 30‐day survival.

Results

Cats with NTIS had lower serum T₄ and T₃ concentrations than did normal cats (P < .001). Serum fT₄ and TSH concentrations did not differ between groups. Serum T₄, T₃, and fT₄ concentrations progressively decreased with increasing disease severity (P < .001). The 56 cats that died had lower T₄, T₃, and TSH concentrations than did the 166 survivors, with no difference in fT₄ concentration. Multivariable logistic regression modeling indicated that serum T₄ and TSH concentrations both predicted survival (P < .02).

Conclusions and Clinical Importance

Cats with NTIS commonly develop low serum T₄, T₃, and TSH concentrations, the prevalence and extent of which increases with disease severity. Clinicians should consider evaluating thyroid function in cats with severe NTIS, because doing so could help determine probability of successful treatment responses before investing considerable time, effort, and finances in addressing the underlying disease.

Cluster of cases of congenital feline goitrous hypothyroidism in a single hospital

OBJECTIVES

To describe the clinicopathological findings and outcomes of cases of feline congenital hypothyroidism diagnosed in a single veterinary hospital in Santiago, Chile.

MATERIALS AND METHODS

Medical records were searched for cases of congenital hypothyroidism over an 18-month period. Inclusion criteria were a diagnosis of congenital hypothyroidism based on consistent historical and clinical findings, a low or low-normal serum total T4 and elevated serum canine TSH (cTSH).

RESULTS

Six unrelated cats ranging in age from 4 to 19 months met the inclusion criteria. The most common historical signs were small stature and lethargy. All cats had disproportionate dwarfism, delayed tooth eruption, retained deciduous teeth, bilateral palpable goitres and low rectal temperatures. Other findings were bradycardia, obesity, poor hair coat and focal alopecia on the ventral aspects of the elbows and hocks. In all cases, cTSH was markedly elevated. Sequential changes noted after the initiation of therapy included normal T4 after 6 weeks, improved hair coat and increased physical activity by 8 weeks, normal cTSH by 10 weeks and normal physical appearance and dentition after 4 months. Goitres shrank markedly but remained palpable. Hypothyroidism was well managed clinically in all cases 2 years after diagnosis except for one cat that died of unrelated causes.

CLINICAL SIGNIFICANCE

This is the first report to describe a cluster of congenital hypothyroidism cases in non-related cats that were presented over a short period of time. Growth defects resolve with treatment, even in cats diagnosed after puberty. Larger, prospective multi-centre studies are warranted to determine the incidence of congenital hypothyroidism in cats.

Short-term biological variation of serum thyroid hormones concentrations in clinically healthy cats

Thyroid disease is common in cats, but little is known about the biologic variability of serum thyroid hormone concentrations and its impact on diagnostic utility in either healthy cats or cats with thyroid disease. The purpose of this study was to determine the biological variation, index of individuality, and reference change values for thyroid hormones and thyroid-stimulating hormone (TSH) in clinically healthy cats. Serum samples for analysis of total thyroxine (T₄), triiodothyronine (T₃), free T₄ by dialysis, and TSH were obtained weekly for 6 wk from 10 healthy cats, then frozen until single-batch analyzed. Data were evaluated for outliers, and we determined the CV within individual cats (CV_I) and between individual cats (CV_G) for each hormone and the variation between duplicates or analytical variation (CV_A). The index of individuality and reference change values for each hormone were then calculated. Serum concentrations of total T₄, free T₄, T₃, and TSH all showed greater variation between cats (CV_G) than within cats (CV_I). Total and free T₄ had an intermediate index of individuality (1.1 and 1.2, respectively), suggesting that these hormones would be best evaluated by a combination of their population-based reference intervals and reference change values. Serum TSH concentrations had high index of individuality (1.8), suggesting this hormone would be best evaluated with reference change values rather than the population-based reference interval. Total T₃ also had a high calculated index of individuality (1.8); however, T₃ had high ratio of analytical variation (CV_A) to within cat variation (CV_I), so RCV could not be accurately calculated. This study demonstrates that clinically normal cats show considerable interindividual biological variation in serum thyroid hormone and TSH concentrations, whereas the intraindividual variability in hormone concentrations is much narrower. This suggests that for all serum thyroid hormones, but especially serum TSH and T₃ concentrations, comparing individual cat's hormone results to a population-based reference interval may be misleading, especially in those with early or subclinical thyroid disease. Clinicians might improve the diagnosis of feline thyroid disease by establishing baseline concentrations of T₄, free T₄, T₃, and TSH for individual cats (ideally when healthy) and applying reference change values to subsequent measurements.

Spontaneous primary hypothyroidism in 7 adult cats

BACKGROUND

Naturally occurring hypothyroidism in adult cats is rare, with only 4 cases reported.

OBJECTIVES

To describe the historical, clinical, laboratory, and scintigraphic features of adult cats with spontaneous hypothyroidism.

ANIMALS

Seven adult cats referred for suspected hypothyroidism.

METHODS

Prospective case series. We collected data on cats' signalment, clinical signs, results of physical examination, routine laboratory and thyroid hormone testing, and thyroid imaging (thyroid scintigraphy or ultrasound). We subsequently treated cats with levothyroxine and evaluated their response to treatment.

RESULTS

Cats ranged from 3.5 to 11 years, with no apparent breed predilection; 6/7 cats were male. Only 2/7 cats were initially tested because of signs of hypothyroidism (hair-coat changes, lethargy, obesity); others were tested for routine thyroid monitoring or palpable thyroid nodules. Four were azotemic (serum creatinine, 2.2-3.4 mg/dL). Six of the cats had low serum thyroxine (T4 ) and free T4 (fT4 ) concentrations, whereas all 7 cats had high thyroid-stimulating hormone (TSH) concentrations. In 6/7 cats, thyroid scintigraphy revealed bilateral goiter with intense radionuclide uptake; imaging showed no visible thyroid tissue in the other. After levothyroxine treatment, serum concentrations of T4 and fT4 increased and TSH fell; high serum creatinine normalized in azotemic cats; and repeat imaging showed reduction in goiter size.

CONCLUSIONS AND CLINICAL IMPORTANCE

Primary hypothyroidism develops in adult cats, with a higher prevalence than previously thought. Most cats appear to develop a goitrous form of hypothyroidism associated with thyroid hyperplasia, whereas thyroid atrophy appears to be less common. With levothyroxine replacement, clinical and laboratory abnormalities improve or resolve.