Changes

What is your diagnosis?  

What is your diagnosis?  

*<font color="white"> Shakespeare is [[Thyroid Pathology#Hyperthyroidism|<font color="white"> hyperthyroid </font>]]. T4 is over 6 times higher than it should be. ALP and ALT are increased which is very common in hyperthryoid cats, with approximately 9 out of 10 animals having raised enzyme levels. </font>

*<font color="white"> Shakespeare is hyperthyroid. T4 is over 6 times higher than it should be. ALP and ALT are increased which is very common in hyperthryoid cats, with approximately 9 out of 10 animals having raised enzyme levels. </font>

What are ALP and ALT short for? Where in the body do these enzymes come from?  

What are ALP and ALT short for? Where in the body do these enzymes come from?  

How would you treat this case?

How would you treat this case?

*<font color="white"> Shakespeare was treated with methimazole. The licenced product is called Felimazole® (Arnolds Veterinary Products). The initial dose is 2.5mg twice daily. By re-taking the total T4 level 3 weeks later the adequacy of the dose can be determined. If the T4 is still high the dose is increased and another blood sample taken 3 weeks later. It is important to satisfy yourself that the client is managing to give the tablets since in that case the cause of a second high T4 may be due to failure of the owner to administer the tablets! There are other treatment options. Surgical removal of the thyroid gland is possible. However, with unilateral excision there is a risk of recurrence (even if the other gland looks normal) and with bilateral excision there is a risk of iatrogenic hypoparathyroidism. Since hyperthyroid cats are high risk anaesthetic patients, they should be treated medically first. Another treatment, the current treatment of choice, is radioactive iodine treatment. Radioactive iodine concentrates in the thyroid gland and destroys it. However, few practices carry out this treatment, so the animal must usually be referred and the cat must remain at the centre for a long time. </font>

*<font color="white"> Shakespeare was treated with methimazole. The licenced product is called Felimazole® (Arnolds Veterinary Products). The initial dose is 2.5mg twice daily. By re-taking the total T4 level 3 weeks later the adequacy of the dose can be determined. It is important to satisfy yourself that the client is managing to give the tablets since in that case the cause of a second high T4 may be due to failure of the owner to administer the tablets! Another product, Vidalta® (Intervet UK), containing carbimazole has recently been licenced and has the advantage of only requiring once daily dosing. There are other treatment options. Surgical removal of the thyroid gland is possible. However, with unilateral excision there is a risk of recurrence (even if the other gland looks normal) and with bilateral excision there is a risk of iatrogenic hypoparathyroidism. Since hyperthyroid cats are high risk anaesthetic patients, they should be treated medically first. Another treatment, the current treatment of choice, is radioactive iodine treatment. Radioactive iodine concentrates in the thyroid gland and destroys it. However, few practices carry out this treatment, so the animal must usually be referred and the cat must remain at the centre for a long time. </font>

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