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Discussion Starter #1
Hey everyone, it's been a bit since I have been on the forum. Missed it!

Aesop has been experiencing a decline lately with his behavior issues. His T4 results, even on 0.8 mg BID of soloxine have never been better than very low normal. I think the highest reading I have is 1.1 ug/dL.

He was initially diagnosed as hypothyroid via the hemopet panel by the rescue he came from. He was very obese (has since lost 30+ lbs). Recently one thing led to another and we decided to withdraw him from soloxine for 8 weeks and run a full panel. During this time without changes to diet his weight has fluctuated +/- 2 lbs, staying right about 98. I know that sounds huge, but he is a very oversized dobe and this is a good weight for him. You can feel easily ribs without seeing all of them, he has reasonable muscle, etc.

Here are the results of his latest panel, reference range in ():
T3 55 ng/dL (45-150)
Total T4 0.7 ug/dL (0.8-3.5)
Free T4 13.3 pmol/L (8-40)
Free T3 1.6 pg/mL (1.7-5.3)
T3AA 0.6 (<2.0)
T4AA 0.9 (<2.0)
TSH 0.21 ng/mL (0-0.60)
TgAA is neg (follow up call placed to see if there is a numeric value for this)

To me this doesn't paint a clear picture of a hypothyroid dog, right? T4 is low yes, but free T4 is normal. TgAA is normal, TSH is normal. What other things could cause T4 to be chronically suppressed in a dog, even with high amounts of supplementation? Agh. I have asked the rescue to release his initial testing to me, and have forwarded this to his vet behaviorist for her take on it of course. But I am at a loss right now for what to do with my boy.
 

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In my experience, Dobermans tend towards the low normal on the range given. I've had dogs that were low normal their whole life with no issues and have one now that went on thyroid meds after dropping from low normal to low at age 7.... I also have one that has been on meds since age 2.
I'm not a vet, so can't say what you should do. I personally would probably do a low dose since some numbers do go below low normal..... but IMHO it is a personal call. If there are no symptoms, I don't think you could be faulted for leaving him off thyroid meds entirely.
 

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Discussion Starter #4
Thank you Fitzmar Dobermans. He has been on thyroid meds for ~3 years, barring the last 8 weeks so we could reassess the disease. Even on 0.8 mg 2x a day he never got up into the mid-high normal range that should be expected, which is why I pushed for this repeat full testing.

I just don't know if this could be caused by some other disease that I should now be looking for? He does have serious behavior issues that are being treated, as well as some serious pain issues. He had a bazillion x-rays today and we found that in addition to worsening arhtritis in his hips and knees, he has worrisome areas in his neck as well. All x-rays were sent to a radiologist for review and I am really hoping they don't diagnose CVI.
 

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My boy Ivan had potential thyroid symptoms. Tested through Hemopet and he was diagnosed and put on meds. Had his retest through my local vet and was told levels were good. Symptoms didn't improve so I contacted Hemopet. Had to retest through thelm. They recommended upping his dose. Still no improvement. So I had him tested for the fourth time. Again with Hemopet. New recomendation was that his dose was too high and his body was over compensating.

I felt like they were throwing balogna at a wall to see what would stick. My vet and the dermatologist both said he was not hypothyroid.

Took him off the meds.

TBC
 

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A quick google search tells me this:

"The total T4 test has been used for many years, but it can be affected by the amount of protein available in the blood to bind to the hormone. Free T4 is not affected by protein levels and is the active form of thyroxine. The free T4 test is thought by many to be a more accurate reflection of thyroid hormone function and, in most cases, its use has replaced that of the total T4 test.”

I’m not a vet, however. :)

I do know that a lot of vets who are familiar with dobes will treat a low normal Free T4 combined with a high normal TSH, even if neither are out of range. As Kip aged, he entered that group of dobes, and I’ve definitely seen an increase of energy since we started treatment--his levels are now right in the middle of where they are supposed to be.
 

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My boy Ivan had potential thyroid symptoms. Tested through Hemopet and he was diagnosed and put on meds. Had his retest through my local vet and was told levels were good. Symptoms didn't improve so I contacted Hemopet. Had to retest through thelm. They recommended upping his dose. Still no improvement. So I had him tested for the fourth time. Again with Hemopet. New recomendation was that his dose was too high and his body was over compensating.

I felt like they were throwing balogna at a wall to see what would stick. My vet and the dermatologist both said he was not hypothyroid.

Took him off the meds.

TBC
You are naively evaluating a very complex issue (canine thyroid disorders) with a very uneducated attitude. This health problem is serious and quite complex/difficult for veterinarians to treat well. Any Doberman owner who has a dog with low normal numbers on any thyroid bloodwork and/or any of a wide range symptoms listed below should read this book. I hope for the sake of your dog, that you will also read it. Untreated, this disorder, even at "mild" levels, can cause a wide range of very uncomfortable and even life-threatening problems for the dog.

http://file.walagata.com/w/the-salamander/3160196.pdf

Common symptoms of thyroid disorder:

"Canine thyroid disease can be tough to diagnose.The symptoms can be legion and sometimes contradictory: lethargy, mental lassitude, weight gain, dull coat, skin infections, constipation, diarrhea, cold intolerance, skin odor, hair loss, greasy skin, dry skin, reproductive problems, aggression, and more.

The associated diseases or conditions can be serious: megaesophagus, ruptured knee ligaments, testicular atrophy, cardiomyopathy, excessive bleeding, and corneal ulcers.

The disease can be inherited or of unknown or uncertain origin. The diagnosis can be complex; the treatment as simple as supplementing a basic essential hormone.

This is the description of canine hypothyroidism, the absence of sufficient thyroid hormone to maintain healthy body functions."

From: http://www.canismajor.com/dog/thyroid.html
 

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Discussion Starter #8
TriciaK I am on my phone and not able to read your links yet, but I am looking forward to doing so.

I am aware there is a cohort of dogs who are hypothyroid and have normal TSH and/or no TgAA. There seems to be some disagreement on how big this group is. If you do have inconclusive results, what follow up testing would you do?

Dog in question does not have a thin coat, does have some dry skin/dander, does have a history of cruciate disease, is clinically affected with vWD, has behavioral/aggression issues, does not heat seek (if anything avoids heat), has no known eye issues, recently had a clear echo and is scheduled to have a Holter at the end of May.

He is actively being treated by a veterinary behaviorist and I am having this discussion with her as well. I just want to make sure I am giving him the best chance at the best life.
 

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TriciaK I am on my phone and not able to read your links yet, but I am looking forward to doing so.

I am aware there is a cohort of dogs who are hypothyroid and have normal TSH and/or no TgAA. There seems to be some disagreement on how big this group is. If you do have inconclusive results, what follow up testing would you do?

Dog in question does not have a thin coat, does have some dry skin/dander, does have a history of cruciate disease, is clinically affected with vWD, has behavioral/aggression issues, does not heat seek (if anything avoids heat), has no known eye issues, recently had a clear echo and is scheduled to have a Holter at the end of May.

He is actively being treated by a veterinary behaviorist and I am having this discussion with her as well. I just want to make sure I am giving him the best chance at the best life.
"...hypothyroid and have normal TSH and/or no TgAA": This describes both of the males I've had, both of whom started having significant yet different symptoms at less than a year of age. Both treated with supplementation, both responded with symptoms significantly reduced.

Boon just had a six week period of no thyroid supplementation while his liver was struggling to recover. With in 45 days of been off the Soloxine, Boon's symptoms returned with a vengeance & grew steadily worse until we started it back last week. His symptoms are: thin coat down the spine, anxiety/nervousness, dandruff, malodor, serious itching.

Interestingly, when the symptoms emerged during his liver crisis, the vet school team immediately posited that he had allergies to dog food. I told them that I thought his symptoms would disappear once he could be put back on Soloxine because they had before. They didn't want to put him back on the supplement, stating, "It's highly unlikely he has thyroid dysfunction with normal TSH and no autoantibodies." Instead, they wanted to run very expensive allergy testing, which I refused.

Seriously, it was evident that they did not want to hear about his clinical history of symptoms improving with Soloxine supplementation, they were really stonewalling me about the whole idea of thyroid disorder. I will be interested to see their expressions at our recheck next week when I point out how the symptoms have all almost resolved now that he's back on the Soloxine supplement.

If I had a Doberman with your list of symptoms, and got low-normal results On bloodwork, I would be strongly insisting on a trial of thyroid supplementation. I would not spend a lot more on an extensive/expensive bunch of testing until the supplementation had been tried and the results documented after six weeks.

NOTE! I'm not a veterinarian Diagnosing your dog! I'm just telling you what I would do.
 

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Discussion Starter #10
Thanks Triciak, Aesop has been on thyroid supplementation at a relatively high dose (0.8 mg BID) for nearly 3 years. During this time his behavior problems have steadily worsened, and he had a cruciate ligament rupture. Even on such a high dose he never tested well into the normal range, always staying low normal. This is what is leading me to question whether or not this treatment is beneficial to him. Even after 8 weeks off his coat is lovely, his energy is good.

Dogs. So complicated :(
 

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Hey Tobester, too high of supplement dosage can cause its own problems and can definitely result in symptoms not resolving! Please read the book as soon as you can. I can't explain how the situation gets complicated by over supplementation but it is definitely a problem affecting symptom resolution.

The over supplementation issue happened back in the beginning for Boon (.8 mg 2 X day) and his symptoms actually got worse until I paid for our mobile vet and my husband (retired vet) to consult together with Hemopet. Hemopet strongly recommended that we reduce the supplementation and after 6 to 8 weeks his symptoms began resolving at .5 mg 2 X day. He has since moved to .6 mg two times a day because of maturing in weight (normal weight is 88 pounds).

Over-supplementation causes the body to do some weird things which I can't technically explain. However, I know from reading and experience that symptoms will often not resolve or even worsen with over supplementation. Unfortunately, veterinarians often just make a number calculation and don't really understand how the body reacts to under or over supplementation of thyroid meds.

Good luck with researching and keep us posted.
 

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Discussion Starter #12
Over three years we have altered his dose from 0.8 to 0.6 and back to 0.7 and 0.8 again, all in attempts reconcile his bloodwork with what was expected. During this time he has been treated by a leading, board certified veterinary behaviorist who has stated to us that she had never seen in her practice a case of aggression that was actually due to hypothyroidism. He has also been treated with pain medications and behavioral medications under her direction.

I just took the time to sit down and read Dr. Dodd book, and while I think she has educated the public and veterinarians about many facets of the disease, I believe she is doing a great disservice to dogs and dog owners who are dealing with serious behavioral issues when she makes it sound as though hypothyroidism is a legitimate cause. In fact, Michigan State University's board certified endocrinologists (which Dr. Dodds is not) have done research between the correlation of aggression and hypothyroidism and found no correlation to a negative correlation. That is hypothyroid dogs are no more likely to be aggressive or perhaps even less likely to be aggressive than non hypothyroid dogs.

Also, in reading the linked book by Dr. Dodds I was somewhat shocked to see her use the term "rage syndrome" as a behavioral diagnosis. This is not a legitimate diagnosis of a behavioral pathology in dogs, but a lay term that is non specific and can encompass any number of disorders.

tl;dr I no longer agree with Dr. Dodds recommendations nor provide her name as a source of information to people looking for information on hypothyroidism and vaccine titering. I do not believe her ideas have quality scientific support.
 

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I managed to over supplement Lana with diet. I was feeding beef gullets and kelp, unaware of the level of iodine in the kelp and that gullets are essentially the thyroid gland plus cartilage.

Stupid me.

Of the 3 dogs, she was the worst affected. She had no energy, her coat was horrible, she was lethargic. I took her to the Vet suspecting hypothyroidism. The poor Vet kept running the tests over and over, suspicious that her Idexx machine was broken - getting T4=8.4, 8, 7.7 etc. Apparently so far into hyperthyroidism the symptoms look about the same.

She looked into it and starting asking me about diet. We cut the gullets and the kelp from everyone's diet. She is now down in the low normal range - got there after 8 weeks. I did all the full testing thru Dr. Dodds. She also had almost fainting episodes between agility runs, poor girlie.

She is back to her normal exuberant self now.
 
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