[TeachersPet]

My 2 year old Dobe was diagnosed with hypothyroidism back in April. After initially stabilizing on a dose of thyroxin, his 6 week retest showed his numbers plummeting back down to hypro range. Switch to levothyroxine at .8mg per day and after 12 weeks his Free T4 has gone down from 22.2 to 19.6.

Vet says he's in the "normal" range, but the range is 7.7-47.6 and hypo dogs should be on the upper end. She's at a bit of a loss as to why he's still uncontrolled at this point, and mentioned referring me to an internal specialist which I'm thinking will be my next step.

In the meantime she's going to recontact the clinic for me and have them check his blood for retesting the TSH levels and ALT levels as both were high when he was initially diagnosed but they haven't rechecked to see if those levels have come down at all since (why not??). My understanding is continued high levels could indicate that he's simply a fast absorber, so he just needs a higher dose apparently. A repeat of a high ALT level could also indicate an uncontrolled secondary issue with the liver that we just caught by chance....and of course my brain immediately jumps to CAH.

I'm also concerned about the connection between untreated thyroid/over-treated thyroid problems and heart concerns. Can anyone remind me of the connection, or the worry? What should I be watching for/aware of/do/not do?

I'm so frustrated and worried at this point.

 

[Adara]

It's been a while since I've had a low thyroid dog, is there a reason she won't give more thyroid? My low thyroid Dobe took the most medication my vet at that point had ever prescribed and that was just to be Low normal. He took 1.6 mg TWO times a day. Granted this was more than 10 years ago so maybe things have changed since then. It took us many months to get him up to that point and barely to low normal.

 

[sam&macksmom]

My vet immediately referred us to an endocrinologist when Sam's levels were low. He takes Soloxine (brand name) .8mg, twice daily. One pill in the am, one in the pm. Sam is 7 so the specialist wanted him on higher med levels because as a dog ages, thyroid levels can decrease.

His levels are now stabilized. DT member Vivienne suggested hypo dogs take the name brand thyroid med (Soloxine) so I ordered it online and my vet approved the prescription through the online source.

Can your vet refer you to a specialist?

 

[TeachersPet]

Adara, vet did mention we could up his dose...right now he's getting .4mg of eltroxin twice a day, and she mentioned giving him another .8mg daily. She sort of threw it out there though as a "we could see what happens" sort of thing, so I didn't know how much to trust that.

Sam and Macs-yes, she's going to refer me to a specialist. I'm wondering though what they'll be able to do? Will they just look at his bloodwork and prescribe something different/more? Will they need to see him at all? I'm not sure what's there to see, as it's all internal at this point.

Did I mention I'm frustrated!?

 

[sam&macksmom]

Well, the specialist can give you a more indepth review of the levels and provide a solid game plan to get the levels up. The thyroid affects many body functions so my vet wanted to make sure we treated it with the knowledge of a specialist involved.

I'm not familiar with other thyroid meds so not sure if a specialist would provide something different.

It's been almost 2 years since Sam started his meds. He's checked every 6months, bloodwork sent to MSU (Michigan State University).

 

[vivienne00]

Additionally, you can have the results (all of them) sent to Dr. Jean Dodds for about $45 and she will assess his situation and make a recommendation for Soloxine and at what level. The starting dose is usually a function of their weight in kg and is quite close - e.g. 72lb dog goes on .7mg BID, 64lb bitch goes on ,6mg BID, 88lb goes on .8mg BID. Then it gets rechecked in a couple of months and increased or decreased.

The TSH is the Thyroid Stimulating Hormone and really doesn't need to be checked very often. I have a dog whose TSH was off the charts and yet his T3 didn't register.

Dr. Jean Dodds - Canine Thyroid Testing | Hemopet.org

What I do is I get my vet to draw the blood, put it in the vial per her instructions and then I mail it to Dr. Dodds along with the request form. My vet charges me about $20 for the blood draw, correct vial and spinning it up. You can get a full thyroid panel plus chemistry panel for $125 with their analysis. She has a non-profit study underway for the thyroid and you tell your vet you are participating in the non-profit study. I get other special analysis like Bromide levels for KBr done.

It is weird the first time you ask your vet to give you the blood in a vial but I emphasised the non-profit study for seizures and thyroid etc. My vets were impressed with her credentials and talked with me about her and what she was doing etc. I was also spending a lot of money at my vet for Cato and his weekly fluid draws so maybe they felt this helped me thru the bad times.

 

[Audrey1]

TeachersPet, if you are giving your dog a total of .8 mg a day (2 doses of .4 mg/day) and she wants to increase it by another .8 mg, that would seem all right as long as that is the normal increment they like to increase it by. Otherwise she could try an increase of .4 a day for a total of 1.2 mg/day; get retested in 4 weeks and see where your dog's levels are.
Given the amounts that Adara and Sam&Macksmom's dogs take, it would appear that an increase of .8 is not a huge amount, even tho it is double what your dog is taking now.
(Just saw vivienne's post - BID is twice a day, so having your dog on .8 twice a day sounds in line with what viv says. You can tell your vet you want to try that and then get retested).

TSH level being high does not mean he is a fast absorber. TSH means that there is more of the thyroid stimulating hormone in his blood. The TSH level goes UP when the thyroid is underactive...and the higher the TSH, usu the lower the thyroid is. eg. when one's thyroid is at a normal level, your own body does not need to produce the TSH which is the hormone to stimulate the thyroid gland ...so if his thyroid is at a normal range, then the TSH readings would be lower since his body isn't trying to get his thyroid gland to produce more thyroid. Don't know if this makes sense, but that is how TSH works.

As for heart concerns, an under and an over active thyroid are not ideal for the heart. The overactive thyroid causes the heart to beat abnormally fast while the underactive thyroid usu also presents itself in a slower beating heart but also perhaps muscles that aren't as strong as they should be. The thyroid really regulates the metabolism and it not only controls things like weight but also muscle function and thus strength etc.

For people, one usu gets retested and then the dosage get adjusted if needed and that can go on a few times until one gets the dosage just right.

 

[TeachersPet]

Thanks Audrey!
Right now Reno's on .8mg of eltroxin daily (0.4/0.4) and vet is willing to increase by another .4 daily. Reno weighs about 85 pounds.

So, now I'm weighing options between Dr. Dodds and an internal specialist I see in person. I can't imagine what all an in-person specialist would do that Dr. Dodds wouldn't/couldn't as I imagine it's all bloodwork analysis at this point.

From what I'm gathering, it sounds like Dr. Dodds is more understanding of breed specific needs (Dobes tend to require higher doses of thyroid meds it seems in order to maintain low-normal levels I'm understanding?) as well as being willing to treat at higher doses. Am I right? I'm leaning that way as of now.

You all are a big help--this has been an ongoing issue that I'm just fed up with and want fixed already, but my vet doesn't seem to know how to help anymore.

 

[Audrey1]

(Dobes tend to require higher doses of thyroid meds it seems in order to maintain low-normal levels I'm understanding?) as well as being willing to treat at higher doses. Am I right? I'm leaning that way as of now.
.

I think my post might have caused confusion...but basically, you want to treat your dog with thyroid so that it is in the normal range when he is tested.

It was the TSH test levels that I was trying to explain and those numbers run contrary to what we usu think ...so I was trying to explain why. But for the regular thyroid T3 and T4 tests, it is straight forward. If it tests low, then you increase the thyroid meds.

It should be relatively simple - your vet was saying you can try to increase and then retest since the increase in dosage wasn't that much. And if the retest has him still in the normal range, that is fine. I don't think you should worry about it going a little lower after 12 weeks...just get him retested until you get it all stabilized at the proper dosage.

Be sure to have your vet follow up on the high ALT results.

 

[sam&macksmom]

It's something to nip in the bud now so it doesn't cause other issues later.
My vet knows I'm the crazy dog lady and he knows his limitations with issues like thyroid, which is why he referred us to the specialist

Keep us updated!

--this has been an ongoing issue that I'm just fed up with and want fixed already, but my vet doesn't seem to know how to help anymore.

 

[TeachersPet]

Oh no, don't worry, you didn't cause confusion. What I was getting at is that my understanding seems to be that Dobes as a general rule require higher doses of meds in order to GET in the normal range. And my vet does agree that below 20 for his free t4 is still low.

The thing is it isn't just 12 weeks, I've been dealing with this since April--we're going on 8 months of fiddling to get things right, and her being stumped as to why it's not working.

I do appreciate your help everyone. Thanks.

 

[Audrey1]

Since April? yes, get another opinion. Hope it goes well. Keep us posted.

 

[TeachersPet]

Yup--April. He was initially controlled for about a 6 week period, and then his T4 went way down again and we began playing around with meds and amounts yet again, and have been since.

I'm not unfamiliar with thyroid issues, but his doesn't seem to be an easy fix (nothing does with him it seems), so I'm thinking that sending his blood work out for a more expert eye might be the smart thing to do.
Thanks again.

 

[Jenny]

Also feed one hour post pill or two hours after pill try to give doses 12hours apart. From what I understand dobes do better on soloxine. See if you can get your vet to give you soloxine.

Also get copies of all bloodwork. Keep a spread sheet.

Send blood to dr dodds.

 

[TeachersPet]

Additionally, you can have the results (all of them) sent to Dr. Jean Dodds for about $45 and she will assess his situation and make a recommendation for Soloxine and at what level.

You can get a full thyroid panel plus chemistry panel for $125 with their analysis.

So, I'm a bit unsure--which should I be doing: ask that my vet draws blood again and have Dr. Dodds do a thyroid panel and chemistry panel, or just send his previous results to Dr. Dodds and ask that she examine the results? Either/or? Both?

 

[vivienne00]

So, I'm a bit unsure--which should I be doing: ask that my vet draws blood again and have Dr. Dodds do a thyroid panel and chemistry panel, or just send his previous results to Dr. Dodds and ask that she examine the results? Either/or? Both?

I was just showing that there are options if you just want another set of eyes over the results you have.

I prefer to send the blood to her because they will test and re-test if they are not satisfied with the 1st set of results - they verify everything. The blood does not need to sent with an ice pack - I use priority mail and it costs me about $5-6 to make a box, wrap the vials in bubble wrap and send it that way. I always do it at the beginning of the week so it arrives the same week - no weekend storage.

You must follow the instructions and use the correct vial and the stated wait time for clotting, then spin-up. Make sure your vet is good with doing this. Dr. Dodds wants the vet's information and will send the results to your vet as well as you. I asked for mine to sent to me by email. Make sure you write that on your form. Then you can call her once you get the results if you want her to speak with you and explain something, or give more explanation and recommendations. I called her 3 times to raise my dog's meds from .35mg BID (where the internist dropped it down to from a starting point of .7mg BID), up to .45mg then .5mg and now we do .6mg - I also switched to Soloxine and I get a script from my vet (he faxes it to the online pharmacy I use). I talked with her and sent emails. I explained all of my dog's health issues and what I was seeing. He shivers when his meds are too low, that will never totally go away, but it needed to be a lot less often than it was.

 

[TeachersPet]

This is so helpful Vivienne. Thank you.