The Chatty Vets Podcast
Meet The Chatty Vets — Charlotte & Brendan — two UK small-animal vets navigating the wild, wonderful, and occasionally ridiculous world of veterinary practice. Expect monthly news, clinical cases, odd consult moments, and the kind of humour only someone who’s survived a chaotic consult room can appreciate.
We give you REAL confessions from the Clinic Floor: Practical, relatable, and CPD-APPROVED.
We release three episodes a month: two fortnightly updates on what’s happening across UK vet med, plus a bonus episode that might be a clinical deep-dive, a research paper chat, or an excuse to talk to interesting people who also chose this brilliant, baffling profession.
If you work in vet med and want learning, honesty, and a few laughs to get you through the shift, you’ll feel right at home.
The Chatty Vets Podcast
Episode 16 - Bonus Episode! Endocrinopathies I - Hyper and Hypothyroidism
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🩺 Episode 16 – Bonus Episode!
Endocrinopathies I: Hyperthyroidism & Hypothyroidism 🎙️
Welcome to the first episode of our brand new mini-series:
🧠 Endocrinopathies
We’re kicking things off with two of the most common endocrine conditions seen in small animal practice:
🐱 Hyperthyroidism
🐶 Hypothyroidism
Weight loss despite eating everything in sight?
Lethargic dogs that “just seem older”?
The cat that won’t stop yowling at 3am? 👀
In this episode we discuss:
• Common presentations in dogs & cats
• Clinical signs to look out for
• How we approach diagnosis in practice
• Working cases up properly
• Treatment options & monitoring
• The things that can easily catch you out
As always, this is a practical, discussion-based episode focused on real GP practice — not just textbook medicine.
Perfect for vets, RVNs, students, and anyone wanting a refresh on conditions we see all the time in consult rooms.
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https://www.chattyvets.com/blog
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Hi everyone, welcome back to the Chatty Vets podcast. I'm Brendan.
SPEAKER_03And I'm Charlotte. Thank you for tuning in. We're back again with our next bonus episode today. So we hope you enjoyed our two-week takedown episode last week, celebrating all things veterinary nurses. We have a lot of incredible people that work in this profession, but given how busy we are, it's often difficult to take the time to reflect and celebrate some of our amazing colleagues. So we really hope you enjoyed the episode.
SPEAKER_00Absolutely. And thank you so much again to our three amazing guests last week, too. Today we're changing it up. We're going back to one of our clinical deep dive episodes. No special guests though today, just us chatting your ears off.
SPEAKER_03Yeah, sorry about that, but hopefully you enjoy it. That's why you listen. But that being said, just you wait for the end of the month. We've got something very, very special in store. So keep your eyes peeled. In these bonus episodes, we aim to discuss some of the diseases and presentations you may commonly see in general practice, aiming to simplify the complex stuff and add new little helpful nuggets to your everyday bread and butter caseload.
SPEAKER_00So today we're starting off our new series of bonus episodes, which will scatter over the months to come with our series where we delve into all things endocrinopathy.
SPEAKER_03Yeah, looking forward to it. So today we're starting with skinny, starry-haired code cats and chunky lethargic dogs. Yes, you've got it. We're talking all things thyroid.
SPEAKER_00So before we get started, is a couple of thank yous to a few of you who have reached out to us recently. Claire, final year vet student, who reached out to us on Facebook and said that she'd find some episodes covering common endocrine disorders useful. And that's what sparked this miniseries. So thank you, Claire, and we hope you find it useful.
SPEAKER_03Yeah, thank you very much. And also to Steph on Facebook, who spoke about struggling with all things diabetes. So don't worry, we've got you covered. We've got plenty of diabetes chats to cover in the following months. But okay, let's dive in for today.
SPEAKER_00Okay. Okay, quick recap of the basics. Dogs and cats have two thyroid glands which sit either side of the trachea, slightly more ventrally than dorsally, just cordal to the larynx. And remember that there can sometimes be some sneaky ectopic thyroid tissue in the thorax, in theory, anywhere from chordal to the larynx up to the diaphragm.
SPEAKER_03Yeah, and just uh as a really super quick recap, the main function of the thyroid gland to remember is to produce T4, otherwise known as thyroxine hormone, which is the only iodinated compound in the body. It's responsible for many metabolic processes in the body, including being anabolic, which means they can stimulate protein synthesis in conjunction with incident and growth hormone. However, in certain situations, like in hyperthyroidism, they can become catabolic and promote gluconeogenesis and protein breakdown. But I like to think of it really simply as if the thyroid gland is working overtime, the metabolic rate is quicker, so animals lose weight, and vice versa for our chunky hypothyroid dogs.
SPEAKER_00And it might be an idea. In fact, let me start with the hypothalamic pituitary thyroid axis, which is that one where we a few things use this, don't they? So the hypothalamus secretes the thyrotropin releasing hormone, TRH, which stimulates the pituitary, which then that releases TSH, which is thyroid stimulating hormone. And that hormone goes to the thyroid gland and stimulates T4 production, basically. And if I add a little bit there, well, I suppose let me just quickly say for our canine, low thyroid, hypothyroid dogs, that's where we want the TSH and the T4 levels. Um we'll go into that a little bit later down the line. But I'll add a little bit here that the T4 then gets converted into the active version, because the T4 is like the pro-hormone, gets converted into T3 at the site of the tissue, and that's where it actually does the business end of what it does.
SPEAKER_03Yeah, exactly. So hopefully that wasn't too much physiology for you, but enough to sort of set the scene. But before we get into the clinical stuff too much, what actually is hyperthyroidism in cats?
SPEAKER_00Yes, what it's basically like too much thyroid hormone, and it's not rarely a cancer. I think one to three percent of cases are a malignant thyroid carcinoma. I think you get that kind of um ones that just the thyroglands gets bigger and bigger and the control gets harder and harder to achieve. I think that's the typical kind of way that I perceive it. Um, but the vast majority, it's a thyroid adenoma or just this hyperplasia, and the cats just make too much T4.
SPEAKER_03Okay, so if we were gonna dive into some clinical scenarios, let's set the scene a little bit. So, what do you think a normal hyperthyroid cat usually looks like, Brendan? What would you say?
SPEAKER_00Okay, well, we'll start, but I think that it's hard to differentiate the enteropathic gut problem cat from the thy hyperthyroid cat.
SPEAKER_01No.
SPEAKER_00But they're the older cats, over nine, over ten, something like that. And obviously, your ears prick up when you hear. When normally actually you get them out and you go, Oh, they're bony. You can feel it straight away, bony over their back. Um, the owner might not have noticed it, interestingly, but the owners are always like, Oh no, he eats really well, or he's always eating really well, or he's more vocal and trying to eat eat even more than ever. And I think in some ways they're a pain to live with. Some owners feel like they're got dementia because they they don't know what the cat wants because the cat's meowing for this and that.
SPEAKER_03Yeah, absolutely. I mean, my law males are going when it's a cat that's been losing weight, when it's been really hungry, if it's possibly been PEPD, so drinking a bit more than normal if it's potentially behaviour's change, so a bit more vocal than it ever used to be. If they come in and they say, Oh, his coat's just a bit different, like she used to really, really look after herself, and now her coat's just a bit scary, not scary, a bit starry, um, or a bit greasy, or sometimes they just say a bit dull. They just don't seem quite right, is a lot of what owners might say.
SPEAKER_00Just going back to that a little bit, the time scale is quite relevant here because if they've been drinking lots for many months and there's not outrageous signs, diabetes is dropping off my list a little bit. Usually things are going to hit something fairly quickly if they're diabetic. Um, and obviously it's the drinking a lot that's gonna take you to diabetes. The thyroid cats will drink a little bit more, it's true, but the the diabetics are super, super uh thirsty. Now, and and obviously you just think you've got concurrent kidneys going on there as well, which might make them drink more. So, in terms of the exam, I mean I I do check for a goiter, a little slip, just run my thumb and finger down their neck just gently, lifting their head up a little bit while I do it, and you just feel that little slip, it flicks just under your under your thumb or finger. I've heard people say about eight out of ten of them have a palpable thyroid goiter. And I I've definitely had the old one which has got a goita, a little goiter, and is normal as well. So they don't have to be active. Heart murmur is obviously common, faster heart is common. How about you?
SPEAKER_03Yeah, I mean, honestly, I have to say, I don't know whether I'm just really rubbish at feeling them. I can't say I've ever appreciated a palpable goiter, but I don't know whether I'm just rubbish at feeling them. Because I think you must be rubbish at feeling.
SPEAKER_00They're all they're all over the place.
SPEAKER_03Well, I don't know. I just feel like I'm not that easy. I don't find them that easy. I mean, but then maybe I'm just not focusing my exam there because I feel like I already kind of know that it's hyperthyroid before I'm taking bloods because of my penetration.
SPEAKER_00How are you doing it then? What do you do when you feel for it?
SPEAKER_03Well, I'm just feeling around the trachea, I'm feeling down the neck, but I just don't feel like I'm lifting around the head up. Yeah. I just don't feel like the head up.
SPEAKER_00And then you so you're stretching the neck out a little bit, like lifting their head up and lifting their chin up. Yeah. Yeah. And then you're running your finger and thumb either side of their trachea. Yeah. And you don't get a a little thing that pings just under your thumb or finger.
SPEAKER_03No, not that I've ever appreciated. But then I don't know whether I'm just rubbish at feeling them. Maybe I don't know.
SPEAKER_00Do you know what's happened? I think you've done not I mean you've been unlucky and not had one for a while, and then you've kind of gone, oh, that's a rubbish test. But maybe. Maybe it's definitely there.
SPEAKER_03Yeah, keep doing it, you'll get loads. Yeah. But I think the thing is, is it's not the thing that makes me check for hyperthyroidism anyway. Like I'm not going, oh, I can't feel a goita, so I'm not checking. So you know, for me, if it's if it's yeah, for me, if it's lost weight, it's got a staring hair coat, it's tachycardic potentially, maybe it's got a gallop sound, all of that sort of stuff is what's going to direct me towards it's probably hyperthyroid.
SPEAKER_00I would yeah, I would say though, when you've got the really chunky one, I will sometimes think they're the ones that are going to be harder to control. And they're they're the ones that sometimes need a higher dose every six to twelve months. So I think there's a slight differentiation there.
SPEAKER_03That sort of leads us on to saying, okay, so if you've got a cat that's losing weight, staring hair coat, hungry, PUPD, you know, we know that hypothyroidism is on our list, but there's also a hell of a lot of other things that are on our list that we want to rule out, right? And I think we do sort of have a bit of a general older cat, these sort of similar symptoms, blood tests that we would potentially be wanting to do. So I mean, what are the other things that we'd be wanting to rule out or check that they don't have concurrently?
SPEAKER_00Yeah, such a good okay, I like the way you phrase that. So eating lots and losing weight is essentially overactive thyroid, diabetes, or enteropathy, gut disease. I think it's got to be one of those three. Now you can have concurrent problems going on, and that's kind of what you're kind of indicating, which obviously kidney disease is one of them. Hypertension is another thing you want to look out for. Certainly, you might want to have urine-related issues like urinary tract infection on your list, and you might need additional things in the urine if if you've got some low-level renal disease, you might want to be thinking about UPC as well. So they're the kind of things in terms of bowel disease, hardest one to diagnose in some ways. My two non-invasive kind of tests for that are B12 and folate blood tests. They're and I I don't know, rightly or wrongly, I noticed of the ranges on the labs. I'll get quite a few cats um in the just above the lower end of the do uh the range for B12, but I will tend to think of that as suspicious for gut disease as well. And then ultrasound, if I've got a willing owner and everything else has come out normal and the cat's losing weight, I'll say to them, Well, cat can't keep losing weight like this. We've got to do something. And I say non-invasive, nice test. And a few of these cats will have um a thickened bowel wall or a thickened muscularis layer to their bowel wall, which is easy to identify once you get the hang of it.
SPEAKER_03And I'd say agree with all the above. The only things I would say is that I have occasionally seen the cat with CKD that is more hungry, not less hungry, occasionally. It doesn't happen very often. But I would say. Yeah, probably. And it's probably because there is something concurrent going on. But I would say don't completely rule out renal disease just because they're not inepotent and always have neoplasia on your list. Always, always have neoplasia, especially if they're more hungry or quite often. It can be because they've got something growing somewhere and it's taking all their calories. So yeah, so just keep that on your list too. To be honest, in any cat that's lost weight, even if there's no other symptoms, generally, especially if they're an older cat, I'll generally run like a what I'd call a full biochem, so like a chem 17 or at least a chem 10. So to check for uh kidney, glucose, liver, protein levels, etc. Um, and then I'd always run a T4 as well, just to double check they're not hyperthyroid. It's quite useful to run your hematology too alongside it, because if you get elevation in white blood cells, you'll be looking for inflammatory problems or infectious problems, obviously, depending on how elevated your white blood cell count is. And but also remember in a lot of these older cats, we see that anemia of chronic disease. So if you get that sort of mild to moderate non-regenerative anemia in these guys, it's worth thinking, okay, there's obviously something going on that's causing them to have a bit of myeloid suppression. Um, but it's worth keeping an eye on it because obviously that PCV can get a little bit lower than we expect. So keep an eye on that too.
SPEAKER_00That's a real big cat dog difference, too, isn't it? Because the older cat, the older teen cat, anemia, whatever, you know, they're so often in the 20s. For me personally, if I get a dog any age, blood count in the 20s, high or low, I am on this on the prowl for cancer. I think that's a much bigger red flag. I'd love to see if someone does a study on that. I can just so many times I've had heratocrit 28 on a dog, cancer somewhere. So yeah, just be really on the lookout for it.
SPEAKER_03Um yeah, I was just gonna say, I think it is so true, isn't it? You sort of we seem to tolerate much lower levels, a much amount lower hermatocrit in cats that are older because we assume it's this anemia of chronic disease, and especially with kidneys, you get your reduced EPO, etc. So I think it's we send tend to tolerate it a bit better, but in dogs, yeah, definitely it gets my back up a bit more. I'm like, where is that blood going?
SPEAKER_00And I think this is where the difficulty lies as vets, because when we talk to the client, the client's coming at it from the perspective, regardless of their funds, old cat, they don't want to mess about with their cat. They don't really want to get involved in doing too much treatment because they perceive it as old and on its last legs, and they so therefore they don't really want to do very much. And I think this is where we have to have a really good chat with them about how much are they going to test? What tests are we gonna do, what suits them? And I think there's a bit of an art to this one.
SPEAKER_03Yeah, it's hard, isn't it? I think because in a lot of practices, if you're saying if you're doing a chem 17, a hematology and a T4, you could easily be looking 180 quid, couldn't you? Easy. So depending on what machines you use, etc. Now, again, like you can cut out the hematology or you could do a manual PCV instead, which is gonna make it cheaper. You could do like a prep profile instead, which is gonna give you the majority of what you need to know, like an NZ clip type thing, and plus the T4, which is gonna make it cheaper. So, yeah, it's a discussion with clients, but I would say test for the things that are highest on your list, and then the rest is great. But just warn the owners, obviously, if you're doing a like a smaller panel, you are more likely to miss other things that you might otherwise pick up. So it's just having that conversation. Um, I guess that brings as well to in these hyperthyroid cats. Obviously, blood test is going to be how we generally diagnose it. But another really important thing to remember that isn't that expensive is check their blood pressure because a hell of a lot of these cats are commonly hypertensive and a lot of them have concurrent problems as well. You know, they might have cardiac disease alongside the hyperthyroidism. They might also have chronic kidney disease and hypertension. So checking their blood pressure, cheap, easy, worth doing. Remember white coat syndrome in cats. Obviously, it might be if it's a little bit elevated, then I'd be like, it's probably fine. If you're hitting systolic of 220, that's hypertensive. So I'd be thinking, okay, this definitely has a hypertension problem too. And the only other thing I'd say is that I've had quite a lot of hyperthyroid cats that have like a gallop sound when you listen to them. And a gallop sound or an arrhythmia in a cat would make me much more suspicious of underlying cardiac disease. A murmur, I'm a bit like might not might be something, might be nothing in a cat, but an arrhythmia makes me more nervous about cardiac disease. So I would generally offer these patients, or the clients for the patient, I'd offer them at least a pro BMP or a quick echo from just to double check what their LAAO looks like. Because you'd be surprised how many of them have underlying cardiac disease as well.
SPEAKER_00And I think as soon as you get that pro bowel, because I'm obsessed by the bowel, then uh I will often do the bowel and well, obviously kidneys, but heart. I just always it's such a nice thing if your boss can agree your price to include that left atrial measurement as well, because sometimes these patients, if they are entropathic, they're gonna go on to prednis alone, and then it's quite nice to know is there a heart issue going on? Because I think did we cover this in an earlier episode? But one in eight cats over 12 or something have got heart disease, you know, it's so common. So you you could argue that screening isn't a bad idea, especially if you've got a mural or gallop or anything like that.
SPEAKER_03Yeah, yeah. And there are actually there are actually a few, I think there's some referral centres or or at least some practices that are pushing for any sort of procedures that they do in older cats. They do recommend like a pre-anesthetic echo because the thing is this cat heart disease is so difficult to pick up. So sometimes you can be anaesthetizing an alter cat for a dental and it's basically incongestive heart failure and it's not really told you. So it's it's definitely worth checking these guys if they're keen to do work up, especially if you've got some sort of arrhythmia or a gallop sound, it's 100% worth checking. So yeah, worth remembering.
SPEAKER_00Yep, and then we kind of haven't quite touched on this, but I think we all run a total T4, don't we, as our screening test? It's worth just reminding ourselves the difference between free T4 and total T4. Because I uh you know, I think we all know that, well, do we all know that if you've got a um a high normal T4, you've got the option to run a free T4 by equilibrium dialysis, and that might pick up, that might be more sensitive and pick up on an early hypothyroid.
SPEAKER_03To put it into simple context, usually the the bound T4, the total T4, is what we're normally checking in-house, isn't it? So they're normally the slides that you run on your machines in-house, whereas your free T4 is generally what you'd send off for. So if in doubt, then you know, if you're not sure based on your in-house result what's going on, send off for a T4 in an external lab because usually that will be a free T4.
SPEAKER_00Yeah, and just so people know that the free T4 is is freely running around in the plasma, and the total T4 includes is 99% of the T4 is actually just bound to protein. But then when I think when they have illness and things, it can change the ratio and then it it can uh mess about with your free T4 level. So sometimes the free T4 is misleading in that it will go up with illness as well because there's now more T4 hanging around. So that's why we don't it's not like 3 T4 is better than Total T4, it's just it's good at picking up those early cases. But in illness, I think it can be misleading and can can go up inappropriately.
SPEAKER_03So usually we're always hoping when we try and diagnose a hypothyroid cat is that you're hoping that your T4 that you run in house is going to be super high and you're like bingo, easy. It's like, I don't know, I can't remember what top end of normal is it, like 45? 16 and yeah, something. And you if it's like, I don't know, 90, then you're like, great, it's definitely hypothyroid, fine. What happens if you get those borderline test results? You know, if they're like high normal and they're screaming hypothyroid at you in terms of their symptoms and you can't find anything else wrong with them, then what do you do then?
SPEAKER_00Yeah, it's the the ones that are high 40s and low 50s, I think, because I think they're definitely not right. I think every normal cat is going to be, I don't know, 20, 10, 15, something like this. The eye test. And um, if it's so if it's 45, that's in the normal range on the lab, but it's definitely heading towards being an overactive thyroid at some point, I think. You I think I look at the owner because it depends, because usually this is the problem with these cats, is that you're almost pulling the owner with you on these cases, and that can get awkward, especially when you get a gray area result, and I don't want to kind of make feel like keep testing them and get another grey area, and then I'm starting to lose my client's motivation. So it depends on how my client is and how fast, how bad the weight loss is, I might try and push the next blood test two to three months down the line. I don't often do a free T4, actually. Maybe I should. So as long as the cat's reasonably well and the owner's not too feeling urgent or worried, and then I would just usually give them some kind of not placebo, but placebo-like thing, extra food, favorite treat, more poultry diet, supplement or something, and then say, oh, let's see you in two, three months. And if the weight's gone down again, then we'll retest the uh retest them for that thyroid and see if it's high. Is does that fit with your your way of doing things?
SPEAKER_03Yeah, sounds good. And I tell you what would actually be really useful here, which is just brought back to mind. Do you remember ages ago in a really early pop, we were talking about that cancer blood testing thing? And we were like, we were like, when would you use that? Like, because it's gonna it's gonna give you an idea that there's cancer, but you've got no idea where it is or what type of cancer it is. But actually, maybe these would be the really good cases when you're like, it's losing weight, you've done all the blood tests, otherwise, you can't really work out what's going on. You've done a basic scan, you're like, can't see an obvious lump. The intestine's not obviously really, really thickened. Maybe these are the ones that you're doing that cancer marker blood test to be like, does it have a tumour somewhere?
SPEAKER_00This is the new Q, the new Q test you're talking about. Yeah. And I think they're working on, I don't know, either either um a study that shows how how it can be used to identify the enteric lymphoma cases. So I think that that might I I did read something that that might be coming soon. So and that that would be a real game changer, actually.
SPEAKER_03I can't remember though whether whether when we were speaking about it before, I don't know whether that one was specifically canine. I I can't remember whether one was feline. Yeah.
SPEAKER_00I'm glad you said that because I was thinking it was canine.
SPEAKER_03But it would be really cool for these cases, because like you say, it's really difficult to keep owners on side when you've done blood tests, you've done a basic scan, you can't find anything, and they're still losing weight. And the owner's like, what the hell is going on? And you're going, Oh, do you want to go for a CT? And they're like, No, thank you. I don't want to spend 1500 quid to find nothing.
SPEAKER_00So I'm not in that boat, yeah, because I'll start them on steroids. Because I'm another old of it. I don't know. No, because I'm obsessed with entropy entropy, and I know that a lot of them aren't going to have ultrasonic graphic changes of bowel thickening. I know some of them are gonna have a normal B12 and folate, and I'd have already taught them through it. And if the other tests are coming back normal, and usually these cats are what, I don't know, 16, 17, 18 plus. Um, you know, I think I'll say, look, you know, the cat's 2.2 kilos, let's try some steroids because it's such a common disease now, rightly or wrongly. But by that point, at least I've got my bloods, I've got my kidney status, I've got you know Yeah, true.
SPEAKER_03But then I guess if you if you go down that route and you haven't done this cancer blood marker or whatever it is, then you can't say, Okay, are my preds helping because it's got intestinal lymphoma or are they helping because it's got chronic enteropathy? But then does it really matter?
SPEAKER_00At that age group it doesn't, and I think Something is so important for the older cats. It's a whole different ballgame, isn't it?
SPEAKER_03Okay, so we've got our positive C4 result, and we're still looking at the rest of our bloods, and we're thinking, okay, is it definitely just thyroid disease that's going on or is there something more going on? And I guess the twist that's worth remembering is that a lot of older cats who can be struggling with hypothyroidism can also have concurrent chronic kidney disease. Now, the tricky thing is with this is that hypothyroidism will increase the GFR, which can basically mask or hide azotemia on your bloods. So it sort of doesn't show you initially that they do have chronic kidney disease. So generally it's recommended in these guys to, if you diagnose hypothyroidism and you start treating, to then recheck bloods a few weeks or a month or however long you want to take later to recheck for that azotemia because there are a lot of cats that will then have that CKD unmasked and become obviously much more easy to see. Now, the difficulty in these cases is are they just coincidentally a part of the same cat? So do you have hypothyroidism and chronic kidney disease as completely separate and it's just one has happened and the other one has happened and it's a coincidence? Is there a causal link between one? You know, have we developed hypothyroidism and it's led to chronic kidney disease? It's always going to be a bit tricky to say. But I think the main thing to know is that if they do have both, it might not be immediately obvious from the first blood test because that hyperthyroidism, the high T4, is likely to be masking your azotemia.
SPEAKER_00Yeah, and whatever your creatinine is or SDMA or whatever you like to use, it's gonna just go up a little bit once you've controlled your thyroid disease. And that's not because you've made your kidneys worse. It's just you haven't got that actually quite damaging ultrafiltration going on in the kidneys that's kind of actually making the kidneys do a better job of getting rid of creatinine, but it's harming the kidneys at the same time. So you're gonna see that little pop up a little bit more. So if there's no kidney disease, it might be mild once you've controlled their thyroid, if there's mild kidney disease, it might be a bit higher. But the point is, from the owner's point of view, it's still better to control the thyroid. You're gonna have a better long-term health of kidneys by getting the thyroid in the right place.
SPEAKER_03The one thing that I would say as well is that because you can unmask this chronic kidney disease, now to us, that makes a lot of sense, right? We can explain it. But if you don't give owners a heads up that that might happen, they will think that you've given your their cat chronic kidney disease because you've given this medication, because you've not warned them. So what I would say is that I would say the kidneys look fine, but we need to keep an eye on them after we've started this medication because sometimes it can unmask that chronic kidney disease. So try and make sure that you mention that first because otherwise you might get a set of owners that think that you've given their cat chronic kidney disease because you've started them on thyroid meds. So it's worth sort of letting them know that that might happen.
SPEAKER_00Okay. Are we going to get into the treatments? Yeah, I think so.
SPEAKER_03I mean, there's so many different things to consider. I think most of us just use meds, don't we? But maybe we start with the most common. So I think a lot of us are just treating these in practice with medications, aren't they? Methimazole, thiamazole, carbimazole. So these are your sort of oral liquid or tablet formulations that you can get. And you can get those transdermal gels as well, the ones that you put on the ear. But to be honest, I've never really got on with them. Do you use them much, Brendan? I just feel like I don't really get on with them that well.
SPEAKER_00Yeah, I've used them, but yeah, I agree with you. Uh the thing is, as soon as um the the liquid versions came out, and I feel like it says on some of the instructions you're not meant to put that with food.
SPEAKER_03Yeah, I think it goes directly into the mouth, doesn't it?
SPEAKER_00Yeah, though, oh no, I don't know. I don't need to be careful how I say this because these are harsh drugs, aren't they? And you don't want any contact with humans and and all of this stuff. So there's some issues there. But I think a lot of uh class owners do end up mixing it with a little bit of a treat, don't you find?
SPEAKER_03I think it's one of those things where I'm always worried about the transdermal gels because I think if people forget to wear gloves, then we're technically giving something to people that could make them hypothyroid, probably. I don't know how it would work in people, but obviously that's a risk, so that makes me a bit nervous. I think it irritates their ears as well. Like I've had quite a lot of cats that I've seen that have got like quite unhappy ears after using it for quite a long time, or they get really head shy, it's just not very nice. Whereas I think the oral medications are a lot easier, but I think the liquids in particular, I know one particular brand especially will say it needs to go directly into the mouth. And I think that's more about efficacy. I think they've done studies that show that it works better, apparently, if you give it directly into the mouth rather than into the food, or whether they just say that because they think that more of it's going to be taken up rather than left in the bowl, I don't know. But uh, yeah, that's something to it, something to think about. But I mean, generally they work pretty damn well, don't they? And most cats get on with them quite well. And the nice thing is is because you've got the option to either do liquid or tablets or gel, hopefully, between any of the medications, you'd have something that can fit for that particular type of care and the particular owner.
SPEAKER_00So yeah, these drugs are embryotoxic or teratogenic, aren't they? That's the other thing. So I think that's the big issue. Because I know when we used to say crush the tablets, we were kind of like, you've got to be really careful you're not crushing the tablet on your chopping board and then chopping up your salad, you know, whatever. People do it. I bet you people do it. I don't know. So um I think that might be one of the things they're worried about as well. Yeah, but I mean, overall, it feels like people get on well with these drugs and they use they do get them in and they do use what do all these drugs actually do? It interferes with the production of T4. And T4 is the pro-hormone. So once you interfere with T4, you interfere with T3. But the important thing is it's not damaging the thyroid gland, it's not shrinking the underlying pathology.
SPEAKER_03Yeah, exactly. And I think the the sort of pros with these medications is that they're reasonably cheap, like people can get hold of them fairly cheaply. You can stop them when you need to, so they're reversible. So if you find that they're not they're not working well for a patient or they're getting side effects, you know, you can stop them. They're quite good for stabilizing patients before considering other therapies. They're fairly easy to give. Most cats tolerate it well. And it sort of gives you some time to give the medication and then recheck their bloods to make sure that there's nothing else going on. So, so for example, before considering any longer-term treatment, you might want to get them on meds and then say, okay, are we going to unmask CKD? Like how healthy is this cat in general? And sometimes you don't know that until after you've started medication. So that's what's quite nice about them. I guess if you were going to talk about cons, what would you say are sort of the downsides to regular meds for these guys?
SPEAKER_00They're usually well tolerated. I don't know. There's that odd cat that will get the facial pruritis. I always find it's facial. And I I don't know, I feel like it's a little bit delayed, maybe three weeks after you start treatment. And uh, it's you can't miss it. I I used to warn owners it might happen, and I I'm not sure I do all the time now, because I think when it happens, it's it's quite marked and it's pretty obvious. Blood dyscrasia is a common though. I think on the hematology, some some white blood cell doing something a bit weird is I I definitely feel like I see that now and then. But I don't think it's clinically relevant.
SPEAKER_03Okay, so that's sort of option one that we have available to us, our medical management. Option two, if we want to look at that, is our dietary management. So we're talking iodine-restricted diets. Now, I don't think I've ever done this. Have you ever done this in practice? Have you ever said, let's not give it meds and stick it on food?
SPEAKER_00Yeah. Um, when it first came out, I probably used to chat about it. And then uh I've probably had two clients over the last whatever years do it. And um, I think you do, I've definitely had the odd client that feels very happy about it. I feel like I've heard some more negativity about it more recently. I don't know. I mean, is it even still available? It's it's so important.
SPEAKER_03So I had a look because I didn't actually know this was a thing. So that's probably me being really stupid. But like I've just never I've never heard of it or heard anyone use it before. So it's still commercially available. You can get it through sort of your big veterinary prescription diets, but it there's just so many elements to it. It has to be an indoor cat because if they eat anything outside, it completely negates it. They can't have any treats, no other food, not getting in touch with any other cat food or scraps or whatever, they can't eat anything else. And I just think it's like a diet trial. People never bloody do it right, do they? Like they're always like, Yeah, yeah, we'll do that, and then it's not worked. And you're like, Well, have you been giving it gravy bones? And they're like, Oh yeah, like it just that people just don't it doesn't work a lot of the time, does it? So I think unless you've got the super committed client and a cat that absolutely loves the food, I don't know how well it's gonna work. And how quickly does it work as well? Like, I feel like medication is quite fast. Whereas if if you're talking food, is it gonna take like a few weeks, a few months for it to start really working?
SPEAKER_00Yeah, I can't remember. I remember them the reps coming over with the lab work. It definitely worked in the in the lab studies they did. I can't quite recall how quick. Treatment number three, raid radioactive iodine.
SPEAKER_03I think it it yeah, I love it if owners are on board and if it's the right kind of cat. I mean, like, you know, you're talking cure rather than a sort of palliative treatment, really, aren't you? But it's not for every cat and it's not for every client. Like, you know, if you've got a an owner who's not particularly well, you're not really gonna want to be sending them back a radioactive cat. That's not ideal. If you've got a cat who has other comorbidities, heart disease, chronic kidney disease, you know, neoplasia somewhere, you're not really gonna want to be sending them for radioactive iodine. I think it has to be the right cat and the right client. But I mean, there's so many good things about it, aren't they?
SPEAKER_00Uh do you know what? The number one case for me is if the cat's on the younger end of the age spectrum, you know, 10, 11 years old, because you just think, well, you might have nine, eight, nine, ten years. And also being a bit kind of careful with my money, I feel like it's more value for money, isn't it? Longer term. If you're gonna get another eight, nine years. And you could make a case for the stressed cat. It's a better treatment because it's all done in one hit uh mostly, rather than a regular checkups, regular blood tests. Yeah, true. You know, 10 other than the younger cat, i.e., the 10, 11, 12-year-old cat uh that looks really well. The other time I wheel it out is if the thyroid dose keeps going up, like so every year or so, oh, you know, especially as I say, these the goitas of thyroid glands are quite big and chunky, and they're not just not stable. It's not fun for owners then. You haven't constantly up the dose. There obviously that's another one.
SPEAKER_03I think if I think if people are happy for it, then it's you know, it it is expensive, it does mean referral, it's a lot of cooperation from the owners and they have to be on board with it. But I think it can work amazingly well. The nice thing is that you target all the thyroid tissue, so even if you've got that funny ectopic thyroid tissue, it will still do the trick. And they say that it's they say that there's about a 95 to 99% cure rate, so you can give that figure to owners and say, you know, the majority of the time it works incredibly well and it does cure them, but there's always a possibility that it doesn't. And it is, I didn't realize this actually, but it is only a single injection of radioactive iodine. I thought it was multiple, but it is literally one, and then they just have to stay there because they're radioactive. But they say a small percentage of cats can become hypothyroid, so you have to be a little bit careful with that, and they need supplementation afterwards if that's the case. But they say the majority of cats show a normal thyroid level within weeks, which is amazing. So it can happen really, really quickly. So that's our third option, and possibly the most ideal if it fits for the cat and for the client. But let's talk about the bit of the controversial fourth option, which used to be done all the time, surgery, so thyroidectomies. So, have you ever done one? You have, yeah.
SPEAKER_00I've done a few. I think we used to do the more too because we used to have the tablets, which some cats it would be hard to give. So then it was it seemed like a good option.
SPEAKER_03I think the thing for me is the risk of you risk the hypoparathyroidism as well, because the thyroid glands are obviously connected, so you can talk about hypocalcemia and stuff as side effects afterwards. You've got to anaesthetise an older cat, which a lot of people probably aren't going to be on board with. So I think you'd have to get clients on side. But I think the big thing that worries me about it is the ectopic thyroid tissue. Like you could do everything perfect with the surgery, get the whole glands out, and think you've done a really great job. You don't get any side effects with the parathyroids, but then there's still hyperthyroid post-surgery because you've got ectopics issue somewhere that you didn't know about. So I think that's the thing that makes me a bit nervous about it. It's not something that I'd be recommending to everyone, put it that way.
SPEAKER_00I do think owners are a bit disproportionately worried about their cats having the radioactive ID. Because you say, Oh, they have to be over at the hospital for a week or whatever, and they're like, Oh my god. But it's like it's not that bad, is it? I I mean, for for the sake of a lifetime cure, I think it's fair to it, it's I don't know. Yeah, if I was a cat, I'd be okay with it.
SPEAKER_03Okay, so we talked about our four different ways that you could treat hyperthyroid cats, but now we need to talk about monitoring how when we start treatment, how we're gonna monitor these patients. Now, it's gonna be very dependent on the type of treatment that you've chosen. So obviously, medical treatment versus radioactive iodine versus thyroidectomy is gonna be very different in terms of monitoring. But I guess generally we're talking about checking your T4 in-house, your renal parameters, what their clinical signs are doing.
SPEAKER_00I would I normally see them two weeks down the line. I'm looking for weight gain because I know obviously if I've got weight gain, I've probably got the right dose. Um, and then I might do a blood test somewhere between two to four weeks from the start of treatment. And I want to I'll do my hematology to look for blood dyscrasias, I guess. Obviously, I'll want my kidney parameters and I want my thyroid. Yeah, and then my post-doc after that, once I've got my thyroid where I want it, I think as long as the weight's going up and everything's going kind of I say, yeah, bottom line, if the weight's going up, heart rate's kind of where it roughly should be. I'm not rushing to do more T4s in that context, but I think you might need to write on your notes that the data sheet says every three months for blood tests.
SPEAKER_03Yeah, I think it is every three months, but I guess it depends on the medication you're using. So I had a little checkup before we were recording today just to see what the data sheet said. And I mean, if you wanted to go buy the book, it says that you should be doing a hematology, a biochemistry, and a serum total T4 before initiating treatment, and after three weeks, six weeks, ten weeks, twenty weeks, and then every three every three months after that. Now, again, it it's contextualized care, isn't it? If you've got a cat that is incredibly stressed every time it comes to the vet, ultimately, if it's gaining weight, it's no longer slightly PUPD, it's no longer yowling like crazy and trying to inhale every single bit of food that it has. If it's settled and it's comfortable and it's happy, like, okay, fine. If it starts to get more unwell, then yeah, blood test it. And I mean, I'm not saying that we should never be blood testing these cats, but I think we can be less strict than what the data sheet might be saying, as long as you, again, you write in your notes we've made the decision not to blood test as regularly for these reasons. That's fine. You're allowed that contextualized care. But if you wanted to go by the book, and for those really committed owners and the the cats that are easier to blood sample, then yeah, absolutely regular testing would be fab.
SPEAKER_00So yeah, and I'm gonna do a little um uh diversion again, because you mentioned about the yowling or the nighttime yowling. Just so just for people who maybe have not been in practice very long, I find that when you have a hypothyroid with yowling, typically nighttime yowling, they will get better, won't they, when you treat the thyroid. But I find they still yowl a little bit. So I tend to say to the owner, yeah, you might find this will get better, but it might not stop. I think an element of the yowling is well, I perceive it as senility um but uh or confusion or or an element of that.
SPEAKER_03It's also worth thinking about as well. If you haven't checked your blood pressure by this point, well, I mean the cat's pressure, blood pressure, not yours. So if you haven't checked blood pressure, if it's still doing those kind of behaviours, it still might be hypertensive and you've just not known. So it that is worth checking those sorts of things as well, because if vision is changing, then it might change behaviour, which then might change vocalization, etc. So there's different things that can be going on too. And like you say, feline cognitive decline, etc., is always in the mix somewhere because generally they are older cats, so it can be other things wrapping up hyperthyroidism in cats. I think it's worth just mentioning it is incredibly rare, but I know we always think hyperthyroidism is cats, hypothyroidism is dogs. There are exceptions to the rules, and cats can still get hypothyroidism. So would not necessarily 100% always rule it out, but it is rare. So it is not a common thing. And to be honest, most of the time that you see it is because you've swung them too much the other way and you've been treating them for hyperthyroidism. So it's it's worth keeping an eye out for. And if they fit hypothyroid symptoms, it's worth checking. But it's not something that I would have on the top of my list by any means.
SPEAKER_00So it doesn't present like I don't think it presents like dogs, I think renal disease and post-radioactive iodine treatment, I think. But it's off the top of my head. Okay, so are we ready? Are we ready for canines?
SPEAKER_03We are. So we've done cats, I feel like we've done them. But what about our lovely doggos? So let's move on to hypothyroidism. So, what actually is hypothyroidism in dogs?
SPEAKER_00It's it's typically immune-mediated destruction of the thyroid gland, which is relevant to diagnosis because we've got a lot of clever ways we can get there. It's a lymphocytic thyroiditis, inflammation caused by lymphocytes. Um, I think eventually you get atrophy, maybe sometimes you just get atrophy. Mostly middle-aged older dogs, medium to large breed dogs, mostly, I think is fair to say. Yeah.
SPEAKER_03Yeah, I think it's that lymphocytic thyroiditis. Um, I think they say that it's either that or this idiopathic atrophy, which we don't really know why it's happened. Those two together make up about 95% of the cases you're gonna see. But there are more rare causes that we can see, like thyroid tumours, congenital hypothyroidism, so birth defects and or damage from radiation therapy. But to be honest, they're much less common. So most of the time it's gonna be to do with the actual thyroid band itself, and like you say, immune mediated destruction or atrophy. So, and when we were talking about T4 and T3 earlier, how does that fit here?
SPEAKER_00God knows. Well, it's less production of T4, therefore less T3, presumably. Yeah, where you get it.
SPEAKER_03Yeah, so I think it's basically reduced T4, which means that you get reduced T3, so slowed metabolism, and basically just everything slows down and you get weight day gain because the metabolic rate is slower, is basically how I think of it. So when we talk about that in terms of a clinical scenario and sort of the classic signal that we're gonna get, you you've already said you're possibly larger breed dogs that are maybe middle aged, maybe like four to ten years, depending on breed. What are we generally going to be seeing clinical sign-wise?
SPEAKER_00I was gonna say this is the it's just like it's cousin disease. Can we call it cousin disease cushions? I don't know. It's just that both those diseases are come on gradual over months, they kind of sneak up on you, and they both involve weight gain, which is kind of unusual for a disease, isn't it? So that's why I kind of say that. But obviously, with cushions, you've got lots of thirst, therefore, drinking a lot, weing a lot, weing at night, weing in the house, urinary problems. So that's the cushing side. With a thyroid, low thyroid, you don't have any of the increased thirst, you don't have that side of things. So it's coming on gradual, it's weight gain, it's owners that are trying to diet their dog and they're not succeeding. And then eventually, if left for quite a few months, which is common, you get the dermatological changes, which is they're coming with like a patchy alopecia on their flanks or on the tail, rat tail on the tail. And sometimes in the exam you can just pull the hair out and make it even more bald. Uh, I don't know if you've done that.
SPEAKER_03Yeah, I mean they talk about that like tragic expression that they get as well, like the mixedema in their face, um and potentially bradycardia. Sometimes they say infertility, but I mean, how are you gonna know how many people are actively trying to breed these dogs? Because they're middle to older age, so I don't know. And they say rarely neurological signs. So in theory, it should be on your list for seizures um and sort of neurosigns in your middle-aged to older dogs. To be completely honest though, when I was in vet school, it got taught as if we were gonna see these cases all the time. I honestly don't think I've ever diagnosed one in practice. I look for it, but I don't think I've ever diagnosed one. I've seen some that are on meds, but I don't think I've ever diagnosed one because every time I look, it comes back negative. So I think it's I just don't think it's anywhere near as common as we thought it was or as it is portrayed when you're in vet school. So I don't know about you. Have you seen many of them that you've actually started on meds?
SPEAKER_00I've had a few. I must say they're the most wonderful cases to have. Yeah, I probably get a case every three or four years. So yeah, they're not that common, but they're the bit they're the most fun cases. Because over a month or three, they just go perfect. And they're they're easy to manage. It's it's very predictable and pleasant. But there's some there's some there's there's more cafe actually with diagnosis with sighthounds, isn't there? Greyhounds have low, sighthounds have low T4 when you measure it. So TSH usually normal, occasionally slightly increased, but not consistently.
SPEAKER_03So you might, it's basically like you might get a slightly low T4, but you're not going to have a really severely elevated TSH like you would do in your normal hypothyroid cases because it's a it's a normal T4 for them, even though it looks slightly low. So I guess that's the way to look at it, isn't it? So basically, we're now talking about diagnosing hypothyroidism in dogs. And like in in cats, it's a little bit easier. Generally, you run your in-house T4, so your total T4, and you get an answer the majority of the time. If it's high, they're hypothyroid, fine. Yes, you have those ones that are borderline and you need to do more testing, but fine. In dogs, it's a little bit more tricky because not only do you need that T4, but you need it in combination with your thyroid stimulating hormone. So to prove that a dog is hypothyroid, they need to have both a low T4. And an elevated TSH because that proves that the body is trying to say, you need more thyroid hormone, please make it. And the thyroid gland is going, nope, I'm going to completely ignore you. And it's still low. So that you need those two together to be able to prove it. Now, the other thing that's worth bearing in mind here is that low T4 on its own does not equal hypothyroidism for another reason because we can sometimes see U thyroid sick syndrome, which makes things a bit more complicated. So basically, in any illness from skin disease to infections to other systemic diseases, you can get a suppression of T4. So a low T4 on its own does not mean hypothyroidism. It technically means that yes, there is a slightly lower thyroxine level in the blood, but it could be for various reasons. So you need that TSH to be able to confirm it. That's what we're normally looking for in terms of diagnosis, isn't it?
SPEAKER_00If you get the classic one, yeah. But if you've got a really high clinical suspicion, the TSH is normal, and that I think that can be one in three, one in four. Then yeah, then you've got some thinking to do. When I run the test now, if I'm really suspicious, I will really be tempted to do the full like panel which has got the thyroid antibodies on as well. So I'll get the whole the whole thing. So because the thyroid antibodies can make the T4 look artificially higher as well. And also if you get the thyroid antibodies, you know the disease is coming. So it's kind of increasing your index of suspicion. So yeah, so I quite like TSH T4 and thyroid antibodies just all in one hit and try and really nail it as quick as I can. Um, but I'm really keen to have some dermatological changes before I start rushing into testing. Because once you start treatment, you can't backtrack it, can you? It suppresses the natural T4 production and you're kind of on this kind of slippery slope of treatment.
SPEAKER_03Yeah, I think ultimately with with these cases, if if you get a lab result that you're not expecting, call the lab and have a chat to them, speak to the clinical pathologists, or say, I don't know, if you're partnered with zoetis or whoever, then they have internal medics and people that you can speak to for free and chat to them and say, Okay, I've got this result, these are my clinical signs. What would you suggest I do next? And it just gives you an outside perspective. So they're not always straightforward cases in terms of diagnosis.
SPEAKER_00So yeah, we had one about two months ago. It wasn't mine. One of the other vets walked it through and she was like, classic thyroid, low thyroid, it had skin, and ear infections, alopecia, it had hyperpigmentation on the alopecia patches and maybe beyond as well, actually. Weight obviously, weight gain, we were all like, yeah, that could be it. So they're they're the kind of that's what you're looking for anyway. And be really positive about them because they're they are nice cases too.
SPEAKER_03Yeah, exactly. And then when we're talking about actual treatment, so it's far simpler than in cats, isn't it? So it's levothyroxine, which is what we're using. So there's loads of different brand names for it, but levothyroxine is the drug name. I think that it's suggested that you can do it twice a day or once a day. But I think actually, because I had a look at one of the common data sheets on it before the pod, and it does say to start off at once daily dosing and then go from there. So I do think that a lot of people in the UK are now doing once daily dosing, but I don't know what the formulary says about it. It probably says once or twice.
SPEAKER_00Yeah, oh I was trying to find it. Here it is, I've got it. It is given with food once or divided twice a day.
SPEAKER_03Yeah, so but then it's like the formulary said initially that you could give gabapentin 10 to 60 meg per kig. So, like don't always don't always trust everything that the formulary says. In terms of blood testing, again, I had a little check of one of the common data sheets and it says in terms of monitoring, you've got two ways that you can do it. You can either take blood tests at their trough levels just before treatment would be due. So, say they gave their pill at 9 a.m. every day. If you got them in for a blood test at eight to half eight, then that's going to be your perfect trough level, or peak values, so about three hours after dosing, then you measure your T4 at that point. In really well-dosed dogs, their peak plasma concentration should be in the high normal range. So, like in our hyper hyperthyroid cats, we want low normal. In dogs, we want high normal of the range, and your trough values should be about, well, this says about 19. So probably what low to mid-range. But I think that it it's basically saying that if you're happy and clinical signs are good, you don't necessarily need to be doing TSH every time too. You can use just your normal T4 levels to check it, which makes things way simpler and way cheaper. And then it just says if you need to do dose adjustments to do it slowly in small increments and adjust as needed until it's within the reference range.
SPEAKER_00Yeah, and choosing between whether you do a peak one at three to four hours or whether you do a trough one at just pre-tablet is dependent on where you think you are with that particular patient. Sometimes the context, you've got, you know, beautiful fur coat, slim dog, or whatever. You're gonna think, well, my trough has got to be okay. I'm more interested where my peak is, because if my peak's too high, I might bring down. Similarly, if you've got, yeah, maybe slight weight gain and yeah, the coat's not 100%, maybe you're gonna be more interested in your trough. So I think that's really important. Because sometimes these clients will book phone up reception, say, when do I do my blood test? Reception will then ask a nurse, when do you do the blood test for the T4 monitoring? And then you'll just get this empirical answer. But I think there is a clinical case to be made from the clinician to to talk through the owner which which one's most appropriate.
SPEAKER_01Yeah. Yeah.
SPEAKER_00Um, I was gonna say they always tell you to check in any neuro condition to check your like seizuring or any neuropathy to check your T4. And I must say, I got a bit bored of checking because it was so off to normal. But I know I suppose I should. And then um and megosophagus, is that another one? I think megosophagus is what we meant to check your T4.
SPEAKER_03But but I always think in those cases, with your U thyroid six syndrome, like if something's seizuring, it's not systemically well. So isn't it gonna be slightly low anyway? And then if it is slightly low, is it because of what's going on in the body or is it the cause of what's going on? Like, how do you know? Are you supposed to be doing T4 anti SH in those guys? So that's the tricky thing, isn't it?
SPEAKER_01Probably.
SPEAKER_03And I'd say that, you know, you're not gonna be able to fix the thyroid problem while it's seizuring. So I'd argue, well, treat what you can see in front of you, get it more stable, and then be checking because then you're more likely to have a correct answer anyway. Yeah, exactly. It's kind of like if you've got a diabetic patient and you think it's cushing, you shouldn't do an ACTH stem when it's still really unstable as a diabetic because you're gonna get an abhorrent result. It's it's I th I I feel like it's probably kind of similar.
SPEAKER_00Should we just quickly, quickly do? Because it's quite interesting to contrast the two. Cushing's dogs and thyroid, low thyroid dogs are um both ones that are well, they're well dogs. They're both gaining weight, they've both got hair loss, symmetrical hair loss, haven't they?
SPEAKER_03Um I think it's more the sort of lethargy and the absence of the typical cushing symptoms that would make me think it's more likely thyroid because you get some of the same symptoms but without your severe polyphagia, PEPD, etc.
SPEAKER_00The cushions are lethargic, slowing down as well, but uh it's the weeing, it's the weing at night, messing in the house, all of these things. But also on the bloods, ALKP is nearly always gonna be really elevated in the cushions because of the steroid obviously makes induces the ALKP, whereas the thyroid is not gonna have that. So there's another point of difference, isn't there? I suppose they're not normally hard to distinguish, but I think when you're a student and before you see many clinical cases, it's hard to get them straight in your head, the difference between the two.
SPEAKER_03And I I guess that the only one last thing that's sort of worth covering is any side effects of medications. Again, the list is like as long as your arm of all the different things that you can see. And normally they say that it's the side effects that you'd get would be associated with if you were giving too much. So if you think that they're getting more hyperthyroid, so weight loss without lots of appetite, hyperactivity, excitability, panting, tachycardia, PEPD, all the things that you'd notice if they were swinging the other way. So basically, if you think they've turned hyperthyroid because of their symptoms, it's probably a side effect of the medication and you're giving too much.
SPEAKER_00And it is as classic as that, because I've had cases, not mine, I'll add, but yeah, that is it. Vomiting, diarrhea, get GI signs, they're polyphagia, they're losing weight, and it's kind of like, oh yeah. Oops, someone might have got this dose a bit too high on it.
SPEAKER_03Exactly. So I think we're at roundup time. So we've covered a lot of ground again today, from presentation to diagnosis, work up and treatment options for both hyper and hypothyroidism in our dogs and cats. Things to watch out for and how to manage these cases generally.
SPEAKER_00We hope that's broken things down for you a little bit and made the cases a bit easier to handle and manage in practice.
SPEAKER_03Absolutely. And as always, please do get in contact with any comments or suggestions you have for us or topics you'd like us to cover next. Remember, you can contact us via our blog on our website, on WhatsApp, or via our WhatsApp, uh via our social channels.
SPEAKER_00We look forward to seeing you next Sunday for our next two-week takedown episode. We'll be covering new Turing controversies. It's a big E. And we've got ophthalmology in general practice and much, much more. So until then, it's bye from me. Take care. This podcast is intended for license for every professionals and is provided for educational and discussion purposes only. Whilst it is publicly accessible, it is not intended as advice for pet owners.
SPEAKER_03The views shared are based on our own clinical experience and interpretation and do not replace individual clinical judgment. We accept no responsibility for decisions made based on this content, and all cases should be assessed on an individual basis.
SPEAKER_00Any references to medications, treatments, or products are made for educational discussion only and are not intended to promote or advertise veterinary medicines to the general public. Veterinary medicine should only be used under the direction of a prescribing veteran surgeon and in accordance with the UK veterinary medicine regulations.
