In this enlightening episode of Speaking of Pets, we dive deep into the world of endocrine diseases that can affect our beloved furry friends. Our hosts welcome Dr. Liesl Bigge, an expert in veterinary medicine, to discuss important conditions such as diabetes, Cushing’s disease, and thyroid disease. We’ll unravel the complexities of these ailments, discussing warning signs that pet owners should watch for, such as increased thirst and urination, changes in appetite, and weight fluctuations. Dr. Biggie shares her insights on diagnosis and treatment options, including the latest advancements in medication and management strategies for both cats and dogs.
Whether you’re a pet owner wanting to learn more about your furry companion’s health or simply curious about veterinary medicine, this episode is packed with valuable information and expert advice. Tune in for a blend of education and engaging conversation that will leave you better informed about your pet’s well-being! Don’t forget to subscribe, like, and share with fellow pet lovers!
◇ ─ ◇ ─ ◇
All footage is owned by SLA Video Productions.
—
Listen to the podcast here
Endocrine Diseases In Pets – Dr. Liesl Bigge
Introduction
Welcome to the show. I’m Dr. Alice Novotny Jeromin, a board-certified veterinary dermatologist.
I’m Janet Novotny King. I’m the doctor’s sister. I am not board-certified in anything or medically inclined. I’m excited, Alice, because we have a return guest.
I know our favorite internal medicine expert and Buckeye, Dr. Liesl Bigge. There is the Buckeye necklace, and one more thing, the hat. Dr. Bigge is in her Buckeye room. If I’m not mistaken, you are just back from the yearly internal medicine meeting in D.C., was it?
It was Louisville.
Diabetes & Its Clinical Signs
We thought we would talk about endocrine disease in our pets. What’s that? It’s things like diabetes, Cushing’s disease, and if we have time, thyroid disease. We’ll start with diabetes. Janet, what would you like to ask Dr. Bigge?
I had a diabetic cat. How do you know if your pet has diabetes? What are the warning signs? What is treatment like? I know what that’s like for a feline.
What’s new? What new stuff about diabetes did you find out at the meeting?
Clinical signs of diabetes are pretty much the same between dogs and cats. It tends to be noticed that they’re drinking more water and subsequently urinating more. Usually, they’ll be eating well but losing weight. That’s probably the things that pet owners see most often, what we call in veterinary medicine, PU/PD PP or polyuria/polydipsia, and polyphagia. We have the polys, as we say. That’s the most common thing that we’re going to see.
Clinical signs of diabetes are largely the same in dogs and cats. Pet owners often notice increased drinking and urination, good appetite with weight loss—these are the most common early signs. Share on XYou can see pets where the owners aren’t going to necessarily see those signs as predominantly. The pet ends up being sick like vomiting. Most of the time, it would be vomiting, off food, and not eating. Sometimes, you’ll get a history that he’s been drinking a lot for a few months. They didn’t pay attention to the fact that the pet was probably losing weight. Those guys are sick of presentations. Most of the time, they’re coming in with a complaint. Most of the time, it’s the drinking and urinating more that we see in both dogs and cats.
What about aging? Is it an old pet?
It’s an old pet disease. We do see a few every once in a while, a juvenile onset or a youngster onset. That’s super uncommon. In your career, you might catch a couple, but the vast majority of them are older pets. They tend to be in cats, especially obese pets. You can have them in thin pets. Dogs can go either way. They don’t necessarily have to be obese. In dogs, they may have had a history of having pancreatitis at some point in time. The pancreas is this organ in the body that creates not only digestive enzymes but also insulin and releases it. It has two giant functions.
In a dog who’s had pancreatitis, which is inflammation of the pancreas. It’s more of the digestive enzyme part of the pancreas that gets inflamed, but the whole pancreas gets inflamed. That can set up a situation where the endocrine part of the pancreas or the part that makes insulin is not able to make insulin. In dogs and cats, the etiologies are a little bit different. The overall reason for diabetes is just like in people. There’s a lack of insulin or the lack of function of insulin in the body.
It can lead to blindness because my in-laws’ dog, their Westie, went blind before they figured it out.
In people who have diabetes for long periods of time, it leads to retinal changes. Also, people can get cataracts less commonly from diabetes. It is most often in dogs. We don’t see too many cataracts in cats from diabetes. It’s like the cat scans. We can get rapid onset cats. That would be a weird presentation if a pet were presented for cataracts and the owner was clueless as to the other things that were happening. I suppose it could if you had somebody who was not paying attention to what’s going on, at least with the drinking and urinating part of things.
What are treatments like for a diabetic cat or a diabetic?
This is where it gets fun because there’s some new stuff that we’ve known about for a little while. There’s more stuff that’s not super new that came out at the meeting. For the most part, our patients tend to be more insulin dependent as opposed to people who can live their life not ever needing insulin. Most of the time, our pets are going to need insulin. Dogs are almost always insulin-dependent.
In fact, I never refer to dogs as not needing insulin. They just do. For kitties, on the other hand, and this is where it gets exciting, we do now have some oral antihyperglycemic agents or oral drugs to help lower blood glucose. They’re cool. They’re a once-a-day drug. There’s a liquid form of it called Senvelgo.
There’s a pill form called Bexacat. The mechanism of action of these drugs is that they block the body’s ability to resorb glucose from the urine. The kidneys are able to pull back glucose on a regular basis. What these do is they block this SGLT2 receptor that allows the sugar glucose to dump into the urine. It can bring down the blood sugar that way. It’s cool. It’s easy.
You’re on Ozempic, right?
I don’t wish to. I don’t want the GI stuff with all that.
I know. It’s terrible.
It’s so bad.
With humans, they have the thing, and they have the app where they can check their glucose level. Do you have to do that with a pet?
New Technology: Continuous Glucose Monitors
We can do that. The CGNs or continuous glucose monitors have been validated for use in dogs and cats. The one that we recommend or the one that’s been validated is the FreeStyle Libre. It’s pretty slick. The Freestyle Libre 3 Plus lasts about fifteen days. They’re super useful when we have to use insulin. We don’t use it when we’re using oral agents. The other thing, getting back to this, because there are a lot of important things with using the oral agents, the Bexacat or Senvelgo. Pets can’t have any other illnesses.
They can’t have any other disease. I think in Europe, people are tending to bend the rules of what’s listed in the pamphlet, the inserts, and stuff, and are using it sometimes with concomitant diseases. You can’t use it with GI disease, heart disease, and kidney disease. That’s the one caveat. Again, only available for cats. Not for dogs.
Does it make those other diseases worse if you put them on Bexacat?
What can happen? They have pretty much no side effects from causing vomiting, diarrhea, and any bad stuff. They don’t cause low blood sugar. They don’t do that because there’s an extra little receptor in the kidney that’s able to still bring back a little bit of sugar, a little bit of glucose. That’s what prevents hypoglycemia or low blood sugar from happening in these guys. What we do have to look for are these things called Ketones.
If you’ve ever been on the Atkins diet or the diets where you’re eating fat and protein, and don’t have a lot of carbs. The body will switch to having to use those fats and proteins to make glucose to make sugar. What can happen with Bexacat and Senvelgo is that you can have a situation where the blood sugar is normal, but there’s been a buildup of ketones in the body. One thing that we do have to watch pretty closely in your veterinary, and we’ll go over that with you. It’s checking ketones periodically and keeping them below a certain level. It’s blood ketones.
Not the urine?
I was going to bring it up. You can check urine ketones with the little dipstick things, but we also check blood ketones. There are little ketone meters, like a little blood glucose meter that you can prick your finger and use. We can now do that for ketones. If the ketones don’t stay below a certain level, we have to discontinue this medication and switch to insulin. It has its place in the correct patients.
It can work well. There is follow-up. You can’t just put them on it, forget it, and say, “If you start drinking a lot and urinating a lot, then come back in.” It’s not how it works because they can get pretty sick with it. It is cool that we now have this option because before, we didn’t have good oral options for cats. It is super exciting.
Someone was doing research to give an option besides insulin.
I was a former injector.
I knew this was coming. Twice a day.
She loved it because you have to feed the cat. That’s cat food on the dryer. We put her on the dryer. She would go like this. “I’m ready.” You put it in. With the food I have now, this would never work.
There’s some cool stuff with cats and this whole, “You got to feed them.” If they don’t eat, you can’t give them insulin. We are getting away from that, especially cats. I don’t want to be too technical. There are two classes of insulins. There are insulins that are clear. They’re solutions. There are insulins that are suspension, where you have to shake them up, and they’re all cloudy. That’s a super basic description of two types of a giant class of insulins.
One of them is considered a basal insulin. The solution insulins, the clear insulins, are called basal insulins. That’s what the vast majority of people are on. That’s what they put in the insulin pumps. Pretty much everybody, a human, is on basal insulin. In veterinary medicine, we have, for the most part, used mostly suspension insulins. Those are your NPH. That’s probably the one that people are most familiar with. Those are going to go by the wayside completely by 2026 on the human side.
We’re only going to be left with a couple of different suspension insulins. Hence, a lot of the research is going into using solution insulins, or basal insulins, in dogs and cats. Since they’re less potent, they can still cause glucose to go super low, but you don’t get these crazy ups and downs that you can get with the more potent, shorter-acting suspension insulins. All that being said, what it has to do with feeding is that when you’re using a basal insulin, the solution insulin, you don’t necessarily have to have the timing perfect.
If a dog or cat is on once-a-day insulin, you can usually vary those by two- or three-hours dosing-wise, and they don’t have to eat at the same time. If they’re on twice-a-day dosing, it’s the same concept, you can vary those doses. It’s so cool. It’s like things that we were so dogmatic about. Your life revolved around having to make sure you got home to give the injections and feed. It’s going to make life a lot easier.
Another cool thing is we’re also migrating towards using more pens. Instead of using an insulin bottle and a syringe. You’ve got to stick them in there and pull them all up. We’re going towards the auto-injecting pens. You can watch YouTube videos on how to use them. Once a person goes from having to drop the insulin to then being able to use a pen, they don’t go back. They do not want to go back.
Why would you?
I know. It has much more accurate dosing. I want you to each pull up one unit of insulin. Believe me, when they’ve done technical studies to read all of what everybody’s pulled up, they’re off by half a unit, and sometimes, even a full unit. That’s a pretty cool thing, too.
We used to have problems. I’m sure, Liesl, as an internist, you had problems with the pharmacy sometimes dispensing the wrong syringes. Talk a little bit about that. That’s scary.
We’re in a good place with that now because there’s pretty much only what’s called U100 insulin for the most part. What that means is that there are 100 units per 1 ml of the insulin that’s in the bottle. On the veterinary side of things, we do still have Vetsulin, which is a suspension insulin. That does use U40 syringes. That means there are 40 units in an mL. Those syringes, you should only be getting from your veterinarian.
You shouldn’t even attempt to get them from a human pharmacy because something’s going to get messed up. With Vetsulin, you have to pay particular attention to the right syringe type. Pretty much everything else is U100. There’s a U300 insulin that’s slick. That’s called Toujeo. I’m sure you’ve seen the commercials on TV. Toujeo is a solution of insulin, but it’s 300 units per mL. It’s super helpful for very large dogs that are on large volumes of insulin. It works slick for them, but you’re right.
As long as they don’t have commercials with those people dancing.
Could you just stop?
I have a comment, though. In Durham, I would get some elderly cats that weren’t diabetic. They were itchy. Their veterinarian gave them a long-acting cortisone shot, a Depo shot. It threw them into diabetes. Was that a transient?
We can see that in cats in particular. Steroids block the action of insulin on the cell. Steroids being prednisone, dexamethasone, and, as Alice alluded to, Depo shots, where it’s a long-acting shot. Most of the Depo shots last at least two weeks, or probably a little bit longer than that. Maybe a month. It depends on the cat. What that can do is, if a cat is set up in a situation to be diabetic like it’s thinking about it. It’s a wannabe diabetic, especially if it’s obese. Obesity fights against the action of insulin, then we give it a steroid shot.
We can see that antagonism, that war between the steroid and the insulin. It can be temporary. Once that steroid does wear off, we can see that they revert to having just enough insulin to do their thing. It does set you up for, “We better get some weight off this pet. We’d better keep a closer eye on it.” Cluing the pet owner into, “You’d better watch for the pet drinking more and urinating more. Watch for the clinical sides of diabetes, so we don’t miss it.”
Watch for your pet drinking and urinating more—those early clinical signs of diabetes matter, so we don’t miss it. Share on XIf the pets are mostly insulin-dependent, does diet make a difference? If I have a diabetic dog, what diet should I use as opposed to a diabetic cat?
It’s like in people, carbohydrates are the enemy of diabetes because they’re metabolized into simple sugars, which is what we have trouble dealing with when we lack insulin. Most of the diets that we put these guys on are going to be somewhat lower-carb diets than the normal dry diets. We do encourage, particularly in cats, to use canned food exclusively.
Is it a special diabetic?
We’ve learned a lot about that lately, too. We do have prescription diets that are formulated specifically for diabetic cats. What we’ve learned is that Fancy Feast canned loaf, not the kibbles with gravy, but the loaf type Fancy Feast diets, we have successfully managed diabetics.
That’s fabulous.
Isn’t that cool? For the dry food junkies, these cats that you can’t get off kibble, it makes it challenging. You’re better off using a veterinary prescription dry food if you can’t get your cat to eat canned over-the-counter food. The dry ones that are veterinary prescription brands are going to be formulated to have less carbohydrate and a little more fiber.
Fiber helps get stuff through the gut faster. The diets tend to be a little lower carb and a little higher fiber. We don’t have to do the canned food with dogs as much. They are a little bit carbohydrate-restricted. Treats are tough. Remember Kibbles ‘n Bits, the food that had the crunchy and chewy stuff? Gaines-Burgers is the worst.
It’s high in sugar and salt.
Exactly. It’s any kind of chewy, soft food for my diabetics with treats.
Do you know why cats like the Fancy Feast? It’s because people serve it in that little glass.
It’s got to be the loaf.
It’s like a meatloaf to me.
It has to be the loaf. It can’t be the little kibbles with juice on them.
Have you ever seen that cat treat that you open up, and it’s liquid goo?
It’s Churu. They’re the best.
That’s where you can get cats to eat. It’s like my Capri at the end, with her renal failure. I bought all kinds of flavors. Any kind of kibble, I bought them. To address the soft and moist treats being high in salt and sugar. When we were driving the girls, the dogs to Florida, and I said this before, Mike bought these treats. I use their food as treats.
You use the kibble as treats.
They don’t even know a Snausage exists. I look at these treats on the table. I’m like, “What is that?” “The girls are going to be in the hotel.” We get to Florida. Tawny is drinking and peeing like crazy. I took her to Dr. Heidi Ward, my internist in Sarasota. We tested her for Addison’s. We tested her for ultrasounds and everything. It was a treat. I thought, “For three days, what’s new?” These treats are not innocuous. They’re high in calories, especially the pliable ones. Think of the sodium in there.
They’re pretty nasty. I tell people with treats with diabetics, as you said, use their food. If you have a dog who’s grown up with always having something fun, I allow people to do green beans, low in simple sugar. People say, “What about a banana?” Banana’s a lot of sugar.
They are high glycemic.
It’s benign. There’s no fat. It’s not going to make them vomit. Grapes are a complete no-no because people sometimes want to use grapes. They can be renal toxic and kidney toxic, too. The other thing I did is low-fat string cheese. Only little teeny pieces of that, because it’s high protein and low fat. That’s fine for treats. Honestly, the treat should be tons of praise, and anytime you’re trying to do that. To Churus for cats has been a blessing. It’s a good thing to have.
You can get them at TJ Maxx, by the way.
What can you get at TJ Maxx?
The Churus. Those things in the tube.
It’s the nasty tube stuff that you were saying.
I can’t do that.
Cushing’s Disease
Let’s move on to Cushing’s disease.
I can’t even open it because it stinks.
They do stink, but cats like stinky food.
They like stink, Janet.
We got to move on to Cushing’s disease.
I know, Janet, you don’t know anything about that.
I know nothing.
Liesl and I see it. That’s our department.
Is that the one where humans get bulgy eyeballs?
That’s thyroid.
We might talk about that if we have time.
What is Cushing’s disease? How do you know if your pet has it?
Here’s another poly disease. Drinking and urinating more is a big sign. Let’s preface this with cats very rarely get Cushing’s disease. Twice in your career, you might see it. Throw that off the list.
One less thing for me to worry about.
In Cushing’s, it’s older pets. There are some breed predispositions toward it. We do tend to see it in Terriers and Schnauzers, but any dog can have it. We do see it in large-breed dogs. I’ve probably seen an over-representation of Boxers, but we don’t see as many Boxers nowadays.
A few Goldens, too. I was surprised. Start listening, Janet.
I am listening. I’m scared now.
Again, drinking and urinating a lot is a huge sign. Sometimes, you’ll have seen some subtle changes in the pet, like, “Your belly’s looking a little pot-bellied. I’m not feeding you some beers. How come your belly’s starting to hang a little closer to the ground or gaining weight without necessarily feeding more calories?”
We don’t fat-shame here, by the way.
I’m not fat-shaming. I’m just saying. It’s not their fault. Those are the signs of it that most people see. Sometimes, you also see panting more often or having more difficulty settling down. There’s a lot of other stuff we can see with it, but that’s what people mostly bring them in for.
People get this and have the same signs as dogs, by the way.
They pant?
There was a news anchor, a woman. I read her story. I was doing something on Cushing’s disease, so I’m looking at all these Cushing’s articles. She could not lose weight. She was a beautiful woman. She was getting a moon face. She was big. She said, “I was always hot. I went to all these doctors.” “You’re just fat. You need to lose weight.” She had Cushing’s. She had a tumor in her pituitary.
Core Definition Of Cushing’s Syndrome
Getting to what it is, it’s a disease where the body is producing too much cortisol or a steroid. With cortisol, and like prednisone, which we talked about with diabetes. The body is producing too much of it. It’s produced by a gland in your belly that’s right next to the kidneys. There’s one on each side. It’s called the adrenal gland. Cushing’s syndrome is characterized by urinating more, drinking more, and the body’s production of too much cortisol.
Cortisol is made by the adrenals, but it could either be made by a tumor in the adrenal. Maybe just in one adrenal gland, or it could be that it’s operating independently of any feedback mechanism in the body. It’s there. It’s pumping out cortisol, or it can be because of a tumor in the pituitary gland up in the brain that is telling the adrenals to make steroid hormones. When it’s the pituitary thing telling the adrenals to make steroids, that’s Cushing’s disease. It’s a semantic thing.
Eighty-five percent of our veterinary patients are pituitary-dependent, where they have a teeny weeny little pituitary tumor that’s acting independently and telling those adrenals to make cortisol. The cortisol is what is causing all the clinical signs, causing all the things that we’re seeing, like “I got to drink more water.” What happens is it makes you pee more first, and then you have to drink to keep up.
This is where Alice’s specialty comes in. It causes changes in connective tissue. Connective tissue being skin. You’ll get muscle wasting. They can’t build. You think of steroids causing bodybuilding kind of thing, but there are classes of steroids. That’s the anabolic steroids that will cause muscle gain. Corticosteroids, glucocorticoids, cause yucky negative changes in skin and connective tissue. This is where Alice gets her cases that get bounced over for this crazy thing called calcinosis cutis, where they get calcium in the skin.
When we diagnose it, you take your pet to the vet. We have a general idea. When I’m talking to the veterinarians that I talk to daily, I’ll say, “When you look at it, do you think it has an endocrine disease? Do you think it looks like Cushing’s disease?” That’s super high on the list. That’s what we talked about, the potbellied. In people, Alice mentioned this moon face thing. We don’t get that in veterinary medicine because there’s hair all over them and all that stuff. When you look at potbellies from above, they don’t have a waist anymore.
We do routine lab work, regular old stuff that we ought to be doing on a yearly basis anyway. That will show some usually some characteristic changes. One of them being this very annoying enzyme called alkaline phosphatase that can be elevated for a lot of different things. It is up with most Cushing’s patients. The first step is a regular old blood work and a urine test. We always want to look at the urine, too.
There’s some specialized testing that we do with respect to cortisol, where we give an itty-bitty amount of a steroid to the pet. We want to see how that pet responds to it. Does it shut down its own body’s production of cortisol, or does the body say, “I’m going to continue to make more cortisol?” It’s called a low-dose dexamethasone suppression test. Sometimes, we’ll do another which is called the ACTH stim test. They’re looking to see whether the body quits making steroids when we tell it to quit making steroids. It’s a very stepwise process.
A lot of people will then do an abdominal ultrasound because most hospitals have an ultrasound machine, or they’ll have people come in that will do ultrasounds on pets for them. We’re going to look at those adrenals directly. Do they look plump? Do they do it to look like we have a big tumor on one and a little shrinky raisin adrenal on the other side? Are they both plump-looking? That would support the diagnosis. From an endocrinology geek perspective, it’s a fun disease for us. It’s annoying as heck for owners. It’s obviously annoying for the pets themselves.
I assume the pet is on some medication.
We put them on a medication that decreases the production of cortisol. It’s probably the easiest way to put it. That’s come a long way back when Alice and I were in school. The drug that we use destroys the adrenal gland. That drug doesn’t exist anymore. You get Lysodren. It’s compounded. Humans don’t use it at all anymore.
We have a drug called Trilostane. It halts the production. It aborts, in the middle of a pathway, the creation of corticosteroids or glucocorticoids. It works very well. It’s expensive. The biggest drawback to it is that it’s an expensive medication. There’s no legal generic version of it. Hopefully, in time. It’s been out long enough. I should look into why we don’t have a generic version yet, because it will definitely be picked up by somebody from a generic perspective. It works well.
The pet then leads a pretty normal life.
It can lead a great life. The whole point of Cushing’s is that when we treat it, we treat it to increase the quality of life of the pet and of the owner. When we treat it, we don’t necessarily prolong their life. We just make their life way better. There are some dogs where there is lots of different stuff going on with them, or the owners can’t afford Trilostane or the drug to treat it.
We treat to improve the quality of life—for both the pet and the owner. We don’t necessarily prolong life; we make it better. Share on XThey can deal with getting up in the middle of the night to let the dog go potty outside or in their home. During the day, they can let it out. A lot of times, we won’t treat because they can’t afford it. It’s not a disease worth euthanizing over if it exists. Unless the quality of life is so bad that we can’t do anything about it. It’s one where sometimes we’ll diagnose it. This frequently happens. People will call and talk to me to do a consultation.
They’ll be like, “This dog has this high alk phos.” The owners are saying, “It’s not drinking a lot. It’s not urinating a lot. I think it has Cushing’s disease.” They’ll go on and test it and say, “I should treat this dog, right?” I’m like, “If the owner doesn’t see things that can be fixed outwardly, then maybe we won’t treat. We’ll treat maybe down the road in six months or a year, or as the case may be, when they present to Alice for nasty skin.”
They lose all their hair and they get a rat tail. They keep their hair on their head, but they lose their trunk hair and their rat tail. Liesl, I love the saying, “Only because we can do something doesn’t mean you should.” When that liver enzyme is elevated, then maybe you’ll do an ultrasound. He has Cushing’s. If they’re doing great, I don’t do anything because there’s a lot of monitoring once you get them on Trilostane. There are people that can’t afford that monitoring, sadly. Have you ever had any surgical cases where they have the adrenal tumor?
We don’t see them too much. If we have adrenal tumors, it does tend to be the large breed dogs more than the small breed dogs. If we do the numbers, 85% of them are pituitary dependent, and 15% of them are adrenal dependent. In that 15% that have our adrenal tumors, the vast majority, 90% of them are large breed dogs. I sent some to surgery.
They can be surgically resected. Before sending them to surgery, the thing that we look at is an ultrasound is, do we have any invasion? The adrenals are right next to the kidneys. They’re right next to these very big blood vessels called the vena cava and the aorta. What can happen is that the tumor can grow and invade the vena cava.
It can wrap around it.
If it’s like that, then we usually won’t even attempt surgery. If it looks like it’s not invading any big vessels with short names, then we can go in with a very good surgeon and cut that out. The dogs can go on and live great lives with nothing. All that stuff gets better, such as the drinking and the urinating. Their skin improves. The hair coat grows back. It takes six months to a year once we get rid of that extra cortisol. No disease is good, but at least it’s diagnosable and treatable.
I watched a good webinar on Cushing’s. I can’t remember who sponsored it.
The human side or the veterinary?
Veterinary. Apparently, there are two vet schools in the country that take out pituitary tumors. They go to the roof of their mouth. They do that in humans.
I think Auburn, Colorado. My husband is a boarded surgeon at the Animal Medical Center. They would do it, too. That’s the free-standing one in New York. That was a long time ago. I don’t know if they’re still doing it now.
That’s got to be teeny tiny.
The problem is that the anatomy of a human is different than the anatomy of our dogs. It’s harder to get to the place. For people, it is pretty simple. It’s right above the roof of the mouth. In dogs, it’s quite a bit harder. We had somebody here locally who did it but he left. I don’t know where he went. He was trained in Auburn.
He ran out of town. I’m kidding.
I have no idea. I am not on the local scoop anymore.
Liesl and I just mind our own business.
You do your own thing.
Feline Hyperthyroidism
We have one more disease we want to talk about, the thyroid disease.
Again, Liesl and I are both involved with that.
I want to do the hyper side.
Let’s do cats first.
Hyperthyroidism, hyper means lots, and thyroid means thyroid glands. The thyroid glands sit right in the neck. They help control metabolic rate in the body through a hormone called Thyroxine. When we measure thyroxine, it’s called T4. If you get your blood work done at the vets and it says T4, that’s what that means. They’re testing thyroid function. In kitties, we tend to see hyperthyroidism. It’s caused by a tumor, but it’s a little area of abnormal cells within the thyroid gland that operates independently and produces too much thyroid hormone.
Normally, the body has a whole bunch of different feedback mechanisms. Something tells something to turn on, and another something tells something to turn off. It’s like with Cushing’s, but with thyroid disease, these are acting independently of the body’s turn-off mechanism. In kitties, we see that the majority of them are hyperthyroid. It’s a fairly simple diagnosis. We do blood work. We see if that number is high. The caveat is if the number is high. Once a cat is over the age of ten, we start to get a lot more interested in that above normal, which is the mid-range of the normal range for thyroid.
I’m not trying to confuse people, but there will be cats whose thyroid will fall on a piece of paper, the normal range. If they’re over ten years of age and they’re sneaking up still within that normal range, we usually will recommend doing a little bit more testing, a more specialized test called a free T4. Especially if the cat has any weight loss for any reason. I should have said this, too, the clinical signs of the disease, such as sometimes eating at a house and home. Crazy eating in a cat that normally was a couch potato. Suddenly, it’s interested in eating all the time and losing weight.
That’s the vast majority of cats. Some of the cats won’t have such crazy clinical signs. Some of them will lose weight, or they’ll come into the vet office. The owners won’t say that they’re eating a ton, but their heart rate will be crazy high. Maybe they’ve had some weight loss. There’s a spectrum of disease. The poster child would be a cat that used to be normal, slept 85% of the day, now comes in, is a lot more active, eats more, maybe drinks more, and is losing weight despite all that. Sometimes, we’ll see diarrhea or vomiting.
It’s because everything is heated up.
That doesn’t happen with humans. You can’t eat, eat, and eat and lose weight. It doesn’t happen.
I don’t know enough about it in people.
I’m just saying it doesn’t work for me.
Maybe we’ll start taking some thyroid medication. The people’s side of thyroid is crazy because it is markedly different from how we manage stuff.
These are older cats.
They’re usually old cats. The youngest that I’ve ever seen was four.
That is young. There’s something wrong with that cat.
Radioactive Iodine Treatment For Hyperthyroidism
There’s always that question of, “Is the cat that you got from the shelter, truly the age that they’re telling you it is?” If it was four, I don’t know that one we knew exactly, but that’s what was in the records. I had to go with it. For treatment, there are two main ways. Probably the best way in reality is to get what’s called radioactive iodine therapy or I-131, a simple treatment. What we do is we inject the kitty with an under-the-skin injection of this radioactive iodine.
We use that drug because iodine is part of the thyroxine molecule itself. When we give that radioactive stuff, what happens is it goes boom, gets picked up, and gets put in the thyroid gland. Since it’s radioactive, it will kill the cell that picked it up and then one or two cells adjacent to it. The cells that are making thyroid hormone the most rapidly are the ones that get killed, and then a little bit adjacent to them.
The nice thing is when those cells are going crazy by themselves, the rest of the thyroid’s are not doing anything. It’s like, “That one’s doing all the work. I don’t have to do anything.” When you kill the crazy cells with the radioactive iodine, a few days later, those other cells go, “Where’s all that thyroid that we were just swimming in?” It will start to come back. The vast majority of the time, we are not making them go in the opposite direction.
They don’t bottom out.
Can we be around that pet?
We usually keep them in the hospital for 3 or 4 days. The reason is that the majority of the urine and feces would have some of the cleared radioactivity in them. We have to keep that stuff for three months. We have to Geiger check it all the time. It’s a lot. When they go home, we do recommend that they stay a minimum of 6 feet from the owners for two weeks. That usually means in their own bedroom, sadly, or a room where they’re not going to be lying all over you because the last thing you want to do is have the cat lying across your thing with this I-131 right across your neck.
The recommendations are probably overkill, but you do absolutely need to listen to them. Particularly with little kids and stuff, or old people. It’s cool. It works great. Usually, one injection is curative. It’s a very small percentage. Maybe 5% might have to have a second injection down the road, but is that because the first one didn’t work, or is it because they decided to make more cells stupid, like the thyroid gland decided to get a little nutty again? That’s what happens more so than the drug not working the first time.
That’s one thing. That’s the best way. If you can afford it, that’s the way I would go all the way. Especially in a cat that doesn’t have other diseases. The other way that we treat them is with a drug called Methimazole. What methimazole does is it blocks the thyroid from being able to pull thyroid iodide into it. In essence, decreasing the body’s ability to make thyroxine. It has to be given daily, usually twice a day. Methimazole works well. It can be given orally. It can be made into chewable tablets. It can also be given so that it’s put on the ear in what we call transdermal dosing.
It’s one of the reliable drugs that we can give on the skin that will then get absorbed through the skin and still be able to do its job. There aren’t a lot of those that are effective at doing that, but we can use methimazole. It works great. Using the oral drug is great when you don’t have a chunk of change to spend on I-131 because it’s well over $1,000 bucks now. I haven’t priced it lately, but it’s a lot of money.
Methimazole costs a little bit of money because it’s an oral drug and it’s not an expensive one. I tend to use that also if I have cats that have concomitant diseases. If we have kidney disease in a cat, I’m reluctant to send them for I-131 because that crazy hyper state from hyperthyroidism delivers more blood flow to the kidneys. What do the kidneys like? They like blood. The kidneys like blood flow. When you pull back by treating the hyperthyroid state and pulling back that excessive renal blood flow, it can unmask underlying kidney disease.
Many old kitties have kidney disease. It ends up being this balance of a little bit of methimazole to keep the thyroid controlled and watch those kidneys. Are you doing okay? Do we need to back off, or can we give a little bit more? This is where the art of medicine comes in, where you have to balance not killing one organ system to fix another one. It’s fun, again, in a geeky endocrine way.
You have to balance not damaging one organ system to fix another. Share on XLove a good endocrine story. What about dogs?
I hate hypothyroidism. I truly do.
I love it because it explains so much.
I know. The hardest thing with thyroid in my world is that we check this T4 on normal blood work. There are a lot of things that influence thyroid production in the body. There’s also this thing that’s called euthyroid sick syndrome, where we can have a thyroid that, on paper, measures low, but that pet is not hypothyroid. That pet does not have a low thyroid. There are so many times when people will call because their thyroid is low. They’re like, “The dog’s hypothyroid. I need to treat it.”
I’m like, “Let’s back up. Do you think the dog has thyroid disease?” It is that question of, “Do you think the dog looks endocrine?” By endocrine, sometimes, they look similar to the Cushing’s dogs in that their hair quality is yucky. They can have skin changes and a poor hair coat. Alice can talk way more in depth about this. Fur doesn’t go through its normal cyclic process. We can also see dogs that tend to be obese. They tend to be like, “I don’t want to do anything.” How many Labradors come in that are obese couch potatoes because they’re fed too much food?
Labs are eaters.
They have a neuron that goes from here to here that says, “Feed me.”
Hypothyroidism And Over-Diagnosis In Dogs
Having said that, there are a lot of dogs on thyroid medicine that have no reason to be on thyroid medicine. That bothers both Dr. Bigge and me. When I adopted Cinnamon, she was a Golden Retriever, 110 pounds. They gave her up because she was limping. She was profoundly low thyroid.
I had her until fifteen and a half. She was 55 pounds once we corrected her thyroid. She was limping because she was so fat and probably had some joint issues from being hypothyroid. She truly was hypothyroid, but there are dogs out there that are on thyroid meds that have no reason to be on thyroid meds.
They’d be better served by using food as a drug, meaning either a prescription diet, low fat diet, or working with your veterinarian or a veterinary nutritionist to come up with a food that’s the correct caloric intake but gives them enough satiety. They’re satisfied by the food, but it does restrict calories and gets that weight off of them. I don’t hate dogs. I hate the situation.
The other thing is that, and this drives me nuts, and I’m just complaining to the universe here, a lot of times, in the lab work that labs will run, the panel will have a thyroid on it for a young pet. Hypothyroidism is an old dog disease. Hyperthyroidism is an old cat disease. Youngsters, if you do a panel of blood to see, “What’s my dog’s normal blood work, so I know what their normal is when they’re a youngster?”
Their thyroid will be above the normal range. People will call me like, “Is the dog hypothyroid?” I’m like, “That’s normal. Thyroid are for old dogs. They’re not for young dogs.” Every once in a blue moon, we’ll have a dog that is hyperthyroid and an old dog with hyperthyroidism, but it’s usually because they have a bad tumor that’s producing excess thyroxine. That’s a whole other story, but that’s less common.
As a pet owner, I’m seeing the importance of those annual blood work. Tell me if I’m wrong. You can identify any of these issues.
I will say this. As a crazy person, now I have young dogs, but I’ve always had old dogs that I’ve adopted because no one wants old dogs. I did blood work on them every four months and ultrasounds at least twice a year. You can have totally normal blood work, and the dog has cancer. Cinnamon, the one that weighed 110 and ended up being 55 pounds because she was hypothyroid, had five different types of cancers.
Her blood work until the day she died was totally normal. It’s still a good thing to do. She had two sarcomas, which were an intestinal adenocarcinoma and thyroid cancer, which I kept aspirating. Finally, Dr. Thalhofer said, “Quit sucking those cells out.” It’s a good idea to have your dog’s blood work done, but with the caveat that normal blood work doesn’t mean they don’t have cancer. It diagnoses a ton of other things.
For humans, too.
It’s all we can do.
The Importance Of Annual Checkups And Pet Observation
Your cholesterol can look good, but who knows? This has been interesting. What I’ve learned is that those annual checkups are super important. You have to pay attention to changes in your pet, like changes in your humans.
Changes mean everything because they are creatures of habit. When they start to do something that’s not in their wheelhouse, you need to go, “She doesn’t do that. She doesn’t go sit in a corner like that. What’s going on?”
Shaggy, all of a sudden, would be going, “Uh,” to get up, and he had Lyme. Shaggy had it three times and I’ve had it once. We’re like this Lyme center. That was a big change. I’m watching and I’m like, “What is wrong with you?”
It’s important. Videos are these things that people have in their hands all the time. I tell people all the time, “Please, can you video what your pet’s doing?” It’s because they come into the office, and they’re excited to be there. It’s a different environment. Epinephrine can override a lot of things. This helps a lot, too. The other thing, I have people and I will say, “Can you pull up an old pic of your pet when it was two or three?”
People always have videos in their hands these days. I often say, ‘Please, just video what your pet is doing.’ Share on XWe’ll say, “You see how this look wasn’t there?” We usually take a baseline picture before we start treatment. This is going to Cushing’s disease in particular. We’ll take a base or thyroid, this would work too, but I hate thyroid. I’m going to send them all to Alice. We do a baseline picture. Every three months or so, we’ll take pictures. It keeps people like, “Look at that,” the weight checks, follow-up labs, and stuff.
The video I missed, though, is I’m looking out the back window, and we have this old birdhouse with a hole in it. I sent Alice a picture. The male cat has one paw on top. It’s got that paw in that hole.
There better not have been babies in there.
We don’t know. It’s been up in the rocks forever. I was laughing so hard because he kept going in there. He’d stop, and then he’d go because he must have heard.
There were babies in there. Are you kidding?
I don’t know.
I have to tell you a very important thyroid story. You can get dog prescriptions at human pharmacies. When you treat a dog for low thyroid, they’re on a higher dose of thyroid than we are as humans. After I retired, I had a pet parent email me. It was a little white Poodle Maltese type dog. It was on the thyroid. It was 0.1 milligrams. It was a 20-pound dog.
It was low for that dose, which was 0.1 milligrams a day. She texted me and said, “I’m so worried. My dog, who is perfectly fine now, has a murmur. She’s panting all the time.” They gave her 1 milligram of thyroid. Thank God, when she went to the vet, the vet said, “Bring me the medication she’s on.”
He looked at the vial. It said 1.0 instead of 0.1. They had all this cardiology workup and everything else. Be very careful. Liesl, I think you would agree. A lot of times, we have pharmacists calling to confirm the thyroid dose because here’s a 50-pound Golden right here. She would be on 0.5 milligrams twice a day or maybe once a day. I never do the textbook dose. That would be high for us as humans. We’re on 0.025 milligrams a day. I would rather a pharmacist call us to confirm than to dispense something, thinking, “That doesn’t sound right.” Maybe it does sound right. Maybe we have a reason for that is what I’m trying to say.
I went to CVS once. They tried to give me the drug for my father-in-law because my daughter has the same name. I don’t like to go to that store for that reason now.
In their defense, they’re filling 500 to 1,000 scripts a day. I get it as a former pharmacist. I can tell you. Still, if there’s ever a question, it’s better to call the doctor or the veterinarian than to give the wrong medication.
Every time I had to shoot the cat, I was so careful. I checked that bottle because it was in the fridge. “It’s 0.2. It’s okay.” I always double-check.
That’s good, Janet.
I didn’t want to overdose or underdose. It was stressful if you’re not a medical person. I didn’t want to screw this.
Liesl, before we go, what pets do you have now?
Rue, come here. She’s not going to get up. She’s not going to come over here.
I love her chair, Janet. It’s an Ohio State chair.
The seat of it’s getting a little raunchy though, so I have to figure out how to recover it.
The seat is the first to go.
Get a fuzzy pad.
I have my Ohio State blanket that I’m sitting on because it’s nasty.
We can get you a stadium seat.
I have lots of those in the garage.
Don’t forget to order Rusty’s book.
It’s Rustin. Don’t you know?
I know. He’s Rusty to us. He’s going to be on, talking about the book. It’s very good.
I looked it up while we were talking. There are 63 days until the Ohio State Buckeyes football season opener against the Texas Longhorns.
I got tickets.
Are you going?
She does. She’s always got tickets.
Not always.
Where do you park? Can I ask you?
I park because I have a senior in Mechanical Engineering who’s there. He has a parking pass for his apartment, but because he lives right off campus, he can get street parking. We bought the City of Columbus pass. He normally parks behind the house, but for football games, he goes and parks in the street so that I can park behind his house. My youngest is starting there in the fall.
I love it. More years of good parking.
Studying what?
Chemical Engineering.
My son is a chemical engineer. You have an Emmy and a Chemical Engineer. That’s awesome.
The oldest is a data analyst. He lives in Texas. He and his girlfriend are coming up for the Texas game, also.
The one who’s going into chemical engineering, I have to send you a book that gets you through Organic Chem.
We already went through that. My friend, who was an engineer, said, “You have to send this to your son.” Henry got the book at Georgia Tech and went, “Whoever told you to get that book, please thank them for me.”
I hated Organic Chemistry. Didn’t you, Liesl?
Everybody does, but there’s this book.
Did I hate it? I knew that it was going to be horrible. I was crazy about it. I taped all the lectures with my little tape recorder. I go back and listen to them another time. Now it’s such a different way of learning because these kids tape all the classes. They’re Zoomed. It’s so different.
It’s called Organic Chemistry as a Second Language. Let me tell you. I read a part of the first chapter and I understood it. I am not a science person. It’s what got him through Organic. He had a whole year of it at Georgia Tech.
Georgia Tech is a great engineering school. One of the best in the country.
He loves it.
It’s not so crazy about Atlanta.
Rue’s my baby.
How old is she?
She’s eight and a half. She’s good. She tried to kill herself, though. Corinne’s graduation party was on the Saturday before ACVIM. People were being helpful. They brought all of the desserts in from the back porch and left them on the center counter. It was a ricotta cake. There wasn’t a lot of chocolate. The chocolate wasn’t the bad thing, but ricotta cake, these complete butter things that my mom made. Alice, what’s the highest triglyceride you’ve ever seen?
In dermatology, maybe 1,900.
It’s 5,000.
She must have had horrible pancreatitis.
It’s horrible. I’m leaving to go to Louisville the following Tuesday. This happened Saturday night. She’s puking on Sunday. I’m like, “Serves you right. You got into this stuff.” I knew the chocolate part wasn’t a big deal. I’m like, “You’ll get better.” On Monday, she was still drinking. She was down on her appetite a little bit. I’m like, “Okay. Whatever.” I had a whole treatment sheet. It’s probably still here.
Personal Pet Anecdote And Expense Of Emergency Care
I had this treatment sheet for the dogs. It’s hilarious. There are all the medications and the times. The last column is Cerenia. That’s the biggest drug. I’m like, “Call me, and we’ll decide if she needs to get it.” She puked one more time. I said, “Go ahead and give Cerenia.” She puked the Cerenia up. I’m like, “You’re in.” She went down to MedVet. It was 24 hours in the hospital. This is with a veterinary discount. It would have been $4,400.
How long was she in the hospital?
24 hours. It’s expensive. It’s crazy.
Liesl, thank you so much.
This has been so great. You explained things so well. I’m using the word simple because I understood it.
Sometimes, I think I overtalk.
Your work here is done if she got it. This is Dr. Alice Novotny Jeromin from Cleveland, Ohio.
This is Janet Novotny King from Cleveland, Ohio, the Novotny sister, saying thank you for tuning in. We appreciate you. Don’t forget to love us, like us, and share us. Thanks for tuning in.
Important Links
About Dr. Liesl Bigge
Dr. Bigge is board-certified as a small animal internal medicine specialist by the American College of Veterinary Internal Medicine. She obtained her veterinary degree from The Ohio State University before pursuing further training at Darien Animal Hospital as a medicine and surgery intern. She then completed her 3-year internal medicine residency at the Tufts University Foster Hospital for Small Animals. Dr. Bigge has spoken at local veterinary association meetings. She is co-owner of Cleveland Associated Veterinary Specialists and also an internal medicine consultant for a large veterinary laboratory. In her spare time she loves to garden and volunteers extensively for community service and arts organizations.