EVALUATION OF QUANTITATIVE THYROID SCINTIGRAPHY FOR DIAGNOSIS AND STAGING OF DISEASE SEVERITY IN CATS WITH HYPERTHYROIDISM: COMPARISON OF THE PERCENT THYROIDAL UPTAKE OF PERTECHNETATE TO THYROID-TO-SALIVARY RATIO AND THYROID-TO-BACKGROUND RATIOS.

Thyroid scintigraphy is commonly used for evaluation of cats with hyperthyroidism, with the thyroid-to-salivary ratio (T/S) being the most common method to quantify the degree of thyroid activity and disease. Calculation of thyroid-to-background ratios (T/B) or percent thyroidal uptake of (99m) TcO(-) 4 (TcTU) has only been reported in a few studies. The purpose of this prospective, cross-sectional study was to evaluate a number of quantitative scintigraphic indices as diagnostic tests for hyperthyroidism, including the T/S, three different T/B, TcTU, and estimated thyroid volume. Of 524 cats referred to our clinic for evaluation of suspected hyperthyroidism, the diagnosis was confirmed (n = 504) or excluded (n = 20) based on results of a serum thyroid panel consisting of thyroxine (T4 ), triiodothyronine (T3 ), free T4 (fT4 ), and thyroid-stimulating hormone (TSH) concentrations. In the hyperthyroid cats, median values for TcTU, T/S, and three T/B ratios were all significantly higher (P < 0.001) than values in euthyroid suspect cats or clinically normal cats. All scintigraphic parameters were relatively sensitive and specific as diagnostic tests for hyperthyroidism, but the T/S ratio had the highest test accuracy. The T/S ratio correlated strongly with the TcTU (r = 0.85). However, the TcTU had a higher and more significant correlation (P < 0.01) with serum T4 (r = 0.76 vs. 0.64), T3 (r = 0.77 vs. 0.64), and estimated thyroid volume (r = 0.62 vs. 0.38). Overall, calculation of TcTU is an accurate diagnostic test, but also appears to be the best parameter to predict the functional volume and metabolic activity of the feline adenomatous thyroid gland.

Multiple cranial nerve motor deficits, resembling polyneuritis cranialis, in a cat with hyperthyroidism.

A 14 plus-year-old (exact age unknown) neutered female domestic shorthair cat presented with a 6-day history of rapidly evolving difficulty in eating, dropped jaw, protrusion of the tongue, sialosis, change in voice (meow softer and higher pitched) and mild variable pelvic limb weakness. Salient clinical features were a left thyroid nodule, 2/6 systolic cardiac murmur, poor body condition, hypertension, bilateral retinal haemorrhages and an increased total thyroid hormone level consistent with a diagnosis of hyperthyroidism (HT). Neurological examination disclosed mild generalised weakness, bilateral visual deficits attributable to a hypertensive retinopathy and multiple cranial nerve (CN) motor deficits that included; mandibular paresis (CN V), bilateral external ophthalmoparesis (CNs III, IV, VI), bilateral facial paresis (CN VII), dysphagia (CNs IX, X), dysphonia (CN XI) and symmetrical paresis of the tongue (CN XII). Treatment with carbimazole, and subsequently, a modified extracapsular bilateral thyroidectomy resulted in a rapid improvement in neurological signs over 13 days and complete resolution by 100 days post thyroidectomy. To the best of the authors' knowledge, this is the first description of multiple CN motor deficits in a cat with HT and resembles polyneuritis crainialis that has recently been described in human patients with this disorder. It is suggested the underlying pathogenesis is a thyrotoxic polyneuropathy selectively affecting CN motor function, that HT needs to be considered in cats that might present with such signs and that resolution can occur with successful treatment of the HT.

Cluster of cases of congenital feline goitrous hypothyroidism in a single hospital.

OBJECTIVES: To describe the clinicopathological findings and outcomes of cases of feline congenital hypothyroidism diagnosed in a single veterinary hospital in Santiago, Chile. MATERIALS AND METHODS: Medical records were searched for cases of congenital hypothyroidism over an 18-month period. Inclusion criteria were a diagnosis of congenital hypothyroidism based on consistent historical and clinical findings, a low or low-normal serum total T4 and elevated serum canine TSH (cTSH). RESULTS: Six unrelated cats ranging in age from 4 to 19 months met the inclusion criteria. The most common historical signs were small stature and lethargy. All cats had disproportionate dwarfism, delayed tooth eruption, retained deciduous teeth, bilateral palpable goitres and low rectal temperatures. Other findings were bradycardia, obesity, poor hair coat and focal alopecia on the ventral aspects of the elbows and hocks. In all cases, cTSH was markedly elevated. Sequential changes noted after the initiation of therapy included normal T4 after 6 weeks, improved hair coat and increased physical activity by 8 weeks, normal cTSH by 10 weeks and normal physical appearance and dentition after 4 months. Goitres shrank markedly but remained palpable. Hypothyroidism was well managed clinically in all cases 2 years after diagnosis except for one cat that died of unrelated causes. CLINICAL SIGNIFICANCE: This is the first report to describe a cluster of congenital hypothyroidism cases in non-related cats that were presented over a short period of time. Growth defects resolve with treatment, even in cats diagnosed after puberty. Larger, prospective multi-centre studies are warranted to determine the incidence of congenital hypothyroidism in cats.

Pharmacokinetics of propranolol in healthy cats during euthyroid and hyperthyroid states.

OBJECTIVE: To examine the pharmacokinetic profile of propranolol in cats before and during experimentally induced hyperthyroidism. ANIMALS: 8 conditioned, random-source, young adult, female cats. PROCEDURE: Propranolol was administered i.v. as a single bolus and 72 hours later by mouth. Thereafter, the cats were dosed for 5 weeks with L-thyroxine (50 micrograms/kg of body weight, s.c., once daily) to induce hyperthyroidism (serum thyroxine concentration, 217 +/- 17 nmol/L). Blood samples were obtained at appropriate intervals before and during hyperthyroidism and were analyzed for plasma propranolol concentration by use of high-performance liquid chromatography. RESULTS: In all cats, a two-compartment model best described the control and hyperthyroid intravenous data. The change in thyroid status from euthyroid to hyperthyroid caused a significant (P < 0.05), but small reduction in propranolol area under the curve (19,932 +/- 7,900 min.micrograms/L vs 15,911 +/- 1,400 min.micrograms/L) after i.v. administration. In contrast, after oral administration during the hyperthyroid state, a twofold increase (P < 0.05) in propranolol area under the curve (105,430 +/- 57,600 min.micrograms/L vs 226,811 +/- 112,000 min.micrograms/L) and peak serum propranolol concentration (651 +/- 247 micrograms/L vs 1191 +/- 590 micrograms/L) were attributed to significant (P < 0.05) increase in propranolol bioavailability caused by increased fractional absorption (57 +/- 28% vs 137 +/- 73%) and decreased total body clearance (58 +/- 27 ml/min/kg vs 30 +/- 19 ml/min/kg). Mean arrival time after oral dosing was significantly lengthened by hyperthyroidism (100 +/- 38 minutes vs 157 +/- 71 minutes). CLINICAL RELEVANCE: Hyperthyroidism-induced changes in propranolol pharmacokinetics may signal the need to reduce doses of propranolol when they are orally administered to hyperthyroid cats.

Multivariate analysis of risk factors for feline hyperthyroidism in New Zealand.

AIM: To search for putative risk factors for feline hyperthyroidism in New Zealand, using a case-control study. METHODS: A questionnaire-based case-control study involving the owners of 375 cats in New Zealand (125 hyperthyroid cats, 125 randomly selected control cats, and 125 age- and sex-matched control cats) was conducted to examine associations between potential risk factors and occurrence of feline hyperthyroidism. Data were collected between December 1996 and February 1998, relative to cat and owner demography and medical history, cats' indoor and outdoor environments, and cats' diets. A range of statistical techniques was employed to analyse the data, including descriptive analyses, univariate logistic regression for each variable and multivariate stepwise forward logistic regression. RESULTS: Multivariate analysis revealed that affected cats were more likely to be female (odds ratio (OR)=3.3; 95% confidence interval (CI)=1.2-9.0) and older than unaffected random control cats. Purebred cats were at a much lower risk of being diagnosed as hyperthyroid than were domestic short- and long-haired cats (OR=0.01; 95% CI=0.001-0.20). If more than one cat was present in a household, hyperthyroidism was less likely to be identified (OR=0.15; 95% CI=0.05-0.44) compared with single-cat households. Hyperthyroid cats were 6.6 times more likely (95% CI=1.8-23.9) to be reported to sleep predominantly on the floor than control cats. Cats whose bedding was regularly treated with anti-flea products appeared to be at a considerably higher risk for hyperthyroidism (OR=57.6; 95% CI=3.8-->200); and, to a lesser extent, so were cats living in households where fly sprays were reported to be used regularly (OR=3.3; 95% CI=1.2-9.3). The interaction between drinking water from puddles and regular use of organic garden fertilisers, such as compost or animal manure, was associated with a 5.3-fold (95% CI=1.1-25.6) increase in the risk of cats being diagnosed with the disease. Hyperthyroid cats were twice as likely (95% CI=0.3-12.9) to have eaten at least half of their daily food requirements as canned commercial cat food compared with unaffected cats. Cats exposed to a variety of flavours of canned cat food were more likely to be diagnosed with hyperthyroidism than were those fed only one flavour (OR=3.8; 95% CI=1.5-9.6). The presence of dental disorders was associated with a 5.5-fold increase in the risk of being diagnosed as hyperthyroid and this association was independent of the cat's age (95% CI=1.7-17.5). CONCLUSIONS: The results of this study support and extend those in several earlier reports and show that cats in New Zealand are, in many respects, similar to cats in Europe and North America in terms of their susceptibility to hyperthyroidism. The finding that female cats are predisposed to hyperthyroidism is at variance with most previously published work. It remains unclear which, if any, of the identified disease associations are causal, so further studies of this increasingly prevalent feline endocrinopathy are warranted.