Association of the risk of development of hypothyroidism after iodine 131 treatment with the pretreatment pattern of sodium pertechnetate Tc 99m uptake in the thyroid gland in cats with hyperthyroidism: 165 cases (1990-2002)

OBJECTIVE: To assess whether the risk of development of hypothyroidism after treatment with iodine 131 (131I) was associated with the pattern of sodium pertechnetate Tc 99m activity in the thyroid gland detected via scintigraphy before treatment in cats with hyperthyroidism. DESIGN: Retrospective study. ANIMALS: 165 cats. PROCEDURE: Medical records of cats with hyperthyroidism that had been treated with 131I (from 1990 to 2002) and had undergone scintigraphy of the thyroid gland before treatment were reviewed; data regarding signalment, scintigraphic findings (classified as unilateral, bilateral-asymmetric, bilateral-symmetric, or multifocal patterns), serum total thyroxine (T4) concentrations before treatment and prior to hospital discharge, and 131I treatment were collected. A questionnaire was sent to each referring veterinarian to obtain additional data including whether the cats subsequently developed hypothyroidism (defined as serum total T4 concentration less than the lower reference limit > or = 3 months after treatment). RESULTS: 50 of 165 (30.3%) 131I-treated cats developed hypothyroidism. Hypothyroidism developed in 39 of 109 cats with bilateral, 10 of 50 cats with unilateral, and 1 of 6 cats with multifocal scintigraphic patterns of their thyroid glands. Cats with a bilateral scintigraphic pattern were approximately 2 times as likely to develop hypothyroidism after 131I treatment than were cats with a unilateral scintigraphic pattern (hazard ratio, 2.1; 95% confidence interval, 1.04 to 4.2). CONCLUSIONS AND CLINICAL RELEVANCE: Cats with hyperthyroidism that have a bilateral scintigraphic pattern in the thyroid gland before 131I treatment appear to have a significantly higher risk of subsequently developing hypothyroidism, compared with cats with a unilateral scintigraphic pattern.     

Serum thyroxine concentrations after radioactive iodine therapy in cats with hyperthyroidism

Thirty-one cats with hyperthyroidism were given one dose of radioactive iodine (131I) IV. Serum thyroxine (T4) concentrations were measured before treatment in all cats, at 12-hour intervals after treatment in 10 cats, and at 48-hour intervals after treatment in 21 cats. Serum T4 concentrations also were measured one month after 131I therapy in 29 cats. Activity of 131I administered was 1.5 to 6.13 mCi, resulting in a dose of 20,000 rads to the thyroid. Serum T4 concentrations before 131I administration were 5.3 to 51.0 micrograms/dl, with a median T4 concentration of 11.0 micrograms/dl. Serum T4 decreased most rapidly during the first 3 to 6 days after treatment. Sixteen cats (55%) had normal serum thyroxine concentrations by day 4 after 131I administration, and 23 cats (74%) were euthyroxinemic by day 8 after treatment. One month after administration of 131I, the 29 cats evaluated were clinically improved, and 24 (83%) of the 29 cats evaluated had normal serum T4 concentrations, 3 cats (10%) remained hyperthyroxinemic, and 2 cats (7%) were hypothyroxinemic. Therefore, administration of 131I was a safe and effective method to quickly decrease serum T4 concentrations in hyperthyroid cats.     

Percutaneous ultrasound-guided radiofrequency heat ablation for treatment of hyperthyroidism in cats

OBJECTIVE: To determine efficacy and safety of percutaneous radiofrequency heat ablation for treatment of hyperthyroidism in cats. DESIGN: Prospective study. ANIMALS: 9 cats. PROCEDURE: Hyperthyroidism was diagnosed via clinical signs and high serum total (TT4) and free thyroxine (fT4) concentrations. One or 2 hyperfunctional cervical thyroid nodules were detected by use of scintigraphy and ultrasonography. If cats had 1 abnormal thyroid lobe, heat ablation was performed on that lobe; if cats had 2 abnormal lobes, heat ablation was applied to the larger lobe. Overall, heat ablation was performed 14 times in the 9 cats. Clinical signs and serum TT4, fT4, and calcium concentrations were monitored daily for 2 days after the procedure, weekly for the first month, and then monthly. Laryngeal function was evaluated and cervical ultrasonography and thyroid scintigraphy were also performed. Monitoring continued for as long as 9 months after heat ablation if a cat became euthyroid or until an owner chose an alternative treatment because of recurrence of hyperthyroidism. RESULTS: Serum TT4 and fT4 concentrations transiently decreased after all 14 heat ablation procedures (< or = reference range after 10 of 14 treatments) within 2 days after the procedure. Cats were euthyroid for 0 to 18 months (mean, 4 months). Hyperthyroidism recurred in all cats. Adverse effects included transient Horner's syndrome (2 cats) and laryngeal paralysis without clinical signs (1 cat). CONCLUSIONS AND CLINICAL RELEVANCE: Percutaneous heat ablation as a treatment for hyperthyroidism in cats is effective transiently but not permanently.     

Radio-iodine treatment of hyperthyroid cats

Thirty-two elderly domestic shorthaired cats (mean age 12.9 years) were treated with radioiodine (131I). The dose of 131I administered ranged from 39 mBq to 134 mBq. Twenty-eight cats became euthyroid after treatment, one became hypothyroid and three remained hyperthyroxaemic. Two of the hyperthyroxaemic cats were successfully re-treated with 131I. Five cats died from concurrent diseases within one year of treatment. The administration of a dose of 131I selected by assessing the severity of the clinical signs, the size of the thyroid gland(s) and the serum level of thyroxine was an effective treatment for hyperthyroidism.     

Treatment of feline hyperthyroidism with radioactive iodine-131

Feline hyperthyroidism can be treated by thyroidectomy, antithyroid drugs, or radioactive iodine-131 (131I). The aim of this retrospective study was to evaluate the treatment of 83 hyperthyroid cats with 131I The dosage of 131I ranged from 4 to 6 milliCurie (mCi). Blood samples for determination of plasma concentrations of total thyroxine (TT4), urea, and creatinine were collected before, ten days after, and several months after treatment. In addition, arterial blood pressure was measured before and ten days after treatment. The median plasma TT4 concentration ten days after 131I treatment (27 nmol/L, 64 cats) was significantly lower than that before treatment (123 nmol/L). The median plasma TT4 concentration several months after 131I treatment was 22,5 nmol/L (40 cats). Ten days and several months after 131I treatment, plasma TT4 concentration had decreased below the upper limit of the reference range in 64 (77%) and 72 cats (87%), respectively. In four cats the plasma TT4 concentration had decreased below the lower limit of the reference range, but only two cats had symptoms of hypothyroidism. Plasma urea and creatinine concentrations were not increased ten days after 131I treatment, but the median plasma creatinine concentration was significantly higher several months after treatment when compared with before 131I treatment. Before treatment in 28 cats a high arterial blood pressure (> 180 mmHg) was measured, whereas after treatment in 25 cats a high arterial blood pressure was measured. The results of this study indicate that 131I treatment is an effective therapy in most cats with hyperthyroidism.     

Metabolic and hormonal alterations in cats with hepatic lipidosis

Hepatic lipidosis in cats is a commonly diagnosed hepatobiliary disease of unknown cause. The purpose of this prospective study was to characterize the blood hormone and lipid status of cats with hepatic lipidosis, and to compare this status to that of cats with other types of liver disease and to control cats. Twenty-three cats with hepatic disease were assigned to 1 of 2 groups on the basis of cytopathologic or histopathologic examination of the liver: group 1, hepatic lipidosis (n = 18); or group 2, cholangiohepatitis (n = 5). Ten healthy young adult cats were used as controls. Food was withheld from control animals for 24 hours before blood collection. Concentrations of plasma glucagon and serum insulin, cortisol, thyroxine, triglycerides, cholesterol, phospholipids, and nonesterified fatty acids (NEFAs) were determined in all cats, in addition to routine hematologic and serum biochemical testing. Cats with hepatic lipidosis had higher serum NEFA concentrations than cats with cholangiohepatitis or control cats (P < .05). Cats with cholangiohepatitis had higher serum cholesterol and phospholipid concentrations than those of cats with lipidosis or control cats (P < .05); their plasma glucagon concentrations were higher than those of control cats (P < .05), but were not different from those of cats with hepatic lipidosis. Serum insulin concentrations were significantly higher in control cats than in diseased cats (P < .05), but neither serum insulin nor the insulin to glucagon ratio was significantly different among the cats with hepatic disease. The high concentration of NEFAs in cats with hepatic lipidosis suggests that at least 1 factor in the pathogenesis of this syndrome may involve the regulation of hormone-sensitive lipase.     

Serum fructosamine concentrations in hyperthyroid cats.

Serum fructosamine concentrations were measured in 35 healthy cats and in 30 hyperthyroid cats before and 30 days after curative radioiodine ((131)I) treatment. Hyperthyroid cats were divided into those with 30 day post-treatment total thyroxine (T4) concentrations within (EuT4) or below (HypoT4) the reference range. The median (semi-interquartile range, SIR) fructosamine concentration was significantly lower in hyperthyroid compared with healthy cats (295. 0 (18.5) micromol l(-1)) both before (254.0 (27.6) micromol l(-1)) and after (268.5 (28.0) micromol l(-1)) treatment (P < 0.001 in each case). (131)I therapy was associated with increases in serum fructosamine (mean increase 20.4 micromol l(-1), P = 0.039) and total protein (6.3 g l(-1), P < 0.002) in the HypoT4 group and in globulin concentration in both EuT4 (5.9 g l(-), P < 0.002) and HypoT4 (5.2 g l(-1), P = 0.023) groups. There were no direct relationships between the observed elevations in fructosamine concentration and those in total protein or globulin concentrations suggesting that the effect may be due to reduced rates of protein turnover. Reduced values may need to be considered when interpreting serum fructosamine concentrations for monitoring the degree of glycaemic control in diabetic cats with concurrent hyperthyroidism.     

Survival times for cats with hyperthyroidism treated with iodine 131, methimazole, or both: 167 cases (1996-2003)

OBJECTIVE: To compare survival times for cats with hyperthyroidism treated with iodine 131, methimazole, or both and identify factors associated with survival time. DESIGN: Retrospective case series. ANIMALS: 167 cats. PROCEDURE: Medical records of cats in which hyperthyroidism had been confirmed on the basis of high serum thyroxine concentration, results of thyroid scintigraphy, or both were reviewed. RESULTS: 55 (33%) cats were treated with 131I alone, 65 (39%) were treated with methimazole followed by 131I, and 47 (28%) were treated with methimazole alone. Twenty-four of 166 (14%) cats had preexisting renal disease, and 115 (69%) had preexisting hepatic disease. Age was positively correlated (r = 0.4) with survival time, with older cats more likely to live longer. Cats with preexisting renal disease had significantly shorter survival times than did cats without preexisting renal disease. When cats with preexisting renal disease were excluded, median survival time for cats treated with methimazole alone (2.0 years; interquartile range [IQR], 1 to 3.9 years) was significantly shorter than median survival time for cats treated with 131I alone (4.0 years; IQR, 3.0 to 4.8 years) or methimazole followed by 131I (5.3 years; IQR, 2.2 to 6.5 years). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that age, preexisting renal disease, and treatment type were associated with survival time in cats undergoing medical treatment of hyperthyroidism.     

Association of Iatrogenic Hypothyroidism with Azotemia and Reduced Survival Time in Cats Treated for Hyperthyroidism

Background: Iatrogenic hypothyroidism can occur after treatment of hyperthyroidism, and is correlated with a reduced glomerular filtration rate in humans and dogs. Hypothesis: Cats with iatrogenic hypothyroidism after treatment for hyperthyroidism will have a greater incidence of azotemia than euthyroid cats. Animals: Eighty client owned cats with hyperthyroidism. Methods: Two retrospective studies. (1) Longitudinal study of 12 hyperthyroid cats treated with radioiodine (documented as euthyroid after treatment), to assess changes in plasma thyroid stimulating hormone (TSH) concentration over a 6‐month follow‐up period, (2) Cross‐sectional study of 75 hyperthyroid cats (documented as euthyroid) 6 months after commencement of treatment for hyperthyroidism to identify the relationship between thyroid status and the development of azotemia. Kaplan‐Meier survival analysis was performed to identify relationships between thyroid and renal status and survival. Results: Plasma TSH concentrations were not suppressed in 7 of 8 cats with hypothyroidism 3 months after radioiodine treatment. The proportion of cats with azotemia was significantly (P= .028) greater in the hypothyroid (16 of 28) than the euthyroid group (14 of 47). Twenty‐eight of 41 cats (68%) with plasma TT4 concentration below the laboratory reference range had an increased plasma TSH concentration. Hypothyroid cats that developed azotemia within the follow‐up period had significantly (P= .018) shorter survival times (median survival time 456 days, range 231–1589 days) than those that remained nonazotemic (median survival time 905 days, range 316–1869 days). Conclusions and Clinical Importance: Iatrogenic hypothyroidism appears to contribute to the development of azotemia after treatment of hyperthyroidism, and reduced survival time in azotemic cats.     

Radio-iodine treatment of hyperthyroid cats

Thirty-two elderly domestic shdrthaired cats (mean age 12.9 years) were treated with radioiodine (¹³¹I). The dose of ¹³¹I administered ranged from 39 mBq to 134 mBq. Twenty-eight cats became euthyroid after treatment, one became hypothyroid and three remained hyperthyrox-aemic. Two of the hyperthyroxaemic cats were successfully re-treated with ¹³¹I. Five cats died from concurrent diseases within one year of treatment. The administration of a dose of ¹³¹I selected by assessing the severity of the clinical signs, the size of the thyroid gland(s) and the serum level of thyroxine was an effective treatment for hyperthyroidism.     

Efficacy and safety of once versus twice daily administration of methimazole in cats with hyperthyroidism

OBJECTIVE: To determine whether once daily administration of methimazole was as effective and safe as twice daily administration in cats with hyperthyroidism. DESIGN: Randomized, nonblinded, clinical trial. ANIMALS: 40 cats with newly diagnosed hyperthyroidism. PROCEDURE: Cats were randomly assigned to receive 5 mg of methimazole, PO, once daily (n = 25) or 2.5 mg of methimazole, PO, twice daily (15). A complete physical examination, including measurement of body weight; CBC; serum biochemical analyses, including measurement of serum thyroxine concentration; and urinalysis were performed, and blood pressure was measured before and 2 and 4 weeks after initiation of treatment. RESULTS: Serum thyroxine concentration was significantly higher in cats given methimazole once daily, compared with cats given methimazole twice daily, 2 weeks (3.7 vs 2.0 micro +/- g/dL) and 4 weeks (3.2 vs 1.7 microg/dL) after initiation of treatment. In addition, the proportion of cats that were euthyroid after 2 weeks of treatment was lower for cats receiving methimazole once daily (54%) than for cats receiving methimazole twice daily (87%). Percentages of cats with adverse effects (primarily gastrointestinal tract upset and facial pruritus) were not significantly different between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that once daily administration of methimazole was not as effective as twice daily administration in cats with hyperthyroidism and cannot be recommended for routine use.     

Radioactive iodine therapy for feline hyperthyroidism: Efficacy and administration routes

The efficacy of radioactive iodine (¹³¹I) administration was studied in a series of 50 hyperthy-roid cats. The dose administered to each cat was based on the clinical severity of the thyrotoxicosis, the serum total thyroxine (TJ concentration and the size of the goitre estimated by palpation. The activity ranged from 80 to 200 MBq (mean ± SD, 143 ± 24 MBq}. The ¹³¹I was injected intravenously in 27 cases and subcutaneously in 23 cases. Each cat was hospitalised for 30 days after the injection. Regardless of the route of injection, none of the cats exhibited any side effects after therapy and all tolerated the hospitalisation period well. There was a significant (P<0.001) decrease in the serum total T₄ concentration (reference range, 10.4 to 42.0 nmol/litre) from a mean ± SD of 181.3 ± 111.4 nmol/litre (range, 43.8 to 575.6 nmol/litre) to a mean ± SD of 19.0 ± 29.6 nmol/litre (range, 2.0 to 175.7 nmol/litre) 30 days following the injection of the radioisotope. Five cats remained hyperthyroid, although in each case the serum total T₄ concentrations had decreased from pre-treatment values. Two of the cats subsequently became euthyroid within three and five months of therapy, respectively, two were lost to adequate follow-up and the remaining cat was successfully retreated four months later. Before treatment, four of these cases had high scores based on the three criteria used for dose estimation. Serum total T₄ concentrations below the reference range developed after treatment in many cases, but were often transient. Clinical evidence of hypothyroidism was not apparent in any cat. Recurrence of hyperthyroidism has not occurred in follow-up periods of up to 32 months. There was no difference in the outcome between the cats injected intravenously or subcutaneously and the latter was considered to be safer and simpler. The administration of an approximated dose of ¹³¹I proved to be an effective treatment for hyperthyroidism in 47 (94.0 per cent) of the cats and obviated the need for sophisticated nuclear computer facilities. There may be a lag period in some cases before euthy-roidism is achieved and this should be considered before the administration of a second dose. ¹³¹I can be administered subcutaneously without untoward effects.     

Serum thyroxine concentrations following fixed-dose radioactive iodine treatment in hyperthyroid cats: 62 cases (1986-1989)

The medical records of 62 hyperthyroid cats treated with a fixed dose of 4 mCi of radioactive iodine (131I) were reviewed. In 60 cats, serum thyroxine concentrations were determined after treatment, allowing evaluation of treatment success. Eighty-four percent of the cats had normal serum thyroxine concentrations after treatment. Five of the 60 cats (8%) remained hyperthyroxinemic after treatment. Five cats (8%) were hypothyroxinemic when evaluated within 60 days of treatment. Three of these cats had normal serum thyroxine concentrations 6 months after treatment, and none had clinical signs of hypothyroidism. The administration of a fixed dose of 4 mCi of 131I was determined to be an effective treatment for feline hyperthyroidism.     

Predictive value of tracer studies for 131I treatment in hyperthyroid cats

In 76 cats with hyperthyroidism, peak thyroidal radioiodine (131I) uptakes and effective half-lives were determined after administration of tracer and therapeutic activities of 131I. In 6 additional hyperthyroid cats, only peak thyroidal uptakes after administration of tracer and therapeutic activities of 131I were determined. Good correlation was found between peak thyroidal uptakes of tracer and therapeutic 131I; however, only fair correlation was observed between effective half-lives. In 79% of the cats, the effective half-life for therapeutic 131I was longer than that for tracer 131I. After administration of therapeutic activity of 131I, monoexponential and biphasic decay curves were observed in 51 and 16 cats, respectively. Using therapeutic kinetic data, radiation doses to the thyroid gland were calculated retrospectively on the basis of 2 methods for determining the activity of 131I administered: (1) actual administration of tracer-compensated activity and (2) hypothetic administration of uniform activity (3 mCi). Because of the good predictive ability of tracer kinetic data for the therapeutic kinetic data, the tracer-compensated radiation doses came significantly (P = 0.008) closer to the therapeutic goal than did the uniform-activity doses. In addition, the use of tracer kinetic information reduced the extent of the tendency for consistently high uniform-activity doses. A manual method for acquiring tracer kinetic data was developed and was an acceptable alternative to computerized techniques. Adoption of this method gives individuals and institutions with limited finances the opportunity to characterize the iodine kinetics in cats before proceeding with administration of therapeutic activities of 131I.     

PRE‐ AND POSTTREATMENT ULTRASONOGRAPHY OF THE THYROID GLAND IN HYPERTHYROID CATS

Ultrasonography is useful for assessing the morphology of the thyroid gland in hyperthyroid cats. Our aim was to describe the ultrasonographic changes of the thyroid gland in hyperthyroid cats after ¹³¹I therapy. Ultrasonography was performed in 15 hyperthyroid cats at initial presentation and 6 months after ¹³¹I using a multifrequency linear transducer set at 12 MHz. The following criteria were evaluated: length, width, height, volume, shape, homogeneity, and vascularity, using Power Doppler. Pretreatment, 10 cats had bilaterally abnormal thyroid lobes, four cats one abnormal lobe with the contralateral lobe being normal or reduced in size, and one cat with one normal lobe and one lobe not visible. Six months after ¹³¹I therapy, there was a reduction in median volume from 819 to 210 mm³, reduced rounding, reduced heterogeneity, and decreased vascularity. In conclusion, ultrasonography may be used to monitor thyroid changes in order to assess ¹³¹I treatment response. Further studies are necessary to determine whether ultrasonography could contribute to the detection of a relapsing course of hyperthyroidism.     

Evaluation of relationships between pretreatment patient variables and duration of isolation for radioiodine-treated hyperthyroid cats

OBJECTIVE: To determine relationships between commonly measured pretreatment variables and duration of isolation for unrestricted dismissal after oral administration of iodine 131 (131I) for treatment of hyperthyroidism in cats. ANIMALS: 149 hyperthyroid cats treated with 131I. PROCEDURE: A dose of 131I (2.9 to 6.04 mCi [1.07 to 2.23 x 10(8) Bq]) was administered orally to all cats after hyperthyroidism was confirmed by evaluation of serum total thyroxine (T4) concentrations. Forward stepwise regression analysis was used to determine whether pretreatment total T4 concentration, serum creatinine concentration, body weight, age, 131I dose, or concurrent administration of cardiac medication (specifically excluding thyroid suppression drugs) could be used as pretreatment predictors of duration of isolation in a clinical setting. Gamma radiation emission rate at dismissal was < 2.0 mR/h at skin surface over the thyroid region. RESULTS: Mean +/- SD duration of isolation was 16.67 +/- 4.42 days (95% confidence interval, 9.2 to 24.1 days). The regression equation for duration of isolation calculated on the basis of dose of 131I (duration of isolation [days] = 3.2 + [2.66 X mCi - 131I dose]) yielded a regression line with a 95% confidence interval of +/- 3.3 days; only 15% of the variation was explained. CONCLUSIONS AND CLINICAL RELEVANCE: A pretreatment estimate for duration of isolation could be determined only from an equation based on the orally administered dose of 131I. These findings suggest that administration of the lowest efficacious dose possible is the dominant factor in reduction of duration of isolation for cats treated with 131I.     

Selenium status of cats in four regions of the world and comparison with reported incidence of hyperthyroidism in cats in those regions

OBJECTIVE: To assess selenium (Se) status of cats in 4 regions of the world and to compare results for Se status with reported incidence of hyperthyroidism in cats in those regions. ANIMALS: 50 cats (30 from 2 regions with an allegedly high incidence of hyperthyroidism and 20 from 2 regions in which the disease is less commonly reported). PROCEDURE: Hematologic samples (heparinized whole blood, plasma, and RBC fractions) were obtained from 43 healthy euthyroid cats and 7 hyperthyroid cats. Plasma concentration of Se and activity of glutathione peroxidase (GPX) in whole blood and plasma were determined. RESULTS: Plasma concentration of Se and GPX activity in whole blood or plasma did not differ significantly among cats from the 4 regions. However, cats had a plasma concentration of Se that was approximately 5 times the concentration reported in rats and humans. The GPX activity in whole blood or plasma in cats generally was higher than values reported in rats or humans. CONCLUSIONS AND CLINICAL RELEVANCE: Cats have higher Se concentrations in plasma, compared with values for other species. However, Se status alone does not appear to affect the incidence of hyperthyroidism in cats. High Se concentrations may have implications for health of cats if such concentrations are influenced by the amount of that micronutrient included in diets.     

Clinical features of inflammatory liver disease in cats: 41 cases (1983-1993)

OBJECTIVE: To compare the clinical and clinicopathologic findings in and prognosis for cats with lymphocytic portal hepatitis (LPH) versus cats with acute or chronic cholangiohepatitis (CH). DESIGN: Retrospective study. ANIMALS: 25 cats with LPH; 16 cats with CH (7 acute, 9 chronic). PROCEDURE: Cats with LPH and CH were selected by evaluating records from liver biopsy specimens submitted to the University of Minnesota Veterinary Teaching Hospital during a 10-year period. Clinical and clinicopathologic data were retrieved. RESULTS: Cats with CH had higher segmented and band neutrophil counts, alanine aminotransferase activities, and total bilirubin concentrations than did cats with LPH. Cats with acute CH had higher segmented and band neutrophil counts and lower serum alkaline phosphatase activities and total bilirubin concentrations than did cats with chronic CH. Twelve of 14 cats with LPH or CH had coarse or nodular texture to the liver on ultrasonography, with loss of portal vein wall clarity noticed in 4 of 8 cats with LPH. Sixteen of 23 cats with LPH and 8 of 15 cats with CH survived > 1 year. Of those cats living < 1 year, all cats with LPH and 5 of 7 cats with CH had a serious concurrent illness that may have been responsible for their deaths. CLINICAL IMPLICATIONS: LPH and CH can be detected and tentatively differentiated through evaluation of clinical laboratory test results, but histologic evaluation of liver specimens is necessary for definitive differentiation. Survival time was good regardless of the type of inflammatory liver disease.     

Evaluation of the effects of ischemic injury and ureteral obstruction on delayed graft function in cats after renal autotransplantation

OBJECTIVE: To determine the relative importance of ischemic injury to delayed graft function (DGF) in cats. STUDY DESIGN: Experimental study. ANIMALS: Six intact female cats. METHODS: Cats had renal autograft transplantation without ureteral transection and reimplantation and a contralateral nephrectomy. Serum creatinine and blood urea nitrogen (BUN) concentrations were measured regularly and abdominal ultrasound was performed before surgery, the day after surgery and twice weekly thereafter. Ultrasound-guided renal biopsy was performed on day 7. Cats were euthanatized on day 21. Histology of the autograft, ureter, bladder, vascular anastomoses sites, and contralateral kidney were performed. Observations were compared with those from an historic group of research cats that had extravesicular ureteroneocystostomy and contralateral nephrectomy. RESULTS: Five cats completed the study. Serum creatinine and BUN concentrations increased after surgery, peaking at 3.2+/-0.8 and 77.6+/-15.9 mg/dL, respectively, 1-2 days after surgery. Serum creatinine concentration returned to the reference interval by 6 days after surgery. BUN gradually decreased in all cats but did not return to the reference interval by study end. Serum creatinine and BUN concentrations were consistently lower but not significantly so (P=.29 and .56, respectively) compared with the historic ureteroneocystostomy group. No ultrasonographic abnormalities or renal biopsy histologic abnormalities were observed. At necropsy, 1 autograft had generalized interstitial fibrosis. CONCLUSION: Harvesting the renal graft and the ischemia before revascularization causes impaired renal function after engraftment. CLINICAL RELEVANCE: The process of harvesting and reimplanting the renal graft can contribute to DGF in cats, independent of ureteral obstruction.     

Evaluation of Serum Thyroid‐Stimulating Hormone Concentration as a Diagnostic Test for Hyperthyroidism in Cats

Background

In humans, measurement of serum thyroid‐stimulating hormone (TSH) concentration is commonly used as a first‐line discriminatory test of thyroid function. Recent reports indicate that canine TSH (cTSH) assays can be used to measure feline TSH and results can help diagnose or exclude hyperthyroidism.

Objectives

To investigate the usefulness of cTSH measurements as a diagnostic test for cats with hyperthyroidism.

Animals

Nine hundred and seventeen cats with untreated hyperthyroidism, 32 euthyroid cats suspected of having hyperthyroidism, and 131 clinically normal cats.

Methods

Prospective study. Cats referred to the Animal Endocrine Clinic for suspected hyperthyroidism were evaluated with serum T₄, T₃, free T₄ (fT ₄), and TSH concentrations. Thyroid scintigraphy was used as the gold standard to confirm or exclude hyperthyroidism.

Results

Median serum TSH concentration in the hyperthyroid cats (<0.03 ng/mL) was significantly (P < .001) lower than concentrations in clinically normal cats (0.05 ng/mL) or euthyroid cats with suspected thyroid disease (0.06 ng/mL). Only 18 (2.0%) hyperthyroid cats had measurable TSH concentrations (≥0.03 ng/mL), whereas 114 (69.9%) of the 163 euthyroid cats had detectable concentrations. Combining serum TSH with T₄ or fT ₄ concentrations lowered the test sensitivity of TSH from 98.0 to 97.0%, but markedly increased overall test specificity (from 69.9 to 98.8%).

Conclusions and Clinical Importance

Serum TSH concentrations are suppressed in 98% of hyperthyroid cats, but concentrations are measurable in a few cats with mild‐to‐moderate hyperthyroidism. Measurement of serum TSH represents a highly sensitive but poorly specific test for diagnosis of hyperthyroidism and is best measured in combination with T₄ and fT ₄.