Prince's Blood Test Results - Page 9

They've got their universities mixed up. Guelph is an hour and a half from Toronto.

http://www.itsfortheanimals.com/DODDS-RESUME.HTM


 1964 - OVC's affiliation with the University of Toronto is severed and the College becomes part of the new University of Guelph. The 'Principal' now becomes the 'Dean' of the College.

Since Dodds graduated in 64, she was obviously a member of the last graduating class while OVC was still associated with the U of T.

 

I am reposting this because it my thread and I can...:) :) I was unable to upload the file here for some reason so I had to copy and paste it instead...These are the two attachments and the last which I can not upload or copy and paste is a 10 page write up by Royal Canin Dog Food and the scientific needs of the GSD's system.. FINAL REPORT Doctor Owner DEANNA Pet Name PRINCE Received 08/21/13 Species Canine Breed German Shepherd Sex M Pet Age 3 Yrs Reported 08/21/13 Test Requested Result Case Specific General Range Units Consult Completed Dear Deanna: THANK YOU for the Consultation/Donation ! I have reviewed the clinical history and lab results you sent from MSU testing on 08/15/2013. I have the following comments and suggestion​ 1) Despite the ongoing clinical and behavioral episodes since puppyhood, this MSU thyroid profile has adequate, although sub-optimal levels of thyroid hormone activity, and there were no elevated thyroid autoantibodies, ruling out autoimmune thyroiditis, TSH is discordant (false negative, a common finding with this test in dogs vs people) -- see attached; 2) As about 40% of skin and other tissue infections respond non-specifically to thyroxine therapy to increase skin and hair coat turnover, he should respond metabolically and behaviorally to a 6-8 week trial course of thyroxine ( e.g. Soloxine) at a modest dose of 0. 1 mg per 15 pounds of optimum weight given twice daily, at least an hour before or three hours after any foods, supplements or treats containing calcium or soy, as these foods bind thyroxine and impair it's absorption; 3) As GSDs have unique difestive requirement s , adding pre- and continuing pro -biotics is a good plan as well as provided a source of FOS (fruto- ) and MOS (mannan- )oligosaccharides. See attsached; 4) Also, as chicken, venison and mutton are considered "hot" pro-inflammatory foods in Chinese medicine, suggest avoiding them and using neutral or cool meats ( turkey, rabbit, goat, bison, beef, grass fed lamb). and white colored fish in stead. Best wishes, Jean​ CANINE TSH IMMUNOASSAY UPDATE  W’ Jean Dodds, DVM     Hypothyroidism, a failure of the thyroid gland, is the most common hormonal abnormality in dogs, causing a variety of medical problems in many breeds, including hair loss and skin infections.   The measurement of serum levels of the pituitary hormone thyrotropin (TSH) has been used as a reliable and sensitive screening test for thyroid glandular insufficiency in human medicine for many years, but the "first generation" assays for canine TSH (cTSH) are missing as many as 1 out of 3 cases of hypothyroidism, resulting in no improvement in diagnostic sensitivity compared to total T4 and freeT4 measurement. Furthermore, the available assays have not been sensitive enough to distinguish low values of cTSH from those in the normal range.   The use of cTSH for predicting canine hypothyroidism is further complicated by the fact that about 1/ 3 of thyroid regulation in the dog is controlled through growth hormone [Lee et al, 2001].         References     ● Dixon RM, Graham PA, Mooney CT. Serum thyrotropin concentrations: a new diagnostic test for canine hypothyroidism.  Vet Rec  138: 594-595, 1996. ●  Jensen AL, Iversen L, Høier R, et al. Evaluation of an immunoradiometric assay for thyrotropin in serum and plasma samples of dogs with primary hypothyroidism.  J Comp Pathol 114: 339-346, 1996. ●  Iverson L, Jensen AL, Høier R, et al. Biological variation of canine serum thyrotropin (TSH) concentration. Vet Clin Pathol 28:16-19, 1999. ● Lee WM, Diaz-Espineira MM, Mol JA, Rijnberk A, Kooistra HS. Primary hypothyroidism in dogs is associated with elevated GH release.  J  Endocrinol 168:59-66, 2001. ●  Diaz-Espineira MM, J.A. Mol JA, Peeters ME, Pollak YWEA, Iversen L,van Dijk JE, Rijnberk A, Kooistra HS. Assessment of thyroid function in dogs with low plasma thyroxine concentration. J Vet Intern Med 21:25–32, 2007. ● Ferguson D. Recombinant thyrotropin: standard for the next generation of cTSH immunoassays with improved sensitivity, in development .

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Alright,,I have been thinking on this a bit..As many probably already know I am a nurse I spend time reading lab results, assessing patients, and advocating for my patients,,,Here is a news flash, Dr's. makes mistakes!!..Many times nurses have to question prescribed medications regimes if we feel that they are not in the best interest of the patient or if we see a contraindication. or if our gut says something is not right based on other clinical experiences... We simply call the Dr. and repeat the order and make certain the Dr. has a full understanding of our assessment findings..At that point either the Dr. confirms the order or changes it...

My point, something has to alert me to question a Dr's. order,I don't just not give the medication ( its against policy, but it is also presumptuous that as a nurse I know better then the doc) ,something has to jump off the paper and say " this isn't right because" or "this doesn't make sense because"...So again my point here is WHY, do some of you have a concern about Dr. 
Dodds order of thyroxine 0.1 mg per 15 lb optimum weight given twice daily?.. Surely you have a reason..Surely you don't just go around disliking random posts for the fun of it or making comments like " this is dangerous to the dog" without real knowledge as to why..You must have some knowledge on the topic that warrants your concern..

So, with that said, those of you who spoke out and those of you who hide behind thumbs please for Prince's sake and mine tell me why this regime ( medication or diet ) isn't good in your opinion..

FWIW...My local vet was asked by me yesterday to write the script and phone it in to a pharmacy in IN..Natually he has his concerns and said he wanted to consult with someone at MI state ...I can respect that he might not be as familiar with reading thyroid blood sample results as vets that make it their daily business .He is seeking further input..He is a Dr. and didn't jump right up and say no! thumbs down!..Yet, some here feel they have that knowledge base and authority to do so..,,,

Glad I got that off my chest,,Now I am headed to the garden and hope to return to more intelligent input regarding the topic..:)
 

There is so much misinformation from your vet...I would not even know where to begin. I dont want to get into a pi$$ing match about my qualifications. My advice was simple, the results are normal.  I will however point out the most dangerous advice..
"As about 40% of skin and other tissue infections respond non-specifically to thyroxine therapy to
increase skin and hair coat turnover, he should respond metabolically and behaviorally to a 6-8 week trial
course of thyroxine ( e.g. Soloxine) at a modest dose of 0. 1 mg per 15 pounds of optimum weight".

1. TSH is normal, based on reference range (0-30 mU/L). Does the vet understand the concept of a reference/normal range. So her lab is saying that a TSH of zero is normal ?, yet she wants to prescribe thyroxine when Prince's TSH is 10 mU/L, well within the reference range and below the midpoint of the range (15). If thyroxine was needed, the TSH should have been closer to 30 mU/L.
2. Are her reference ranges correct ?, a TSH of zero suggests inaccurate reference range. 
3. What do you think happens, when you prescribe Thyroxine. It will depress the TSH, and will screw up the normal regulation of thyroid hormones. So after the trial when you repeat the TSH, it will be low...then the dog is royally messed up.
4. It is stupid to try and treat skin infections with thyroxine.
I could go on and on...perhaps its the 1960's education that is to blame.

 

TSH assays are generally crappy, especially at measuring low levels of TSH, that is why she does not use them.... That is also the reason the normal range goes down to zero in her assay. Its not that TSH is zero, it's just that her measurement method is not sensitive enough to measure low levels of TSH. She is likely using a 1st generation TSH assay. In humans, much more sensitive 3rd or higher gen assays are used, dont know if 3rd gen is available for dogs.

wrt Prince, the TSH assay result is fine, as it is around 10 mU/L and clearly non-zero. As I mentioned its below 15 (the mid point of the 0-30 ref. range), thus there is absolutely no reason to give more thyroxine. For the uninitiated, a TSH near or higher than 30, would suggest a deficiency and require replenishment. 

Furthermore,the FT4 assay is completely normal. Why would you supplement a dog with hormones, when the levels are clearly normal ?. If you want a basic panel, a TSH and FT4 is quite adequate. A low or high TSH predicts the direction of T4 levels (high or low) for confirmation. This combo, also allows one to screen for hypothalamic function at the same time.

Vet.Medicine like human medicine is a business, where a lot of money is made prescribing and diagnosing hypothyroidism. Thus as an example, in humans depending on their self interests various professional societies will support or not support routine screening for hypothyroidism. Thus the recommendations of the endocrinologists, do not match those of the govt (who has to pay), and the family practioners have their own ideas (have the least to gain financially). 

 

It's not uncommon for vets in dermatology/endocinology  practices and vet schools to prescribe/recommend a trial period of a low dose of thyroxine for dogs who they think may benefit from replacement therapy in spite of T3's and T4's that fall within the normal range. Been there done that with several dogs of another breed, TSH's  generally have not been recommended for years in the veterinary medical world unless a symptomatic dog was unresponsive to the replacement therapy.  The dosage Dodds is recommending for Prince is very low for a dog, side effects are rare, not permanent and will quickly resolve  if the medication is stopped. Humans are generally started at a much lower dosage and are treated to effect. 

Did you tell Dodds that Prince has coats issues - thin coat, dry skin, etc? Her recommendation for the thyroxine looks to me like it's intended to help with skin issues, not aggression. I believe her reference to "responding behaviorally" may have meant you should see a change in the way the skin and coat responds/behaves, not temperament. You may want to ask her about that." As about 40% of skin and other tissue infections respond non-specifically to thyroxine therapy to increase skin and hair coat turnover, he should respond metabolically and behaviorally to a 6-8 week trial course of thyroxine ( e.g. Soloxine) at a modest dose."

Skin infections would be secondary; when the source is eliminated - ie no more dry flaky, oily skin, no more bacterial infections.

Bottom line - your dog, Deanna. Your decision and if your vet won't prescribe the synthyroid, it's all moot anyway.

PS: dogs are not normally as difficult to treat for thyroid issues as are  humans; they seem to respond more favorably and quicker to replacement therapy than most  humans. Comparing the diagnosis and treatment of thyroid diseases in humans to dog is not apples to apples. Surf the net for the normal ranges in humans and compare to canines. The normal  range from most labs for T3 in humans is 80-220, T4 4.5 -12.5.

It's not uncommon for vets in dermatology/endocinology  practices and vet schools to prescribe/recommend a trial period of a low dose of thyroxine for dogs who they think may benefit from replacement therapy in spite of T3's and T4's that fall within the normal range. That's what I am saying...most vets are not up to date with recent medical advances.

TSH's  generally have not been recommended for years in the veterinary medical world unless a symptomatic dog was unresponsive to the replacement therapy.  So what you are saying is that vet's treat first and do lab tests later. Looks like putting the cart before the horse. A better screen could be TSH with reflex to FT4, if TSH is abnormal or borderline abnormal.

The dosage Dodds is recommending for Prince is very low for a dog, side effects are rare, not permanent and will quickly resolve  if the medication is stopped. The dose is actually high for a dog, 0.1 mg/15 lbs, corresponds to 400 micrograms for a 60lb dog. The typical  dose for a 150 lb human is 25-100 micrograms. So unless, the drug is a crude extract/impure, its a very high dose. If they are giving a crude extract, its likely that its contaminated with other hormones. If they are not giving a crude extract, the dose is too high. Take your pick. Once you stop thyroxine therapy, it will take MONTHS for TSH to normalize. 

Bottom line - your dog, Deanna. Your decision and if your vet won't prescribe the synthyroid, it's all moot anyway. Looks like a sensible professional.

PS: dogs are not normally as difficult to treat for thyroid issues as are  humans; they seem to respond more favorably and quicker to replacement therapy than most  humans. Comparing the diagnosis and treatment of thyroid diseases in humans to dog is not apples to apples. The physiology of the thyroid is same as in humans and in dogs (pl. show me any evidence that it is not). Yes, you can pump animals with supratherapeutic doses of hormones and get amazing results. Fortunately, for us they dont speak or complain.

Surf the net for the normal ranges in humans and compare to canines. Yes, TSH ranges can start from zero, but that's not because there is no TSH, but because many 1st generation method are not sensitive to measure low levels of TSH. See ref range for method http://www.alpco.com/pdfs/55/55-TSHCA-E01.pdf ref.range is 0.017-0.591 ng/mL.
 

Guddu, honestly have you ever worked in the vet medicine field? Why do you think you know so much more than Dodds? How many dogs have  you  treated for thyroid issues?

The initial recommended dose is 0.1mg/10lb (4.5kg) body weight twice daily. Dosage is then adjusted by monitoring the thyroid blood levels of the dog every four weeks until an adequate maintenance dose is established. The usual maintenance dose is 0.1mg/10lb (4.5kg) once daily.