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Herbichi AP, Lorenzetti DM, Dos Santos MY, Hartmann G, Fighera RA, Flores MM. Thyroid lesions in a population of domestic cats submitted to necropsy without clinical suspicion of thyroid disease. J Comp Pathol 2024; 215:1-9. [PMID: 39276725 DOI: 10.1016/j.jcpa.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/20/2024] [Accepted: 08/19/2024] [Indexed: 09/17/2024]
Abstract
Although hyperthyroidism is the most common endocrine disorder in elderly cats, systematic studies investigating the prevalence of thyroid lesions in feline animals are scarce. Our objective was to evaluate morphological changes in the thyroid glands of 61 cats submitted to necropsy without clinical suspicion of hyperthyroidism. Thirteen (13/61 [21.3%]) cats had thyroid enlargement and 54/61 (88.5%) had some histological thyroid changes. Proliferative lesions were histologically seen in 33/61 (54%) cats while non-proliferative lesions were observed in 48/61 (78.7%) cats. Thyroid hyperplasia (18/33 [54.5%]) and cystic adenoma (6/33 [18.2%]) were the most prevalent proliferative changes and lesions with little or no clinical significance (37/61 [60.6%]), degenerative (31/61 [50.8%]) and inflammatory changes (12/61 [19.7%]) were the most common non-proliferative changes. Among cats with proliferative lesions, 16/33 (48.4%) had a proliferation grade ≥A4, a grade previously associated with clinical hyperthyroidism. Although the cats from this study did not have any clinical diagnosis of thyroid disease, it is possible that one or more had some degree of clinically unnoticed thyroid dysfunction. The high prevalence of follicular lesions in this study highlights the importance of a more careful clinical and pathological investigation regarding thyroid diseases in mature and elderly cats.
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Affiliation(s)
- Alana P Herbichi
- Programa de Pós-Graduação em Medicina Veterinária, Centro de Ciências Rurais, Universidade Federal de Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS 97105-900, Brazil
| | - Douglas M Lorenzetti
- Programa de Pós-Graduação em Medicina Veterinária, Centro de Ciências Rurais, Universidade Federal de Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS 97105-900, Brazil
| | - Matheus Y Dos Santos
- Programa de Pós-Graduação em Medicina Veterinária, Centro de Ciências Rurais, Universidade Federal de Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS 97105-900, Brazil
| | - Gabriela Hartmann
- Programa de Pós-Graduação em Medicina Veterinária, Centro de Ciências Rurais, Universidade Federal de Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS 97105-900, Brazil
| | - Rafael A Fighera
- Programa de Pós-Graduação em Medicina Veterinária, Centro de Ciências Rurais, Universidade Federal de Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS 97105-900, Brazil
| | - Mariana M Flores
- Programa de Pós-Graduação em Medicina Veterinária, Centro de Ciências Rurais, Universidade Federal de Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS 97105-900, Brazil.
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Černá P, Antonakakis M, Peralta J, Kofron K, Hawley J, Morris A, Lappin MR. Total thyroxine and thyroid-stimulating hormone responses of healthy cats to different doses of thyrotropin-releasing hormone. J Vet Diagn Invest 2024; 36:56-61. [PMID: 37968868 PMCID: PMC10734576 DOI: 10.1177/10406387231212816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Thyrotropin-releasing hormone (TRH) stimulation can be used as a test of thyroid function and pituitary thyrotropin (thyroid-stimulating hormone, TSH) reserve, but optimal stimulation testing protocols in cats are unreported. We randomly divided 6 healthy young adult cats into 3 groups of 2 and administered 3 different intravenous doses of TRH (0.01, 0.05, 0.1 mg/kg) at weekly intervals in our crossover study. Serum TSH and thyroxine (T4) concentrations were measured using chemiluminescent immunoassay before, and at 30 and 60 min after, TRH administration. All cats were monitored for 4 h post-TRH administration for side effects. All 3 TRH doses induced significant TSH (0.01 mg/kg, p = 0.001; 0.05 mg/kg, p = 0.002; 0.1 mg/kg, p = 0.006) and total T4 (0.01 mg/kg, p = 0.008; 0.05 mg/kg, p = 0.006; 0.1 mg/kg, p = 0.001) responses. Lower TRH doses (0.01 and 0.05 mg/kg) caused fewer side effects (1 of 6 cats) than did the highest dose (3 of 6 cats), and may be safer in cats than the previously reported higher dose (0.1 mg/kg) of TRH. Our results do not support the use of maropitant to prevent side effects of a TRH stimulation test in cats.
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Affiliation(s)
- Petra Černá
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Markos Antonakakis
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Jade Peralta
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kristine Kofron
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Jennifer Hawley
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Arianne Morris
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Michael R. Lappin
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Geddes R, Aguiar J. Feline Comorbidities: Balancing hyperthyroidism and concurrent chronic kidney disease. J Feline Med Surg 2022; 24:641-650. [PMID: 35481810 PMCID: PMC11107990 DOI: 10.1177/1098612x221090390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Both hyperthyroidism and chronic kidney disease (CKD) are common long-term conditions in older cats, which might be diagnosed concurrently or develop at different times. Hyperthyroidism may mask the presence of CKD, and vice versa, by various mechanisms that are described in this review. Hyperthyroidism treatment options should be carefully considered when CKD has also been diagnosed. CLINICAL CHALLENGES Although it can be difficult to diagnose hyperthyroidism and CKD simultaneously, given that one condition may mask the other, it is important to consider the presence of both diseases when examining an older cat presenting with vomiting, weight loss, polyuria/ polydipsia, anorexia or sarcopenia. The concurrent presence of hyperthyroidism and CKD requires careful monitoring of glomerular filtration rate biomarkers, and adequate and prompt support of kidney function when normal thyroid function is re-established. Iatrogenic hypothyroidism is a recognised complication of all of the treatment options for hyperthyroidism, and increases the risk of azotaemia. Therapy with levothyroxine is recommended for cats that are hypothyroid and azotaemic. EVIDENCE BASE The information in this review draws on current literature and guidelines related to the pathophysiology, diagnosis and treatment recommendations for feline hyperthyroidism and CKD.
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Affiliation(s)
- Rebecca Geddes
- Clinical Sciences and Services, Royal Veterinary College, University of London, London, UK
| | - Joana Aguiar
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, UK
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4
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Peterson ME, Rishniw M. Predicting outcomes in hyperthyroid cats treated with radioiodine. J Vet Intern Med 2021; 36:49-58. [PMID: 34817910 PMCID: PMC8783366 DOI: 10.1111/jvim.16319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Radioiodine (131 I) is the treatment of choice for cats with hyperthyroidism. After 131 I, however, euthyroidism is not always achieved, with 5% to 10% of cats remaining persistently hyperthyroid and 20% to 50% developing iatrogenic hypothyroidism. OBJECTIVES To identify pretreatment factors that may help predict persistent hyperthyroidism and iatrogenic hypothyroidism after treatment of cats using a novel 131 I dosing algorithm. ANIMALS One thousand and four hundred hyperthyroid cats treated with 131 I. METHODS Prospective, before-and-after study. Pretreatment predictors (clinical, laboratory, scintigraphic, 131 I dose, 131 I uptake measurements) of treatment failure or iatrogenic hypothyroidism were identified by multivariable logistic regression analysis. RESULTS Cats that developed iatrogenic hypothyroidism were more likely to be older (odds ratio [OR] = 1.10; 95% confidence interval [CI], 1.04-1.17; P = .001), female (OR = 2.04; 95% CI, 1.54-2.70; P < .001), have detectable serum thyroid-stimulating hormone (TSH) concentrations (OR = 4.19; 95% CI, 2.0-8.81; P < .001), have bilateral thyroid nodules (OR = 1.57; 95% CI, 1.19-2.08; P < .001), have homogeneous, bilateral distribution of 99m Tc-pertechnetate uptake (OR = 2.93; 95% CI, 2.05-4.19; P < .001), have milder severity score (OR = 0.62; 95% CI, 0.49-0.79; P < .001), and have higher 131 I uptake (OR = 2.40; 95% CI, 1.75-3.28; P < .001). In contrast, cats remaining persistently hyperthyroid were more likely to be younger (OR = 0.81; 95% CI, 0.72-0.92; P < .001), have higher severity score (OR = 1.87; 95% CI, 1.51-2.31; P < .001), and have lower 131 I uptake (OR = 3.50; 95% CI, 1.8-6.80; P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE Age, sex, serum TSH concentration, bilateral and homogeneous 99m Tc-pertechnetate uptake on scintigraphy, severity score, and percent 131 I uptake are all factors that might help predict outcome of 131 I treatment in hyperthyroid cats. Cats with persistent hyperthyroidism had many predictive factors that directly contrasted those of cats that developed 131 I-induced hypothyroidism.
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Affiliation(s)
- Mark E Peterson
- Animal Endocrine Clinic, New York, New York, USA.,College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Mark Rishniw
- College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.,Veterinary Information Network, Davis, California, USA
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Peterson ME. Hyperthyroidism in Cats: Considering the Impact of Treatment Modality on Quality of Life for Cats and Their Owners. Vet Clin North Am Small Anim Pract 2020; 50:1065-1084. [PMID: 32665137 DOI: 10.1016/j.cvsm.2020.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In cats, hyperthyroidism can be treated in 4 ways: medical management with methimazole or carbimazole, nutritional management (low-iodine diet), surgical thyroidectomy, and radioactive iodine (131I). Each form of treatment has advantages and disadvantages that should be considered when formulating a treatment plan for the individual hyperthyroid cat. Medical and nutritional managements are considered "reversible" or palliative treatments, whereas surgical thyroidectomy and 131I are "permanent" or curative treatments. The author discusses how each treatment modality could be the optimal choice for a specific cat-owner combination and reviews the advantages and disadvantages of each treatment option.
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Prieto JM, Carney PC, Miller ML, Rishniw M, Randolph JF, Lamb SV, Place NJ, Peterson ME. Short-term biological variation of serum thyroid hormones concentrations in clinically healthy cats. Domest Anim Endocrinol 2020; 71:106389. [PMID: 31731251 DOI: 10.1016/j.domaniend.2019.106389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 01/24/2023]
Abstract
Thyroid disease is common in cats, but little is known about the biologic variability of serum thyroid hormone concentrations and its impact on diagnostic utility in either healthy cats or cats with thyroid disease. The purpose of this study was to determine the biological variation, index of individuality, and reference change values for thyroid hormones and thyroid-stimulating hormone (TSH) in clinically healthy cats. Serum samples for analysis of total thyroxine (T4), triiodothyronine (T3), free T4 by dialysis, and TSH were obtained weekly for 6 wk from 10 healthy cats, then frozen until single-batch analyzed. Data were evaluated for outliers, and we determined the CV within individual cats (CVI) and between individual cats (CVG) for each hormone and the variation between duplicates or analytical variation (CVA). The index of individuality and reference change values for each hormone were then calculated. Serum concentrations of total T4, free T4, T3, and TSH all showed greater variation between cats (CVG) than within cats (CVI). Total and free T4 had an intermediate index of individuality (1.1 and 1.2, respectively), suggesting that these hormones would be best evaluated by a combination of their population-based reference intervals and reference change values. Serum TSH concentrations had high index of individuality (1.8), suggesting this hormone would be best evaluated with reference change values rather than the population-based reference interval. Total T3 also had a high calculated index of individuality (1.8); however, T3 had high ratio of analytical variation (CVA) to within cat variation (CVI), so RCV could not be accurately calculated. This study demonstrates that clinically normal cats show considerable interindividual biological variation in serum thyroid hormone and TSH concentrations, whereas the intraindividual variability in hormone concentrations is much narrower. This suggests that for all serum thyroid hormones, but especially serum TSH and T3 concentrations, comparing individual cat's hormone results to a population-based reference interval may be misleading, especially in those with early or subclinical thyroid disease. Clinicians might improve the diagnosis of feline thyroid disease by establishing baseline concentrations of T4, free T4, T3, and TSH for individual cats (ideally when healthy) and applying reference change values to subsequent measurements.
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Affiliation(s)
- J M Prieto
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - P C Carney
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - M L Miller
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - M Rishniw
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - J F Randolph
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - S V Lamb
- Department of Population Medicine & Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - N J Place
- Department of Population Medicine & Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - M E Peterson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA; Animal Endocrine Clinic, New York, NY, USA.
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7
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Hooper SE, Backus R, Amelon S. Effects of dietary selenium and moisture on the physical activity and thyroid axis of cats. J Anim Physiol Anim Nutr (Berl) 2017; 102:495-504. [PMID: 28984032 DOI: 10.1111/jpn.12776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/31/2017] [Indexed: 12/18/2022]
Abstract
Consumption of canned cat food is considered a risk factor for the development of feline hyperthyroidism. Because selenium and water are substantially higher in canned diets compared to dry diets, objectives of this study were to determine whether increased dietary selenium or water alters the function of the hypothalamic-pituitary-thyroid axis and leads to an increase in activity level. Employing a 28-day latin square design with a 14-day washout, six lean, neutered male domestic shorthair cats were fed (i) commercially available adult dry feline diet containing 0.8 ppm selenium (control), (ii) control diet with added sodium selenite to achieve a dietary selenium concentration of 1.125 ppm (selenium treatment) and (iii) the control diet with additional water to achieve a moisture content of 75% wt/wt (water treatment). Water consumption was determined using deuterium oxide washout. Actical activity monitors were placed on each cat's collar to allow quantification of the activity of each cat. Circulating serum T3 and T4 was measured on days 0, 14, and 28. On day 28, a thyrotropin-releasing hormone (TRH) stimulation test was conducted to determine treatment effects on serum concentrations of thyroid hormones. There was a significant increase in daily water consumption with dietary water treatment (192 ml ± 7.85 SEM) compared to the control (120 ml ± 20.4) and selenium (116 ml ± 14.6) treatments. Both water and selenium treatments were associated with greater (p < .05) activity over that of the control treatment by 20.5% and 11% respectively. Serum TT3 AUC concentrations (0-4 hr) of TRH stimulation tests were greater (p < .05) by 16% with water compared to control treatments. The results of this study indicate that dietary water content may alter the function of the thyroid axis and that this effect is associated with an increase in physical activity.
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Affiliation(s)
- S E Hooper
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - R Backus
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - S Amelon
- USDA Forest Service, Northern Research Station, Columbia, MO, USA
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McLean JL, Lobetti RG, Mooney CT, Thompson PN, Schoeman JP. Prevalence of and risk factors for feline hyperthyroidism in South Africa. J Feline Med Surg 2017; 19:1103-1109. [PMID: 28826266 PMCID: PMC11110999 DOI: 10.1177/1098612x16684408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objectives Hyperthyroidism is a disorder of older cats that may have a geographical variation in prevalence. Prevalence studies have not yet been performed in South Africa, a geographical area where hyperthyroidism in cats has recently been observed and where, reportedly, the incidence appears to be increasing. The purpose of this study was to determine the prevalence of feline hyperthyroidism in South Africa and to identify any potential risk factors. Further information on the worldwide prevalence and possible causative factors would increase our understanding of the aetiology of this disease and help identify any preventive measures. Methods Serum total thyroxine (tT4) and canine thyroid-stimulating hormone (cTSH) were measured in 302 cats aged 9 years and older that were presented at various veterinary clinics throughout South Africa. In cats with equivocal tT4 and undetectable cTSH values, serum free thyroxine (fT4) was also measured. At the time of blood sampling a questionnaire was completed regarding vaccination history, internal and external parasite control, diet and environment. Results Prevalence of hyperthyroidism (tT4 >50 nmol/l or tT4 between 30 and 50 nmol/l with TSH <0.03 ng/ml and fT4 >50 pmol/l) was 7% (95% confidence interval 4.4-10.4), with no significant difference between healthy (5%) and sick (8%) cats. Cats ⩾12 years of age (odds ratio [OR] 4.3, P = 0.02) and cats eating canned food (OR 2.1, P = 0.1) were more likely to be diagnosed with hyperthyroidism. No significant relationship between vaccinations, parasite control or indoor environment and hyperthyroidism was observed. Hyperthyroid cats were more likely to present with weight loss (OR 3.2, P = 0.01) and with a heart rate ⩾200 beats per min (OR 5, P = 0.01) than cats without the disease. Conclusions and relevance Hyperthyroidism does not appear to be uncommon in the South African cat population. Risk factors for hyperthyroidism, specifically older age and eating canned food, were present in this as in other reported populations.
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Affiliation(s)
- Joanne L McLean
- Department of Companion Animal Clinical Studies, University of Pretoria, South Africa
- Bryanston Veterinary Hospital, Johannesburg, South Africa
| | - Remo G Lobetti
- Bryanston Veterinary Hospital, Johannesburg, South Africa
| | - Carmel T Mooney
- University Veterinary Hospital, University College Dublin, Dublin, Ireland
| | - Peter N Thompson
- Department of Production Animal Studies, University of Pretoria, Pretoria, South Africa
| | - Johan P Schoeman
- Department of Companion Animal Clinical Studies, University of Pretoria, South Africa
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Walter KM, Lin YP, Kass PH, Puschner B. Association of Polybrominated Diphenyl Ethers (PBDEs) and Polychlorinated Biphenyls (PCBs) with Hyperthyroidism in Domestic Felines, Sentinels for Thyroid Hormone Disruption. BMC Vet Res 2017; 13:120. [PMID: 28468659 PMCID: PMC5415813 DOI: 10.1186/s12917-017-1031-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 04/17/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hyperthyroidism is the most common endocrine disorder observed in domestic felines; however, its etiology is largely unknown. Two classes of persistent organic pollutants, polybrominated diphenyl ethers (PBDEs) and polychlorinated biphenyls (PCBs) are known to interfere with thyroid hormone (TH) signaling and regulation; thus, it is postulated that they contribute to the etiopathogenesis of feline hyperthyroidism and pose a risk to humans and other species. In this case-control study, the concentrations of 13 PBDE and 11 PCB congeners were measured by gas chromatography mass spectrometry in serum or plasma samples from 20 hyperthyroid and 31 control cats in order to investigate the association between concentration of PBDE and PCB congeners and feline hyperthyroidism. Logistic regression analysis was used to determine whether elevated concentrations of individual congeners were associated with a higher risk of feline hyperthyroidism. RESULTS Hyperthyroid cats had higher concentrations of four PBDE congeners (BDE17, BDE100, BDE47, and BDE49) and five PCB congeners (PCB131, PCB153, PCB174, PCB180, and PCB196), compared to control cats. In addition, the sum of both PBDE and PCB congener concentrations were elevated in the hyperthyroid group compared to control cats; however, only the increased PCB concentrations were statistically significant. The sum total PBDE concentrations in our feline samples were approximately 50 times greater than concentrations previously reported in human populations from a geographically similar area, whereas sum total PCB concentrations were comparable to those previously reported in humans. CONCLUSIONS These observational findings support the hypothesis that PBDEs and PCBs may contribute to the etiopathogenesis of hyperthyroidism in felines. As domestic house cats are often exposed to higher concentrations of PBDEs than humans, they may serve as sentinels for the risk of TH disruption that these pollutants pose to humans and other species.
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Affiliation(s)
- Kyla M. Walter
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Dr., Davis, CA 95616 USA
| | - Yan-ping Lin
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Dr., Davis, CA 95616 USA
| | - Philip H. Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Dr., Davis, CA 95616 USA
| | - Birgit Puschner
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, 1089 Veterinary Medicine Dr., Davis, CA 95616 USA
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Carney HC, Ward CR, Bailey SJ, Bruyette D, Dennis S, Ferguson D, Hinc A, Rucinsky AR. 2016 AAFP Guidelines for the Management of Feline Hyperthyroidism. J Feline Med Surg 2016; 18:400-16. [PMID: 27143042 PMCID: PMC11132203 DOI: 10.1177/1098612x16643252] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
CLINICAL CONTEXT Since 1979 and 1980 when the first reports of clinical feline hyperthyroidism (FHT) appeared in the literature, our understanding of the disease has evolved tremendously. Initially, FHT was a disease that only referral clinicians treated. Now it is a disease that primary clinicians routinely manage. Inclusion of the measurement of total thyroxine concentration in senior wellness panels, as well as in diagnostic work-ups for sick cats, now enables diagnosis of the condition long before the cat becomes the classic scrawny, unkempt, agitated patient with a bulge in its neck. However, earlier recognition of the problem has given rise to several related questions: how to recognize the health significance of the early presentations of the disease; how early to treat the disease; whether to treat FHT when comorbid conditions are present; and how to manage comorbid conditions such as chronic kidney disease and cardiac disease with treatment of FHT. The 2016 AAFP Guidelines for the Management of Feline Hyperthyroidism (hereafter referred to as the Guidelines) will shed light on these questions for the general practitioner and suggest when referral may benefit the cat. SCOPE The Guidelines explain FHT as a primary disease process with compounding factors, and provide a concise explanation of what we know to be true about the etiology and pathogenesis of the disease.The Guidelines also:Distill the current research literature into simple recommendations for testing sequences that will avoid misdiagnosis and separate an FHT diagnosis into six clinical categories with associated management strategies.Emphasize the importance of treating all hyperthyroid cats, regardless of comorbidities, and outline the currently available treatments for the disease.Explain how to monitor the treated cat to help avoid exacerbating comorbid diseases.Dispel some of the myths surrounding certain aspects of FHT and replace them with an evidence-based narrative that veterinarians and their practice teams can apply to feline patients and communicate to their owners. EVIDENCE BASE To help ensure better case outcomes, the Guidelines reflect currently available, evidenced-based knowledge. If research is lacking, or if a consensus does not exist, the expert panel of authors has made recommendations based on their extensive, cumulative clinical experience.
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Affiliation(s)
- Hazel C Carney
- WestVet Emergency and Specialty Center, 5019 North Sawyer Avenue, Garden City, ID 83617, USA
| | - Cynthia R Ward
- University of Georgia, College of Veterinary Medicine, 2200 College Station Road, Athens, GA 30605,USA
| | - Steven J Bailey
- Exclusively Cats Veterinary Hospital, 6650 Highland Road, Ste 116, Waterford, MI 48327, USA
| | - David Bruyette
- VCA West Los Angeles Animal Hospital, 1900 South Sepulveda Blvd, Los Angeles, CA 90025, USA
| | - Sonnya Dennis
- Stratham-Newfields Veterinary Hospital, 8 Main Street, Newfields, NH 03856, USA
| | - Duncan Ferguson
- College of Veterinary Medicine - University of Illinois, Department of Comparative Biosciences, 3840 Veterinary Medicine Basic Sciences Bldg, 2001 South Lincoln Avenue, Urbana, IL 61802, USA
| | - Amy Hinc
- Cosmic Cat Veterinary Clinic, 220 East Main Street, Branford, CT 06405, USA
| | - A Renee Rucinsky
- Mid Atlantic Cat Hospital, 201 Grange Hall Road, Queenstown, MD 21658, USA
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11
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Peterson ME, Guterl JN, Nichols R, Rishniw M. Evaluation of Serum Thyroid-Stimulating Hormone Concentration as a Diagnostic Test for Hyperthyroidism in Cats. J Vet Intern Med 2015; 29:1327-34. [PMID: 26192742 PMCID: PMC4858046 DOI: 10.1111/jvim.13585] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 06/18/2015] [Accepted: 06/23/2015] [Indexed: 11/26/2022] Open
Abstract
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 (fT4), 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 fT4 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 fT4.
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Affiliation(s)
- M E Peterson
- Animal Endocrine Clinic, New York, NY.,College of Veterinary Medicine, Cornell University, Ithaca, NY
| | | | - R Nichols
- Animal Endocrine Clinic, New York, NY
| | - M Rishniw
- College of Veterinary Medicine, Cornell University, Ithaca, NY.,Veterinary Information Network, Davis, CA
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Chow K, Hearn LK, Zuber M, Beatty JA, Mueller JF, Barrs VR. Evaluation of polybrominated diphenyl ethers (PBDEs) in matched cat sera and house dust samples: investigation of a potential link between PBDEs and spontaneous feline hyperthyroidism. ENVIRONMENTAL RESEARCH 2015; 136:173-179. [PMID: 25460634 DOI: 10.1016/j.envres.2014.09.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/03/2014] [Accepted: 09/30/2014] [Indexed: 06/04/2023]
Abstract
The cause of feline hyperthyroidism (FH), a common endocrinopathy of domestic cats, is unknown. A potential association between exposure to environmental contaminants polybrominated diphenyl ethers (PBDEs) and FH was investigated. The median serum level for the sum of congeners BDE-47, BDE-99, BDE-153, BDE-154 and BDE-183 (Σ5) in hyperthyroid and euthyroid cats was 82 and 174 ng g(-1)lw respectively with no significant difference in PBDE levels or profiles between groups. Overall, the median (min to max) concentration of PBDEs in cat serum (n=65) was 118 ng g(-1)lw (5-5260 ng g(-1)lw), which is approximately 10 times higher than that observed in the Australian human population. Furthermore, congener composition in feline serum samples was dominated by congener BDE-99, followed by BDE-47 then BDE-153 which differs from results of human biomonitoring. There was no correlation between PBDE levels in feline serum samples and matched house dust samples (n=25). However the similarity of BDE-47/99 ratio in each matrix suggests dust is likely the dominant exposure. Calculation of the daily exposure dose via dust ingestion for cats equated to a mean of 33 ng kg(-1) bw d(-1) (0.2-150 ng kg(-1) bw d(-1)). Differences in exposure estimates for Australian and US cats, based on dust ingestion alone, are consistent with the observed differences in body burdens. Our results do not support a role for PBDE exposure in the aetiopathogenesis of FH.
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Affiliation(s)
- K Chow
- Valentine Charlton Cat Centre, The University of Sydney, Evelyn Williams Building B10, The University of Sydney, NSW 2006, Australia
| | - L K Hearn
- National Research Centre for Environmental Toxicology, The University of Queensland, 39 Kessels Road, Coopers Plains, QLD 4108, Australia
| | - M Zuber
- Gladesville Veterinary Hospital, 449 Victoria Road, Gladesville, NSW 2111, Australia
| | - J A Beatty
- Valentine Charlton Cat Centre, The University of Sydney, Evelyn Williams Building B10, The University of Sydney, NSW 2006, Australia
| | - J F Mueller
- National Research Centre for Environmental Toxicology, The University of Queensland, 39 Kessels Road, Coopers Plains, QLD 4108, Australia
| | - V R Barrs
- Valentine Charlton Cat Centre, The University of Sydney, Evelyn Williams Building B10, The University of Sydney, NSW 2006, Australia
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Abstract
Since first discovered just 35 years ago, the incidence of spontaneous feline hyperthyroidism has increased dramatically to the extent that it is now one of the most common disorders seen in middle-aged to senior domestic cats. Hyperthyroid cat goiters contain single or multiple autonomously (i.e. TSH-independent) functioning and growing thyroid nodules. Thus, hyperthyroidism in cats is clinically and histologically similar to toxic nodular goiter in humans. The disease in cats is mechanistically different from Graves' disease, because neither the hyperfunction nor growth of these nodules depends on extrathyroidal circulating stimulators. The basic lesion appears to be an excessive intrinsic growth capacity of some thyroid cells, but iodine deficiency, other nutritional goitrogens, or environmental disruptors may play a role in the disease pathogenesis. Clinical features of feline toxic nodular goiter include one or more palpable thyroid nodules, together with signs of hyperthyroidism (e.g. weight loss despite an increased appetite). Diagnosis of feline hyperthyroidism is confirmed by finding the increased serum concentrations of thyroxine and triiodothyronine, undetectable serum TSH concentrations, or increased thyroid uptake of radioiodine. Thyroid scintigraphy demonstrates a heterogeneous pattern of increased radionuclide uptake, most commonly into both thyroid lobes. Treatment options for toxic nodular goiter in cats are similar to that used in humans and include surgical thyroidectomy, radioiodine, and antithyroid drugs. Most authorities agree that ablative therapy with radioiodine is the treatment of choice for most cats with toxic nodular goiter, because the animals are older, and the disease will never go into remission.
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Affiliation(s)
- Mark E Peterson
- Animal Endocrine Clinic21 West 100th Street, New York, New York 10025, USADepartment of Clinical SciencesNew York State College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA Animal Endocrine Clinic21 West 100th Street, New York, New York 10025, USADepartment of Clinical SciencesNew York State College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA
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West KL, Ramer J, Brown JL, Sweeney J, Hanahoe EM, Reidarson T, Proudfoot J, Bergfelt DR. Thyroid hormone concentrations in relation to age, sex, pregnancy, and perinatal loss in bottlenose dolphins (Tursiops truncatus). Gen Comp Endocrinol 2014; 197:73-81. [PMID: 24321177 DOI: 10.1016/j.ygcen.2013.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/13/2013] [Accepted: 11/15/2013] [Indexed: 01/17/2023]
Abstract
This study evaluated circulating concentrations of thyroid hormones in relation to age, sex, pregnancy status, and perinatal loss in bottlenose dolphins (Tursiops truncatus) under human care. A total of 373 blood samples were collected from 60 individual dolphins housed at nine aquariums/oceanariums. Serum concentrations of total and free thyroxine (T4) and triiodothyronine (T3) were analyzed with commercial RIA kits validated for use with dolphins. While the effect of age was indicated by higher (P<0.0001) concentrations of total and free T4 and T3 in juveniles than adults, the effect of sex on thyroid hormones was inconclusive. The effect of pregnancy was indicated by higher (P<0.035) total and free T4 and T3 during early pregnancy compared to non-pregnancy. For both successful and unsuccessful pregnancy outcomes, maternal concentrations of thyroid hormones were highest during early, intermediate during mid, and lowest during late pregnancy (P<0.07 to P<0.0001). Compared to live and thriving births, concentrations of total and free T4 and total T3 were lower (P<0.08 to P<0.001) in dolphins with perinatal loss. Lower concentrations ranged from 10% to 14% during early, 11% to 18% during mid, and 23% to 37% during late pregnancy. In conclusion, the effects of age, reproductive status and stage of pregnancy on thyroid hormone concentrations are necessary factors to take into account when assessing thyroid gland function. Since perinatal loss may be associated with hypothyroidism in dolphins, analysis of serum T4 and T3 should be considered for those dolphins that have a history of pregnancy loss.
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Affiliation(s)
- Kristi L West
- Hawaii Pacific University, College of Natural and Computational Sciences, Kaneohe, HI 96744, United States.
| | - Jan Ramer
- Indianapolis Zoo, 1200 W. Washington St., PO Box 22309, Indianapolis, IN 46222, United States.
| | - Janine L Brown
- Department of Reproductive Sciences, Conservation and Research Center, National Zoological Park, Smithsonian Institution, Front Royal, VA 22630, United States.
| | - Jay Sweeney
- Quest Global Management/Dolphin Quest, 4467 Saratoga Ave., San Diego, CA 92107, United States.
| | - Erin M Hanahoe
- Dolphin Quest Hawaii, Waikoloa Beach Drive, Waikoloa, HI 96738, United States.
| | - Tom Reidarson
- Sea World of California, San Diego, CA 92109, United States.
| | - Jeffry Proudfoot
- Indianapolis Zoo, 1200 W. Washington St., PO Box 22309, Indianapolis, IN 46222, United States.
| | - Don R Bergfelt
- US Environmental Protection Agency, Washington, DC 20460, United States.
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15
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Abstract
CLINICAL CHALLENGES In older cats presenting with clinical features of hyperthyroidism, confirmation of a diagnosis of thyroid disease is usually straightforward. However, the potential for false-negative and false-positive results exists with all thyroid function tests (especially in the context of routine screening of asymptomatic cats) and leads to clinical dilemmas. For example, a high serum T₄ value may be found in a cat that lacks clinical signs of hyperthyroidism, or hyperthyroidism may be suspected in a cat with normal total T₄ concentrations. PRACTICAL RELEVANCE To avoid unnecessary treatment and potentially adverse effects in a euthyroid cat, thyroid function tests must always be interpreted in the light of the cat's history, clinical signs, physical examination findings and other laboratory findings. EVIDENCE BASE In this article the author reviews the use of commonly recommended thyroid function tests, focusing on clinical scenarios that present diagnostic difficulties. In doing so, he draws on the veterinary and comparative literature, his own clinical experience, and data, unpublished to date, obtained from a series of 100 hyperthyroid cats consecutively diagnosed at his clinic.
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Affiliation(s)
- Mark E Peterson
- Animal Endocrine Clinic, 21 West 100th Street, New York, NY 10025, USA.
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16
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Thyroid Disorders in the Geriatric Veterinary Patient. Vet Clin North Am Small Anim Pract 2012; 42:707-25, vi-vii. [DOI: 10.1016/j.cvsm.2012.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wakeling J, Elliott J, Syme H. Evaluation of Predictors for the Diagnosis of Hyperthyroidism in Cats. J Vet Intern Med 2011; 25:1057-65. [DOI: 10.1111/j.1939-1676.2011.00790.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Revised: 06/24/2011] [Accepted: 07/18/2011] [Indexed: 11/27/2022] Open
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Proliferative thyroid lesions and hyperthyroidism in captive fishers (Martes pennanti). J Zoo Wildl Med 2010; 41:296-308. [PMID: 20597222 DOI: 10.1638/2009-0186r2.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diseases of the thyroid gland are common in many zoo species, but there are few descriptions of thyroid dysfunction in Mustelidae. A 7-yr-old, captive-bred female fisher (Martes pennanti) with progressive alopecia was diagnosed with clinical hyperthyroidism based on persistent elevation of both total and free serum thyroxine and triiodothyronine, ultrasound examination, and histologic evidence of adenomatous hyperplasia. Four additional geriatric adult fishers (two male and two female) were identified with thyroid adenomatous hyperplasia in a review of 23 postmortem records. Banked sera were available for thyroid hormone testing from three of the four necropsy cases. Total and free thyroxine were elevated in four of four animals tested, and triiodothyronine was elevated in two of three animals tested. Necropsy findings in four cases identified cardiac hypertrophy, congestive heart failure, and vascular lesions consistent with hypertension; complete tissues were not available from the remaining case. Clinical and subclinical hyperthyroidism may be a common but overlooked condition of captive fishers.
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Quante S, Fracassi F, Gorgas D, Kircher PR, Boretti FS, Ohlerth S, Reusch CE. Congenital hypothyroidism in a kitten resulting in decreased IGF-I concentration and abnormal liver function tests. J Feline Med Surg 2010; 12:487-90. [PMID: 20223692 PMCID: PMC10822274 DOI: 10.1016/j.jfms.2010.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2010] [Indexed: 11/15/2022]
Abstract
A 7-month-old male kitten was presented with chronic constipation and retarded growth. Clinical examination revealed disproportional dwarfism with mild skeletal abnormalities and a palpable thyroid gland. The presumptive diagnosis of congenital hypothyroidism was confirmed by low serum total thyroxine (tT(4)) concentration prior to and after the administration of thyroid stimulation hormone (TSH), increased endogenous TSH concentration and abnormal thyroid scintigraphic scan. The kitten had abnormal liver function tests and decreased insulin-like growth factor 1 (IGF-1) concentration, both of which returned to normal in correspondence with an improvement of the clinical signs after 6 weeks of thyroxine therapy. Congenital hypothyroidism is a rare disease that may present with considerable variation in clinical manifestation. In cases in which clinical signs are ambiguous, disorders such as portosystemic shunt and hyposomatotropism have to be taken into account as differential diagnosis. As hypothyroidism may be associated with abnormal liver function tests and low IGF-1 concentrations, test results have to be interpreted carefully.
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Affiliation(s)
- Saskia Quante
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Federico Fracassi
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Daniela Gorgas
- Division of Clinical Radiology, Vetsuisse Faculty, University of Berne, Switzerland
| | - Patrick R. Kircher
- Division of Clinical Radiology, Vetsuisse Faculty, University of Berne, Switzerland
| | - Felicitas S. Boretti
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Stefanie Ohlerth
- Section of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Claudia E. Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Switzerland
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Wang C, Swanson WF, Herrick JR, Lee K, Machaty Z. Analysis of cat oocyte activation methods for the generation of feline disease models by nuclear transfer. Reprod Biol Endocrinol 2009; 7:148. [PMID: 20003339 PMCID: PMC2797514 DOI: 10.1186/1477-7827-7-148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 12/11/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Somatic cell nuclear transfer in cats offers a useful tool for the generation of valuable research models. However, low birth rates after nuclear transfer hamper exploitation of the full potential of the technology. Poor embryo development after activation of the reconstructed oocytes seems to be responsible, at least in part, for the low efficiency. The objective of this study was to characterize the response of cat oocytes to various stimuli in order to fine-tune existing and possibly develop new activation methods for the generation of cat disease models by somatic cell nuclear transfer. METHODS First, changes in the intracellular free calcium concentration [Ca2+]i in the oocytes induced by a number of artificial stimuli were characterized. The stimuli included electroporation, ethanol, ionomycin, thimerosal, strontium-chloride and sodium (Na+)-free medium. The potential of the most promising treatments (with or without subsequent incubation in the presence of cycloheximide and cytochalasin B) to stimulate oocyte activation and support development of the resultant parthenogenetic embryos was then evaluated. Finally, the most effective methods were selected to activate oocytes reconstructed during nuclear transfer with fibroblasts from mucopolysaccharidosis I- and alpha-mannosidosis-affected cats. RESULTS All treatments were able to elicit a [Ca2+]i elevation in the ooplasm with various characteristics. Pronuclear formation and development up to the blastocyst stage was most efficiently triggered by electroporation (60.5 +/- 2.9 and 11.5 +/- 1.7%) and the combined thimerosal/DTT treatment (67.7 +/- 1.8 and 10.6 +/- 1.9%); incubation of the stimulated oocytes with cycloheximide and cytochalasin B had a positive effect on embryo development. When these two methods were used to activate oocytes reconstructed during nuclear transfer, up to 84.9% of the reconstructed oocytes cleaved. When the 2 to 4-cell embryos (a total of 220) were transferred into 19 recipient females, 4 animals became pregnant. All of the fetuses developed from oocytes activated by electroporation followed by cycloheximide and cytochalasin B incubation; no fetal development was detected as a result of thimerosal/DTT activation. Although heartbeats were detected in two of the cloned fetuses, no term development occurred. CONCLUSION Electroporation proved to be the most effective method for the activation of cat oocytes reconstructed by nuclear transfer. The combined thimerosal/DTT treatment followed by cycloheximide and cytochalasin B incubation triggered development effectively to the blastocyst stage; whether it is a viable option to stimulate term development of cloned cat embryos needs further investigations.
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Affiliation(s)
- Chunmin Wang
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - William F Swanson
- Center for Conservation and Research of Endangered Wildlife, Cincinnati Zoo and Botanical Garden, Cincinnati, OH 45220, USA
| | - Jason R Herrick
- Center for Conservation and Research of Endangered Wildlife, Cincinnati Zoo and Botanical Garden, Cincinnati, OH 45220, USA
- College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61802, USA
| | - Kiho Lee
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Zoltan Machaty
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
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Ferguson DC, Hoenig M, Kaptein EM, Peterson ME. Comments regarding "Subclinical hyperthyroidism in cats: a spontaneous model of subclinical toxic nodular goiter in humans?". Thyroid 2008; 18:1339-40; author reply 1341. [PMID: 19067644 DOI: 10.1089/thy.2008.0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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22
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Wakeling J, Moore K, Elliott J, Syme H. Diagnosis of hyperthyroidism in cats with mild chronic kidney disease. J Small Anim Pract 2008; 49:287-94. [DOI: 10.1111/j.1748-5827.2008.00544.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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