Evaluation of Weight Gain, Clinicopathological and Radiographic Changes after Early Diagnosis and Treatment of Congenital Hypothyroidism in Cats

Age-dependent changes in plasma concentrations of 25-hydroxyvitamin D may complicate vitamin D status assessment of immature cats

Background

Vitamin D deficiency and excess in clinically presented cats conventionally is diagnosed by comparison of patient plasma 25-hydroxyvitamin D (25 (OH)D) concentration with plasma reference intervals determined in healthy adult cats. For immature cats, validity of this vitamin D status assessment method is uncertain.

Objective

The overall objective was determination of whether plasma concentration of 25 (OH) D and other vitamin D metabolites in immature cats markedly change with developmental age as has been reported in other species.

Methods

Four male and 4 female domestic short-hair kittens from weaning were continuously presented a single nutritionally adequate growth-diet. Concentrations of 25 (OH) D and 24,25-dihydroxyvitamin D (24,25 (OH)2D), and calcitriol were quantified in plasma of jugular venous blood collected at 12, 15, 18, and 21 weeks and 1 year of age. Plasma was liquid and solid-phase extracted and fractionation by normal-phase HPLC, and 25 (OH) D and 24,25 OH)2D quantified by reverse-phase HPLC-UV and calcitriol by RIA.

Results

Plasma 3-epi-25 (OH) D and 25 (OH) D concentrations increased (p < 0.001) with age so that by study end the concentrations rose by 1-and 2-fold, respectively. Concentrations of 3-epi-25 (OH) D relative to 25 (OH) D were 30% at 12 weeks and 20% at 1 year. Between ages 12 and 21 weeks, rises in 25 (OH) D concentration were positively correlated with body weight gains (ρ = 0.952, p < 0.001) and 24,25 (OH)2D concentrations were consistently greater than 25 (OH) D concentrations (p < 0.001). At 1 year of age, concentrations of 24,25 (OH)2D declined below those of 25 (OH) D and 3-epi-24,25 (OH)2D consistency occurred in low concentrations. Vitamin D2 metabolites and sex differences in metabolite concentrations were not observed.

Conclusion

Reliance on quantification of plasma 25 (OH) D concentration for vitamin D status assessment in kittens may be confounded by developmental changes in 25 (OH) D independent of vitamin D intake. High 24,25 (OH)2D concentration and occurrence of 3-epi-25 (OH) D in plasma additionally may interfere with the quantification.

Feline congenital hypothyroidism: a case report

We report a two-month-old male cat weighing 630 grams with congenital hypothyroidism. The main complaints were difficulty defecating for more than three days and prostration. Physical examination revealed a broad, flat face, a short neck, enlarged submandibular lymph nodes, chemosis, mild bilateral mucopurulent ocular discharge, seborrheic coat, with gingival thickening around the upper and lower deciduous incisor teeth with partial eruption. The abdomen was distended due to constipation and right unilateral cryptorchidism. Based on this, feline congenital hypothyroidism was suspected. Hormonal tests (free T4 by equilibrium dialysis of 0.06 ng/dl, total T4 of 0.1 ng/ml and TSH of 4.7 ng/ml) confirmed this. Treatment was started with levothyroxine sodium (5-32.2 µg/kg/day). After 120 days of treatment, there was clinical stabilization. Then the patient underwent orchiectomy of the left and of the right ectopic testicles, and at 380 days of treatment, the thyroid scintigraphy showed intense uptake of the radiopharmaceutical by both thyroid lobes and a significant increase in volume. Clinical evaluation showed weight gain (2.6 kilograms during treatment), improvement in the shape of the skull, and a notable increase in body size. At 17 months of age, hormone values were within the reference limits after administration of levothyroxine sodium (32.2µg/kg/day).

Association of recessive c.430G>A (p.(Gly144Arg)) thyroid peroxidase variant with primary congenital hypothyroidism in cats

BACKGROUND

Primary congenital hypothyroidism (CH) is a rare endocrine disorder in cats with a largely unknown genetic cause.

OBJECTIVES

Describe the clinical presentation of CH in 11 affected cats and identify the causal genetic variant.

ANIMALS

Eleven CH-cats from 10 unrelated families, 11 CH-free family members, 21 unrelated CH-free cats, and 155 unrelated nondiagnosed cats from different breeds.

METHODS

Case control study of CH-cats and their siblings (2019-2021). Diagnosis was based on low to low-normal serum thyroxine (T4) concentrations, high thyroid-stimulating hormone (TSH) concentrations and clinical signs compatible with CH. We identified the causal variant using Sanger sequencing, genotyping via PCR-RFLP and variant interpretation using ACMG/AMP guidelines.

RESULTS

All CH-cats (5 weeks-8 years) had disproportionate dwarfism. A goiter was not palpable in all. Thyroid scintigraphy with radiopertechnetate showed abnormally high uptake by thyroid glands, whereas scintigraphy with radioiodine showed abnormally low uptake, compatible with a defect in iodine organification by thyroid peroxidase (TPO). All cases were homozygous for TPO variant XM_006930524.4:c.430G>A(p.(Gly144Arg)), while none of the CH-free cats were. All sampled parents were heterozygous for this recessive variant. This variant was found in 15 cat breeds with an estimated allele frequency of 9%.

CONCLUSIONS AND CLINICAL IMPORTANCE

Disproportionate dwarfism, abnormally high TSH and abnormally low to low-normal T4 concentrations are diagnostic for CH in cats. All cases had dyshormonogenesis demonstrated by thyroid scintigraphy. This novel TPO missense variant (not described in humans) causes CH in cats and awareness of it can assist in diagnosis and breeding.