Potential thyroid related neurological problems.

[cattychew]

Hi, I'm kind of at a loss as to what to do right now. I should mention first up that I have been seeing a vet, but for reasons I will soon explain, have been going kind of crazy regarding the condition of my (soon to be, on October 28th) 11 year old Labrador, Lan.

I apologise for the length, but it is kind of an epic story.

It started at the end of May of this year when I noticed that Lan was having trouble chewing. She tends to be fairly tolerant of pain so it is hard telling when something is wrong with her. It turned out that she had a fractured carnassial tooth that needed to come out. And just previous to her operation, I noticed that she also had a lump in her chest. I mentioned this to the vet and he took some blood for analysis and decided it was an adenoma.

She then had an operation to remove both the tooth and the adenoma in June, but during the op the vet noticed a second lump and removed both for biopsy. One of the lumps was growing from her thyroid which he removed along with it.

The test came back that the second lump was carcinoma and after a few tests we found out that we were lucky because it hadn't spread.

Unfortunately, a while later she injured one of her hind legs. She has had a run of bad luck lately, it is almost unbelievible. It turned out that she had a ruptured cruciate and needed another operation. We were kind of broke having already just paid for her previous surgery so we kept her quiet and carried her up and down the steps at our house, while keeping her on a low fat diet. Sometime previous to the operation she injured her front leg and had a slight weakness in her other (non-ruptured) hind leg. The vet attributed the soreness in her front leg to compensating for the bad hind one since it was on the opposite side to the front. The back he said could be a torn cruciate since it is apparently not uncommon for them both to go.

It had been hard for the vet to diagnose the initial cruciate injury due to Lan not being very happy about being at the vets and she tends to tense up when he touches her so he was going to x-ray her before the operation to be sure.

The operation was performed at the beginning of September, at which time the nurse commented about the hair on her chest (where the cancer was removed) having not grown back properly. Some had grown back, but it was patchy. She thought that maybe it was due to scar tissue.

About a week after that she had begun putting some weight on her repaired knee and was bunny-hopping around. Things seemed to be improving and then all a sudden she stopped putting weight on the repaired leg, then a few days later she seemed to have trouble putting weight on her other hind leg. In the meantime the front leg, which was not completely right, had benefited somewhat from painkillers.

But one day about three weeks ago she tripped (or so we thought) and it seemed as though she had reinjured the repaired leg and blown the unrepaired knee. She was having a really hard time getting around for the two days following that and then one Saturday after carrying her outside to the toilet she couldn't support her weight and sat on the ground and messed herself. After everything that had happened, it just kind of ruined us.

The next morning our vet came to the house because there was no way we were going to be able to get her into the car without causing her a bunch of stress and potentially injuring her.

The vet took a look at her chest (with the patchy hair) and her coat, and then took some blood and slung her back legs in a towel so he could take a look at her walking. She would pull herself along on her front legs OK, but her hind legs were knuckling. He said that it seemed to be a neurological thing relating to the removed thyroid, or potentially some sort of spin or nerve damage.

When we got the test results back for the bloodwork it turned out her thyroid hormone levels were lower than they should have been and she was prescribed one and a half tablets of thryroxine twice daily and one tablet of macrolone once daily.

Almost the next day she started having trouble holding onto her bladder and my vet said that it was probably due to the medication, but had us bring a urine sample in anyway (which he had wanted us to do after looking at the blood).

The frustrating part is this, my vet then went on a holiday. Don't get me wrong, I don't begrudge the man a holiday but it made things kind of difficult for us, having to deal with another vet at the practice. Anyway, after nearly getting a bottle of medication designed to stop her from urinating the vet took a look at the urine sample and discovered she had contracted a urinary tract infection. He said that it probably came about due to the macrolene which is (as I understand it) some sort of steroid similar to cortisone.

The side effects of it (which she showed after a couple of days) were panting and excessive thirst. Which combined with the urinary tract infection has had my washing machine working overtime. By the way for the UTI he prescribed clavulox.

She has been on the macrolone and the thyroxine since the 29th of September. Sometime at the end of last week I noticed she seemed anxious and was crying a lot so I did a search online and discovered that some potential side effects of macrolone were anxiety. She was also noticibly down during the time of day previous to taking the medication. I spoke to another vet (since her regular one was still on holiday) on I believe Friday. He told me to not give her the macrolone for a couple of days and then give her half in the morning and half at night. I had her off of it for one day (Friday) that night she threw up her dinner along with (I assume) her dose of thyroxine and I was unsure about whether or not I should give her any more. I didn't, but after reading about the problems with coming off of macrolone cold turkey I gave her half of one Saturday along with her usual dose of thyroxine in the morning. Her anxiety started up again, and then when we took her to the toilet we noticed that she had started knuckling on her front leg, the same one which had given her trouble earlier.

Since the 29th of Sept. when she started taking the thyroxine she has had no noticeable improvement with walking, but I have been doing physio on her hind legs while she has been laying down and she will every now and again kick me. She can move her legs when you exercise them, but doesn't seem to be able to when she moves around on her bed.

So now she had three legs that are knuckling and I called the vet again this morning (Sunday). This is still not her regular vet, and now he thinks that she might have some nerve damage. I don't understand how this could be, because she has sensation in her feet and she can move her legs a bit, but just can't walk. So now tomorrow I am taking in another urine sample.

I had just been thinking that perhaps she needed her thyroxine dosage adjusted, but nerve damage? The thought is bothering me. I don't know if I can put her through more operations. She has never dealt well with being away from me. I haven't been apart from her for more than a month in 11 years.

I should also mention that when she leans on her front leg when laying down she falls onto her side and has trouble righting herself again. And after her regular dosage of a total combine 3 thyroxine tablets today, after fixing her foot she walked on it a bit when I took her to the toilet.

Something else, when she knuckles her front paw it is almost as though she is clenching it. I didn't notice her clenching her hind feet.

As for her other problems, I'm assuming the macrolene is causing her anxiety again after one day of broken up doses. She has completed her clavulox course (for the UTI) but this morning after she had her half dose of macrolene she started whining, then later tonight after the second dose she started again. I gave it to her at about 8pm, it's now 2am (I am sleeping in the lounge room with her) and she is still whining. Usually she'd be asleep by now. If I go and lay on the floor next to her bed she seems to relax a little. Her pupils are also pretty wide considering the light is on, she is panting a lot and I also have noticed that she has put a lot of the weight she lost back on even though we have been careful with her food.

I will be addressing these things tomorrow when I speak to the vet (our regular vet still isn't back from his vacation). But if anyone could offer any advice or any insight into any of this I would greatly appreciate it.

Again I apologise for the length, I realise that she is getting on a bit for a labrador, but it's just hard because she was starting to get better and now it's just one thing after another.

- Matt

[hazelrunpack]

Hi, Matt. I'm sorry Lan is having such a hard time of it.

First off, do I understand correctly that when Lan's thyroid was removed, no replacement thyroid hormone was prescribed until symptoms were noticed?

Also, we currently have 3 dogs on thyroid meds for autoimmune hypothyroidism and none have shown neurological symptoms.

Do you think Lan could possibly have suffered a stroke or something similar?

Prednisone I do have some experience with--it does increase thirst, appetite and frequency of urination as well as cause weight gain. As I understand it, it can increase the risk of damage to tendons and ligaments (like the cruciate ligaments, for instance). It can make treating a UTI harder, because it suppresses the immune system. And it can cause anxiety (whining, panting, etc). You should never stop a steroid cold turkey--a slow weaning off it is best to avoid some potentially nasty side effects. I'm not sure how similar macrolene is, but if it's a steroid, probably the side effects are about the same.

However, (and I'm not a vet, so it's likely I'm wrong) I don't think the vet would have prescribed it unless he suspected maybe some underlying inflammation that was causing the knuckling. Steroids are harsh drugs, but sometimes they are necessary to get a condition under control. They're usually used very short term at higher doses, then tapered off till you reach a maintenance level or (ideally) the dog is off them entirely.

It can be very tricky to tease out what are real symptoms and what are side effects from the drugs... I know how frustrating it can be and I'm sorry I can't be of more help.

Good luck with Lan. I hope your vet can give you some answers when you see him next. Please keep us updated on Lan's progress.

[cattychew]

Hi, Hazel. Thanks for your reply. I appreciate it. I'm going to break up your reply so I can answer it properly. I didn't get much sleep and just got in from work.

Originally Posted by hazelrunpack

First off, do I understand correctly that when Lan's thyroid was removed, no replacement thyroid hormone was prescribed until symptoms were noticed?

That's true. In hindsight it seems odd to me. Our vet usually seems pretty thorough. I remember she was prescribed two things after the initial operation. I can't remember what they were called offhand. But I remember looking them up at the time and they were both forms of antibiotics.

Originally Posted by hazelrunpack

Do you think Lan could possibly have suffered a stroke or something similar?

I don't think so. The hardest part of all this has been that despite the problems she has been having, she still is the same dog she has always been. She just can't walk. Also her face seems as expressive as it's always been, she hasn't had any trouble eating (though that might not mean much since she's a lab) or drinking. And I haven't noticed anything out of the ordinary. A couple of days ago I did notice a moment where she looked like she was going to sneeze, but it went on for a few minutes. I had read that sometimes dogs with low thyroid hormone can have seizures and got worried that she might have had one. But I haven't seen her do anything else since.

Originally Posted by hazelrunpack

Prednisone I do have some experience with--it does increase thirst, appetite and frequency of urination as well as cause weight gain. As I understand it, it can increase the risk of damage to tendons and ligaments (like the cruciate ligaments, for instance). It can make treating a UTI harder, because it suppresses the immune system. And it can cause anxiety (whining, panting, etc). You should never stop a steroid cold turkey--a slow weaning off it is best to avoid some potentially nasty side effects. I'm not sure how similar macrolene is, but if it's a steroid, probably the side effects are about the same.

When I did some research I discovered that Macrolone's is "Micronised prednisolone". I asked a friend of mine who works at a chemist about it and she said the same thing about going off of it cold turkey.

Originally Posted by hazelrunpack

However, (and I'm not a vet, so it's likely I'm wrong) I don't think the vet would have prescribed it unless he suspected maybe some underlying inflammation that was causing the knuckling. Steroids are harsh drugs, but sometimes they are necessary to get a condition under control. They're usually used very short term at higher doses, then tapered off till you reach a maintenance level or (ideally) the dog is off them entirely.

I looked into this just now because I wasn't sure why she was on them either. The best I could come up with was this.

In Hashimoto's thyroiditis the immune system mistakenly directs an immune "attack" against its own healthy cells. Antibodies are manufactured and misdirected against the thyroid gland.

Any condition in which the body's immune system attacks its own cells is called an auto-immune disease.

Inflammation associated with the abnormal immune response causes continuing loss of thyroid cells. Eventually, this loss in function (which may take months or even years) reaches the level where there is insufficient thyroid hormone Chemical substance produced by the thyroid gland and released into the bloodstream. It interacts with almost all body cells, causing them to increase their metabolic activity. Two forms of thyroid hormone, abbreviated as T3 and T4, are found in blood. to minimally support body function, and the person develops the symptoms of hypothyroidism.

Perhaps he thought this might be a problem?

I am seeing one of the other vets tonight, I guess I have a lot to ask them. I would prefer if I could speak to the one who prescribed this stuff so I could know what he was thinking. But we'll see...

Thanks for your help, though. I needed to hash this stuff out so I can try to make sense of it, and ask the right questions before it gets worse.

[hazelrunpack]

All three of our affected dogs have autoimmune-mediated hypothyroidism, but none of them were treated with steroids. They were all given thyroid replacement hormone (we use Pala-tech, a chewable thyroid med) even before the T3/T4 levels were particularly low, however.

Lan's hypothyroidism is due to surgical removal of the thyroid, and so wouldn't have the immune system issues.

If it were me, I'd ask the vet why the steroid was prescribed in the first place, and since it doesn't seem to be helping, if you can wean her off them.

Very puzzling how her symptoms cascaded, though.

Are you anywhere near a veterinary teaching hospital? When we've had complicated health issues with our dogs, we've used the one at the U of MN with very good results. Perhaps a University clinic might be an option for you? You could always ask if your vet thinks a referral is a good idea.

[cattychew]

Unfortunately there doesn't seem to be any veterinary teaching hospitals around here.

But I am making a list of things to ask the vet and I will definitely ask why she was put on steroids. I think at this stage the best I can hope for is that they find her hormone levels low and increase her dosage of thyroxine or prescribe another pill. If not, I suppose it will mean more tests.

Once again, thank you for your help and support. I will report back when I know more.

[cattychew]

Not great news. The vet says the macrolone was prescribed to help with swelling around Lan's spine which was attributed to the operation and displaced weight on her hind legs. My usual vet never told me this, because when I went to pick up her medication he was already on vacation.

Another issue has come about. I assumed that her being bloated for the past day or so was due to yet another macrolone side effect, but the urine sample showed blood and the vet believes that her bladder is distended.

He gave me three more days of clavulox and instructions to force her to walk around outside as much as possible to get her bowels moving more. He believes that the pressure from her bladder is pushing on the swelling in her spine and causing the problem with her front leg. Her hind legs he believes are not functioning due to her thyroid issues.

He also wants me to bring her into the surgery to possibly stay for a couple of days so they can run tests on her. I'm concerned about this because I'm not sure how she is going to take the stress. She has a lot of non-medication related anxiety about the vet now. Considering whenever she goes there she comes back with stitches, I'm not surprised. She had only ever been sick once in her life previous to this so this is new for her and she starts shaking as soon as she senses where we're taking her. :sad:

I don't suppose there is anything else I can do but take her in for the testing, since they don't seem to know why exactly the medication combination isn't having the effect it should.

To be honest I'm pretty angry at my vet for not following up the thyroid removal with testing her hormone levels. It seems to me that her leg would have healed a lot faster and she would have regained enough muscle mass to prevent any spine injuries if she wasn't also dealing with some, however slight at the time, neurological problem.

The only good thing about this is that after giving her the dose of macrolone tonight, once the restlessness and anxiety set in we took her outside to try to get her to go to the toilet. It was not an easy walk around the yard for her, but she did pass a lot of urine and was so tired from the effort she has fallen asleep and I presume is sleeping through the horrible side effects of the macrolone.