Hyperthyroidism and other questions regarding blood tests


Liz7033@...
 

Hi,
Dante was retested after 4 week of not being on kelp products.  HIs thyroid numbers were worse!  T3 - 251 (range 30-80),  Free T4- 7.39 (1.2-1.8) T4 - 5.73 (1-3). Before these test results, the vet did ultrasound his thyroid. And thought it looked normal, but noted that he doesn't look at many thyroids. 1) I'm looking for suggestions on what my next step is.  Hyperthyroidism is rare and I don't even know what questions to ask.

Dante's ACTH came back at 37.3.  He has been on 2.2 pergolide.  I can't seem to get his ACTH out of the thirties. 2) Do I go to 3 mg or much higher?  3) Could this be effecting his thyroid?

His insulin was 4.0 uIU/mL.  He had plenty of food in front of him the night before, had his "grain" at 4 am was turned out on pasture by 5 am.   Blood work at 11, before any other procedures. He might not be eating enough, but he is eating. 4) Any reason for this low of insulin, since I do not believe he was fasting.

He is schedule for a stomach scope tomorrow with a 14 hr fasting before.  5) Is there a reason he shouldn't be fasted  based on his insulin numbers?

Overall, he is looks tired, but at the same time he is ready to go for a walk.  Losing more muscle on top line, but at time maybe a slight belly. The most disturbing thing, is at times he completely zones out doesn't seem to know where his feet are, his feet cross when he walks,   Almost like he is a sleepy drunk.  After less than two minutes of this he is back to his normal self. I don't know how often he does it, but I'm beginning to see it more. 

Any insights would be greatly appreciated.

-


Liz
SW Washington
January 25, 2020
https://ecir.groups.io/g/CaseHistory/files/Liz%20and%20Dante
https://ecir.groups.io/g/CaseHistory/album?id=268141 Dante photos


Tasha photo album
Case History


Sherry Morse
 

Hi Liz,

What form of pergolide are you using (capsules/in oil/powder)?  If this were my horse going into the rise I would be upping his dose to at least 3mg of pergolide now.  As his glucose number was normal I wouldn't think the insulin was a mis-count but it's certainly no longer indicative of him being IR.  Have you had his Vitamin E level checked?  Had a neuro evaluation done?  Feet crossing when they walk and loss of muscle makes me think of motor neuron disease, not thyroid or PPID.  





Eleanor Kellon, VMD
 

Are you close enough to the vet school at WSU to make an appointment there. There is a condition in humans, MEN, multiple endocrine neoplasias, that has also been found in horses although it's rare. For example, pheochromocytoma may be found at the same time as PPID and thyroid tumors https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913635/ .

It does sound like his PPID is not well controlled and 2.2 mg is still a low dose in our experience - and even in both the FDA approval data and other reports. Talk to your vet but I would go up at least to 3. His insulin is normal but glucose a little high. That would be consistent with an epinephrine release from a pheochromocytoma or possibly pancreatic exhaustion although I've never seen an insulin that low even in frankly diabetic horses.

If he is safe to be around during his episodes, see if you can feel for a rapid pulse/heart beat by feeling for the artery along his bottom jaw or sliding your hand under his left elbow. You can also take a pulse on the midline of the undersurface of the tail but you need someone on the head for that.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Liz7033@...
 


Dante's dosage of pergolide has been increased to 3mg. The pergolide is in a capsule, which I hand feed daily. In March, his Vitamin E  was normal at 6.1 ug/mL and Selenium was slightly elevated at .31 ug/g.  Last month the vet did do a mini neuro exam, walked in a tight circle and backing and he said he looked good.

I'm planning on contacting OSU today. (closer than WSU)  They were consulted by the vet a month ago. And see how they would precede.  At that time I'll pass on Dr. Kellon comments.  I haven't been able to get a pulse on him during one of his episodes.

The stomach scope went yesterday went ok (I was worried about 14 hours without food).  Found 2 small ulcers, but vet says not his major problem. Will treat for ulcers though.

Thanks

Liz
SW Washington
January 25, 2020
https://ecir.groups.io/g/CaseHistory/files/Liz%20and%20Dante
https://ecir.groups.io/g/CaseHistory/album?id=268141 Dante photos


Tasha photo album
Case History