Hey Traci,
After everything we've been through Ami's anal gland appears to be infected again. He was leaking fluid and when I squeezed it there was a pink tinge at the end. The vet checked him out and said it isn't abscessed, and he's going to be on 4 weeks of antibiotics. He's also going in for a dental cleaning on Tuesday as his back teeth have tartar, and the gums are irritated.
We did routine bloodwork and everything is perfect except his free T4 which is less then 3.8. I've asked them to do a second test to confirm it (I think they're doing the FT4eq). He had the FT4eq 2 years ago and it was normal. He has no other symptoms - not lethargic, fur fine, eating well, drinking well, peeing and pooping well. The only issue he has is his gland, and the area isn't red nor hot nor swollen. He doesn't have a fever. He HAS put on 3 pounds in the last year or so, but I thought that was because we found polyps and added rice to his food. He also has warts, but has had them since he was a puppy. New ones pop up randomly.
Do you have an input on this? Should we be testing for other things? Are there issues we should be considering? Thanks!
Low free T4
Re: Low free T4
I'd persue the equilibrium dialysis free T4 (fT4(ED).
If for some reason, the vet is still uncertain after an ft4-ED, you could do the following, but it may not be necessary:
A thyroid stimulating hormone test (TSH) - this is used in conjuction with a T4 and is more accurate than just a T4. For example, if a healthy dog has a raised T4 after the TSH test, then it's unlikely hypothyroidism. If the T4 does NOT rise after the TSH test, then it's possible true hypothyroidism exists. I know it sounds backwards, but that's how the tests are determined to be accurate. Also, the levels need to be tested in an 8-hour period at the clinic, so you'd have to leave him there for testing.
Do you know if the chemical blood profile showed an increase in cholesterol? May not be significant, but sometimes, true hypothyroid dogs have this enzyme elevated.
If your dog is on any current medications for any other conditions, including prednisone or any corticosteroids, sometimes these medications can cause a low T4 but not actually have hypothyroidism. In cases like this, the T4 may or may not be accurate, therefore the need to test either ft4-ED or the TSH test for better accuracy.
If the ft4-ED confirms hypothyroidism, it might help explain your dog's symptoms these last few years, in part, but I never thought hypo-T at his age (then), and certainly not because his other symptoms always seemed so severe. The constantly recurring infections certainly could explain it.
If after the ft4-ED and the vet confirms hypothyroidism, after a course of thyroid meds, see if that helps with staving off another infection. If not, then you could be dealing with a specific anal gland problem unrelated to, but in addition to hypothyroidism. I'm assuming his current diet has helped with limiting or stopping his past skin issues?
If for some reason, the vet is still uncertain after an ft4-ED, you could do the following, but it may not be necessary:
A thyroid stimulating hormone test (TSH) - this is used in conjuction with a T4 and is more accurate than just a T4. For example, if a healthy dog has a raised T4 after the TSH test, then it's unlikely hypothyroidism. If the T4 does NOT rise after the TSH test, then it's possible true hypothyroidism exists. I know it sounds backwards, but that's how the tests are determined to be accurate. Also, the levels need to be tested in an 8-hour period at the clinic, so you'd have to leave him there for testing.
Do you know if the chemical blood profile showed an increase in cholesterol? May not be significant, but sometimes, true hypothyroid dogs have this enzyme elevated.
If your dog is on any current medications for any other conditions, including prednisone or any corticosteroids, sometimes these medications can cause a low T4 but not actually have hypothyroidism. In cases like this, the T4 may or may not be accurate, therefore the need to test either ft4-ED or the TSH test for better accuracy.
If the ft4-ED confirms hypothyroidism, it might help explain your dog's symptoms these last few years, in part, but I never thought hypo-T at his age (then), and certainly not because his other symptoms always seemed so severe. The constantly recurring infections certainly could explain it.
If after the ft4-ED and the vet confirms hypothyroidism, after a course of thyroid meds, see if that helps with staving off another infection. If not, then you could be dealing with a specific anal gland problem unrelated to, but in addition to hypothyroidism. I'm assuming his current diet has helped with limiting or stopping his past skin issues?
..........Traci
Re: Low free T4
I've requested a copy of the bloodwork, but haven't been by to pick it up. I just called and she said the test we did didn't check cholesterol. We're going to postpone the dental work until his thyroid is in check, too.
He's not on any other medications, I wish it was that easy!
I had previously been warned about Cushings, so I had pushed earlier thyroid/adrenal tests to be sure. They were all perfect, and I'm glad I did them so we have a baseline now.
The diet has stopped his old skin issues, the only infection that returns is the anal gland. Once he's on antibiotics it typically goes away for 6 months to a year, but then it always seems to return.
Thank you for this information!
He's not on any other medications, I wish it was that easy!
I had previously been warned about Cushings, so I had pushed earlier thyroid/adrenal tests to be sure. They were all perfect, and I'm glad I did them so we have a baseline now.
The diet has stopped his old skin issues, the only infection that returns is the anal gland. Once he's on antibiotics it typically goes away for 6 months to a year, but then it always seems to return.
Thank you for this information!
Re: Low free T4
Oops, I never came back to post the results! His T4 was horrifically low, so we've been treating it and it's back to normal. He dropped all the extra weight he'd put on and he's peppy again. The anal gland infection is back, but it's minor, not causing discomfort (it's just green anal gland goo instead of brown). Here's to hoping things pick up for him from now on. :/