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Laika's hypothyroidism

Why a section on hypothyroidism?

Well,... Laika's symptoms were so atypical, so strange, that we only found the reason for all of this by chance. Laika showed none of the "typical" symptoms one expects to see like lethargy, depression, skin problems, hair loss, fearfullness (of loud noises or bright lights) or even weight gain and "aggression" which is allegedly so common a side effect of hypothyroidism. But then, Laika is not a "normal" dog anyway. So who would expect her to show "normal" symptoms? I should have known better I think.

We found her hypothyroidism when trying to figure out if there was any underlying medical condition that led to her severe adverse reaction to ACE-inhibitors she had been prescribed for her heart problems! And then there was the somewhat frantic call, that this dog had "no T4" (thyroid hormone) in her blood, at least none the laboratory could find. Well, none was not quite enough, anyone would admit that! The cardiologist had remarked in an off hand way that she had a "pretty low heart rate" at the time of examination. The exact opposite (accellerated heart rate) would be more along the lines of what one would expect to see in this kind of heart disease.

So I will just list all the little odds and ills she had that dissappeared with treatment of her hypothyroidism and the year or time I first noticed it. Always keep in mind, that she had been (borderline?) hypothyroid at least since the August of 2010 but I just did not know it then. Probably she was a little low before that (I have read this numerous times and it was confirmed by a human endocrinologist, that very young individuals - and a three year old dogs is still "young" - are expected to have levels somewhat above the minimum level given in the reference range laboratories supply. Mostly those "lowest levels" are standardized to somewhat older non-sighthound dogs or respectively people). Furthermore when we started treating her hypothyroidism some problems disappeared very soon. She started treatment in late March 2012. In October 2012 quite by chance and by suggestion of the cardiologist I had her thyroid checked again and we slightly raised the thyroxine dose she received. This, again, made a tremendous difference in terms of quality of life for her. As of the day I am writing this (27 August 2013) her heart rate is in the range of what is considered "normal" for her (and no longer "slow"). This is according to the cardiologist. Despite her heart problems she appears to be in excellent condition (speaking of the time until today) and in fact appears much healthier than she was at a time where presumably her heart was working much better than it is now. I can only speak of today, because this heart disease can be viscious. She can be well today and dead tomorrow. But anyway. Today is all we have!

As we know now (October 2014) her heart disease was probably not of the type we all feared for good reason. We now know it may truely have been associated to her hypothyroidism. What killed her was her heart, but in combination with an inflamamtory process in her body eventually affecting the heart and causing sinus anomalies.

List of problems and time frame:

  • incontinence (especially when jumping or walking up or down stairs, even at last usually not in her sleep, the problem grew progressively worse with time and no treatment and nothing really helped. I had just resigned myself to cleaning the floor a lot and washing dog bedding constantly) -> some time in late 2009 (when she started "leaking" when walking up or down stairs for her evening or morning "potty walks", this progressed somewhat over the following years to quite substantial amounts of urine and later even occasionally feces being "lost" with her quite evidently having little control over the problem in early 2012) until May 2012
  • difficulty concentrating or remembering what she was told to do, for example would genuinely "forget" I had told her "find" (the bread/cookie/bone), to "sit" and "stay" for more than 10 seconds or things like that -> November 2011 until April 2012
  • weight issues: she has always had problems to keep on weight no matter what I did. In the summer or early autum of 2011 she suddenly started to have "adequate weight". Then in December 2011 she suddenly started to get just a little bit "chubby" and I reduced her food a little. However, the cardiologist did not see any need for her to loose weight in March 2012. As of October/November 2012 she suddenly eats normal amounts of food and seems to have an adequate energy expenditure
  • cold intolerance: I don't know when this started. I definately recall her being "always cold" in the early winter months of 2010. Since autum 2012 she has no longer had this problem and is only cold when it really is icy cold outside and she is not moving that much (that is temperatures below freezing).
  • in the summer of 2010 I started to notice she had problems digesting starch (confirmed by analysis of a stool sample). She was perfectly ok with meat and fat, but starch just would not do. I could only feed her her normal food in lots of tiny little meals. Otherwise I had to add digestive enzymes to her food. Otherwise she was just a "food heater", because she would not actually be able to make use of the energy in it. At the time we tried to find a reason, but the only thing the vet could think of once pancreas problems were ruled out was "inflammatory bowel disease" or "irritable bowel disease" and the symptoms did not really fit for that (because if it had been either of that one would expect this to also affect food other than starch, when fed home prepared meals free of any starch she had no problems at all). It did not really make sense that she is allergic to all sources of starch, even those she had never eaten before. In fact, as of June 2012 these digestive issues have completely disappeared and she can now eat any normal kibble and any normal source of starch used in dog food. So this cannot have been an allergy or any "true" bowel condition.
  • Laika has never been lethargic. She did, however become extremly hyperexcitable. She would go "through the roof" with excitent for just about anything. The dog who had never had problems in crowded city centers or supermarkets would suddenly be completely unable to cope with even mildly exciting situations. For example in late 2011 it was progressed so far that having a visitor would be so exciting she would completely "loose it", could not calm down at all and would eventually collapse and fall asleep with exhaustion completely drained of energy only to jump up again and start all over again. Calming her down was very difficult as the only way to do that was to physically restrain her to a point where she was unable to move. Crating her was totally useless, it only increased the risk of injury. Many people said that "if she were a child she would be diagnosed with ADHD (attention deficit hyperactivity disorder)" and there was a lot of truth in that. She became calmer and better able to control herself during the summer of 2012. It was a very gradual process, so it was more a situation where there were specific incidences where she was suddenly calm and controlled when at earlier times she would have been completely unable to controll herself. I find it hard to say when this started because, again, onset was very gradual. I think probably first signs became apparent in autum or winter 2010 but it may have been later than that in 2011.
  • Another problem was that Laika started to "panic". She would get full blown "panic attacks" with racing heart, panting and so on when all she really wanted was to be picked up, cradled in my arms and carried to safety (not an easy task with a ≈30kg/65lbs dog!). Usually it was other dogs that would throw her into full blown panic. Especially if she has had negative experiences with those dogs. I recall taking her for a walk and there were two Kuvasz-Golden Retrievers and she was so panicky and running around like a "headless-chicken" barking frantically, coming to me for safety but feeling I could not give her the safety she wanted (she was too heavy for me to pick up!) and start running away, totally out of control. At that point Henna would just stand there and watch and not really understand what was going on. However, she noticed that if she would run with Laika, Laika would only get more frightend if that was at all possible. So she would just stand there and watch and try to keep herself between Laika and whatever Laika was frightend of. Some people would get frightnd of Laika in those situations, but surprisingly the vast majority of people could see she was terrified. These problems started as far as I can tell in 2011, but I think it was building up to that. She had been very easily scared of other dogs long before that and that was so apparent that she was frequently bullied by other dogs which made her more afraid and so this was a viscious cycle she got into. This problem only dissappeared within the first two or three weeks of the increased dose of thyroxine, so around late October/early November 2012. In November 2012 I caught her calmly standing up to a neighbours dog who had bullied her previously and this time she just stood there as if to say "so what do you want?". I think that neighbours dog was quite puzzled by that sitution! One neighbour even asked me if I had a holiday guest because her demeanor was so transformed from what the neighbours were used to. No "rescue remedy" or homeopathic globuli or DAP collars or anything helped. (I refused to consider 'real' sedatives or pharmacological treatment for that, the "triggers" were predictable and could be avoided. She would even feel much safer if she had the opportunity to press herself against my legs and "hide" behind Henna, who was more than willing to protect Laika against any real or imagined threat. So the result was I would avoid taking her for walks without Henna and she was doing just okay this way.)
  • In early 2012 I started to notice she was dragging her feet constantly. It was almost as if her feet were too heavy for her. She would have very worn toe nails on the outer side of the foot because she was always dragging her feet. This dissappeared in April 2012.
  • She developed problems with dandruff around her season. Originally I thought this was just a result of the hormonal changes of estrus, but after starting treatment for hypothyroidism she has no longer had this problem. So possibly there is a connection and possibly not. She never developed itching, raw skin or any sort of skin infection whatsoever. It was more of a "cosmetic problem" than anything else. Started her spring/summer season 2010 and was gone for the spring/summer season 2012.
  • I think the only roundworm egg in the whole of southern Denmark and northern Germany found its way into my Laika. I think she had roundworm infections (including diarrhea, worms in her stools, flatulence, mild bloating of the intestine and colon and accordingly a "stomach ache") every months or at least every other month. At the same time Henna would be just fine with no care at all. All the "home remedies" like herbs, garlic and stuff were entirely useless in this situation. I reverted to giving only Laika worming-medication and not Henna, because it seemed unnecessary to worm a dog every month who had no problems. I wormed her 3 times a year or so "just in case", but that was about it. This problem started in early 2011 or maybe even late 2010. Her last severe worm infection was in Febuary 2012. In fact - at that time she had tape worm on top of round worms. I could see it in her feces, because there were tape worm cysts in it. (I still follow my dog every times she has a bowel movement to check if there are any early signs of worms.... so far, so good....)
  • In 2009, I think around the summer of 2009, Laika started to have problems with the pads of her feet. Not only would she easily tear them, but they healed very slowly. In 2011 she used to have cuts on her feet that would not heal for weeks and weeks no matter what I did or did not do. In the spring of 2012 she had raw spots on her hind feet, her knuckles and her hocks and it would not heal. With a lot of patience, a model patient and Zinc-Gel it finally healed after what felt like an eternity. This problem only dissappeared in late 2012. I think I noticed in November that suddenly I could take her cycling and her feet were just fine. I had always assumed she just had "sensitive feet", but apparently that was not the whole story. There is one photo where her raw foot can actually be seen where she is lying around dozing. The foto was taken in October 2012. 
  • Oddly enough in the summer of 2011 Laika started to loose pigment of her nose, rims of her eyes, gums and lips. The nose develoepd a colour similar to what would be expected in a badly pigmented blue doberman. Not the "winter nose" one sees in Labrador or Golden Retrievers, but a very odd greyish-bluish pigment of the nose and skin coloured pigment of the eyes and lips. I noticed in the summer this improved, thought it was just the season, but the pigment has stayed good ever since, even now it clearly is winter and not summer anymore and her nose remains black.
  • The last seasons Laika had in 2010-early 2012 were very light. She had always been in tune with Henna's seasons. But then suddenly she would be two months later than Henna (oh joy - having two slightly 'hormone crazy' females at the same time is no fun, but having one after the other is not presicely desirable either, trust me!). The summer seasons was "normal" in most ways. I am now waiting for her winter season. We will see if this will normalise.
  • In 2011, I think the summer of 2011, Laika developed problems with constipation. She had very loose stools, but only very irregular. Something like every three or four days. Which is unusual for her. She was always regular once every day. The vet said not to worry and it did not seem to bother her much. So I never paid it much attention. But I noticed that since the summer of 2012 she is much more regular and on top of that has firm and well formed stools with the identical type of food.
  • In January 2012 Laika developed very odd neurological symptoms something like every two or three weeks. She would have twitches in the legs on one side of her body (usually the right) sometimes so badly she would stumble and fall when walking. She also had times where she was completely "mentally absent". Standing, looking into space and not reacting when addressed, not reacting to food (usually Laika will react to that, especially if it is fish or cucumber and she is not expected to work for it), not reacting to touch and then suddenly "snapping out of it" and she was just fine. She would also sometimes doze of and wake up and see her legs twitching. The look she gave her legs suggested she was very puzzled by that. I have not seen this since April 2012. It was never severe, never caused her any discomfort as far as I can tell, but it made me wonder what was going on quite a bit, especially since I also own a Belgian Shepherd...
  • If her DCM (dilative cardiomyopathy) has anything to do with the hypothyroidism I do not know. We never did a 24-hour holter exam, so I have no idea if there were any arhythmias or the like. The 20-30 minute "normal" ECG was normal (except at the point where the electrode fell off). I think only time will tell if her heart disease can be slowed in progression with the help of medication including thyroxine (and, to be honest, she has already survived the rather conservative estimated maximum survival time with the stage of her heart disease I had been given). Hoping against all odds for her "healing" from heart disease is probably like praying for a miracle. As much as I would love her to live to the ripe old age of 12 years or more I am a realistic person and simply do not believe this is going to happen. I treat her with thyroxin for today and tomorrow and the quality of life it gives her. I do not believe it will significantly change the quantity of life she has left. However, only time will tell what will happen.

 

Maybe the conclusion of this section has to be the autopsy report that also specifically examined her thyroid. On autopsy the right half of her thyroid was no longer present. The left half was significantly atrophied. The veterinary pathologist confirmed what we had suspected by negative antibody tests. The changes indicate an "idiopathic thyroid atrophy". Thus this was no autoimmune disease. To her death Laika did well on thyroxine substitution, even though it had to be continually adapted. 

 

I think this is probably the place to thank a few medical profressionals who have guided us on the path towards quality of life over the last two years or so:

First of all many heart-felt thanks go to our vet in Duisburg for her thoughtful suggestions and advice on Laika's treatment and for believing me that it wasn't just me being "hysterical" when I said Laika cannot tolerate the medication she received and for testing her thyroid on top of everything else. Many thanks for everything. 

My thanks to the cardiologist, who suggested I review her thyroxine dosage to make sure she really is getting enough of that and the young holiday-replacement who happend to be filling in for my ordinary vet and just went along with all my suggestions and ideas and had some input of her own.

Many, many thanks to Dr Jean Dodds of Hemopet, Garden Grove, California, USA, for all the references to professional publications, information and advice she has provided. She opened my eyes to some things I might otherwise have missed.

With what I learned and with the assistance of my vets in Germany and Jean Dodds I may at worst not have added days to Laika's life, but I most certainly have added life to the days she has left with me on this earth. Laika lives for today and does not care too much about tomorrow. I built memories of the 'today' we have together, the joy, the energy, the silliness in her for the day when she will no longer be by my side. Now the day has come, that our paths on this earth at least have parted. And even being self critical I can still say that with what I did I did "the right thing".

Also my deepest gratitude to Laika's breeder for everything and for everyone who has supported me so far - you probably know who you are. 

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