Low T4 - Cause for Concern?

spac

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I am being helped on another cat forum, but I kind of need a second opinion here. My vet is useless, as usual.

My cat has what appears to be kidney issues based on his most recent lab work. I worry he has cancer though and so does the vet. He needs to get more lab tests done and I want to keep the costs low without sacrificing his health. His labs showed low T4.

Does that need to be retested or can it be assumed that it's probably normal, but something else is going on affecting it? What I mean is that maybe if we can figure out what's wrong with him and treat him, maybe the T4 levels will return to normal. I hope that made sense.

Basically, does the low T4 need to be tested and treated with medication, or is it more important just to figure out what's throwing off the other test results.

He has proteinuria, that's the big thing. The other stuff was borderline low potassium and borderline high BUN. I forget the other thing, but it was something off in the urinalysis, not an infection though. Something related to the kidneys, like proteinuria.
 

FeebysOwner

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Hi. How old is your cat? He isn't being treated for hyperthyroidism is he? How low is his T4? A low T4 can happen if the med dosage for hyperthyroidsm is too high. If not that, then testing him for hypothryoidism might be a wise idea. I know when treating for the former (hyper) and the T4 is lowered it can unmask kidney issues since the hormone that is over-produced is reduced and can decrease kidney function. So, if the T4 is too low from either hypothyroidism (or for another reason), it would seem it could have a similar effect on kidney function. One of the biggest indicators of kidney disease is creatinine - what is his reading for this element?

I think in your case, there is an underlying illness - either kidney or something else altogether - that is causing the low T4 reading. That is - if your cat is sick, T4 levels can be “falsely” low just from the sickness itself. The proteinuria is probably related to that underlying illness. Have you read up on proteinuria? If not, I've included a link below, which contains the following information:
"Proteinuria can occur for a variety of reasons other than serious kidney disease. In fact, bleeding or inflammation in the urinary system is a far more common cause of proteinuria. In these cases, the bladder and lower urinary passage (the urethra) are usually involved, but the prostate gland (in males), or vagina (in females) may also contribute."
Urine Protein | VCA Animal Hospital (vcahospitals.com)
 
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spac

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Thanks for the help.

He is not on any medication. He recently turned 7.

He had a Total T4 test. I believe anything below 0.7 would be considered low T4, and his was 0.4.

Any suggestions on what tests he should have? It's been 2.5 months since his last lab work. I cannot get any helpful answers from the vet. There's a vet and vet tech shortage in this area and they're all overworked. I feel like I'm left on my own. :bawling:

It would seem like the urine protein:creatinine ratio test would be most important.

I don't know if I should just get a full panel or not. Full being chem 25, CBC, Total T4, Free T4, urinalysis with protein:creatinine ratio test. That would run close to $300. I just spent $200 2.5 months ago for his lab work. I suspect he's going to need an ultrasound too.

Or maybe I should get the urinalysis with a culture plus the protein:creatinine ratio test. There was no indication of any infection on his last urinalysis or CBC though.
 

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So, all the testing he had was done was 2.5 months ago? In that testing, The Chem profile should have included a reading for creatinine - do you know what that number was? It is one of the numbers typically used to help determine if there is kidney issues, but can sometimes be skewed by infections anywhere in the body, as I understand it. It is also important for you to know the other reading in the urinalysis that was 'off'. Your vet should provide you (for free) copies of all the tests that were run - I always have my vet email them to me. You probably should get a copy of the tests and familiarize yourself with them.

I think the protein/creatinine ratio is an independent test, so you could ask the vet about that, assuming you can get someone to respond to you. I am also including a document that discusses the testing just so you are armed with knowledge about it.

The urinalysis you had done last should have also indicated if there was blood found in the urine, as well as WBC/RBCs - which from what I know is probably more pertinent than those same counts recorded in the CBC.

I am not sure what other tests would be applicable at this point, and whether a complete retest of CBC/Chem would be required. I do know - in the document I originally provided you - that his blood pressure should be checked as well. That is sometimes a tough one because not all vets carry the equipment that is needed. It is similar to what humans have done with a blood pressure cuff, but obviously customized for cats/pets.

Urine Protein:Creatinine Ratios | VCA Animal Hospital (vcahospitals.com)
 

fionasmom

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I am sorry that you are facing these issues and am concerned that your vet is useless. Do you have the option for another vet not in the same practice, or possibly a cat only (not just cat friendly) vet? It seems as if you are working very hard at trying to diagnose and figure all of this out yourself.
 
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spac

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The creatinine was about 1.7, anything over 2.3 is high. Potassium was borderline low, but normal. Phos was not tested. Everything else in the chemistry was normal, except the BUN was borderline high, just a tad over.

SDMA, ProBNP, Spec fPL were all normal, but the SDMA was borderline high.

Urinalysis:
Specific Gravity was 1.045
pH was 7
Both the white and red blood cells were 0-2.
No bacteria.
Protein was 2+ (subsequent home tests with a dipstick also indicated this)

The CBC was normal, but I do worry that he's going to become anemic soon.

Blood pressure was normal. I think they said they used the blood pressure monitor they use for surgeries, not the portable thing that goes around the tail.
 

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Creatinine is actually pretty good! Also, good on the BP. Urine counts look pretty good too other than the protein. And, BUN can be impacted by food/stress, so it usually is not an indicator all by itself of kidney disease. If the CBC shows numbers that concern you about anemia - remember the bleeding aspect of Proteinuria - not related to kidney disease.

Did they test him for diabetes? What about infectious diseases? From a strictly layperson's perspective, you might be looking at an ultrasound. What have you concluded so far?

I do agree with fionasmom fionasmom about seeing if you can find another vet. Or, perhaps your vet would be willing to consult with either an internist or maybe even a urologist?
 
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spac

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Thanks for your help.

His blood glucose has been normal. I tested him at home several times as I used to have a diabetic cat and still have a glucometer.

He did have glucose in his urine though. So he has protein and glucose in his urine, but no signs of diabetes.

Should I just focus on doing another urinalysis with the protein:creatinine ratio test?

The vet did actually call the lab to ask about the test results. The doctor at the lab is supposedly an internal medicine vet and he didn't have any answers. So if the specialist is clueless, you can understand why I am upset, worried, and frustrated.
 

FeebysOwner

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Glucose in urine can also be from stress. Did the internal medicine vet or your vet say anything about another urinalysis just to see if the last one might have been a fluke? Did you mention anything to the vet about the protein/creatinine ratio testing?
You might want to find out the parameters (requirements/limitations) and cost of this test before you decide.

As far as the urinalysis, I guess you could look at it from the standpoint that doing it again might show better results than the last test - or, it might help you to light a fire under your vet's a$$ if the results are similar or worse than before.

How is his eating/drinking/litter box use?
 
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spac

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A follow-up urine dipstick test at home showed the same results.


His eating habits have changed. He wasn't eating enough dry food to maintain his weight, so I started feeding him canned food. He usually eats that ok. But, he doesn't eat it as well as he used to. His potassium was borderline low, and I know that can affect the appetite.

I keep insisting there is something bothering him in his mouth. He's doing something weird that I can't describe. Usually cats with dental problems or oral cancers do this. The vet could not find anything abnormal in his mouth. But, he was not sedated so they didn't check under his tongue or do a thorough inspection. If it's a cancer, it could be in the back of his mouth or throat where they can't see. That's what happened to one of my cat's a few years ago. That's why I think this may ultimately be cancer. I'm more or less seeing the same thing as far as behavior goes.

I have other cats so I don't know if he's using the litter box normally. I can say that his time of day he uses it has changed. He would always use it right after I cleaned it out at night, now he doesn't.

He doesn't act quite right either. He's usually a very happy, perky, extra nosy, friendly, little fella. Now he just acts just as blah like all the other cats.
 

FeebysOwner

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Again, I am just a layperson, but I cannot imagine that it would be mouth/throat cancer. And, if it were, then you would have to believe your cat (what's his name?) has numerous health issues going on at once, given the proteinuria - which to me would have nothing to do with his mouth. I would be leaning more toward a dental issue. You can try to get a video of what he is doing and not only share it here on this site, but send it to your vet to take a look at as well.

If your vet is sitting on their hands and not being proactive in trying to pursue what could be wrong with your cat, you really, really need to see what you can do to find another vet. If it is not the case, and is more related to your vet wanting to run tests that concern you cost-wise, perhaps you should just go for the tests they want to do if you can afford it. This has gone on for over 2 months and if there is truly something seriously wrong, you can assume it is progressing.

Otherwise, getting a copy of all your cat's records would go a long way in reducing redundant costs by sharing them a new vet. I know you said there is a shortage in your area, but perhaps - depending on where you live - you could solicit cat loving neighbors through the Next Door Neighbor web site for recommendations on where they take their pets. Or, ask friends/family/co-workers, and even just talk to your neighbors. Go through local rescue centers/shelters looking for vets to contact.

The other thing to consider, if you think your cat's situation is stumping an internal medicine vet is to ask for them consult with a nearby vet university, who deals with many unusual cases that vets may never see in their practice.

What does this other cat forum tell you?
 
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spac

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Thanks.

I more or less got things straightened out with the vet. We have an appointment for Monday morning.

But they're now thinking that maybe this has something to do with chronic stress - in the home. I said there had been some changes in the house and my routine and now they think that could be the cause. :confused2:

I used to have a cat that got so stressed out when I carried her into a particular room, that she started peeing blood. Then she started peeing on the floor and bed for weeks. We tried antibiotics and it didn't help. I ended up locking her in my office with a litter box and that solved everything. She had no interest in leaving the room. I'd leave the door open during the day and she refused to leave. But, she was an older cat almost 16 y/o and was losing her senses.

I wish stress was the cause in this case as that's probably easier to deal with than kidney disease or cancer. But I have my doubts.
 

FeebysOwner

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I didn't realize that you have had changes in the house and your routine - don't recall reading that in your posts. So, sure that can come into play, no doubt. However, I think that is a stretch to say it is causing proteinuria (what do I know?). Please ask (for me, if not for yourself) how stress can result in proteinuria. I would love to know. Keep us posted.
 

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I am a easily confused.
The original question is about T4.
However it seems Kitty may possibly be experiencing the onset of kidney problems.
Kitty's SDMA is borderline high.
SDMA is a newer development in diagnosing kidney problems early in development.
There is an IDEXX kit that includes T4 and SDMA.
Could this, plus the urinalysis get the information you are looking for on his follow up visit?

==== cut and pasted sections below (see final link)
The Catalyst SDMA Test gives you in-house results with one sample, in one run.
====
SDMA testing from IDEXX Reference Laboratories
IDEXX Reference Laboratories includes the IDEXX SDMA Test in all routine chemistry panels. There’s no additional cost and the turnaround time is the same.
====
Order SDMA - IDEXX US
 
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