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Sent to August 31, 2006 8:15 a.m.

My 12 year old cat was just diagnosed w/ hyperthyroidism. Prior to his radiation treatment body x-rays were performed. The x-rays showed and enlarged spleen and heart.
An ultra sound was performed and the findings are as follows: there is LV concentric hypertrophy w/ papillary hypertrophy. There is mitral & tricupisid regurgitation. The tricupsid regurgitant velociy is increased at 3:22 m/sec which equates to a pressure gradient of 41 mmHg. There is turflow in the aorta w/out an increase in aortic velocity. The mitral inflow varied between a single peak and a dual peak w/ a small A wave. There is mild to moderate pleural effusion. Biatrail enlargement is also present. No cranial mediastinal mass was noted. No left atrial smoke or thrombus formation was noted. A brief abdominal ultrasound was performed. Splenomegaly was noted. There are bilateral renal hyperechoic regions compatiable w/ regions of fibrosis.
Ultrasonogragrapgic Impressions: 1) LV concentric hypertrophy. DDX: HCM, hyperthyroidism, vs. hypertention. No SAM noted. 2) Bialateral enlargement w/ pleural effusion. Heart failure is suspected. 3) mild pulmonary hypertention thought to be due to left heart failure. 4) splenomegaly. Infiltrative disease should be ruled out. 4) bilateral renal infaracts. Fluid Cytology: 1) fine needle aspirate from spleen description: fifteen slides are submitted. The sample submitted has low to moderate cellularity. The sample is hemoduliluted and platelet clumps are observed. There are few aggregates of splenic stroma. Prediminant cells seen on these slides are small lymphocytes. A few prolymphocytes and occasional lymphobiasts are obeserved. There are also moderate numbers of nondegenerate neutrophils. A few macrophages and eosinphilis are present. Scattered nucleated erthyroid precursors are observed. There are a few rupted cells that consist of swollen chromatin. These cells cannot be identiefied. Scattered plasma cells are noted. Microscopic Findings: Although the sample is hemodiluted there are areas of moderate cellilarity. The presence of the erthyroid precursors indicates some extramedullary hematopoiesis. There are alos a few plasma cells present which may indicate reactive lymphiod tissue. However, the predominant cells are small lyphocytes w/ fewer numbers of prolyphocytes and lymphoblasts. This is consistent w/ aspration of normal spleen. A few neutrophils, eosinphils and macrophages are alos present. If these findings are inconsistent w/ the clinicl picture, reaspiration or histpathology may provide additional info. Evidence of overt neoplasia is not seen on these slides. Pleural effusion: A direct smear, a concentrated smear and cytospin preparation are examined. Moderate numbers of cells are ruptured and consist of only swollen chromatin. These cells are excluded from the differential. 84% of the nucleated cells seen are small lyphocytes, 14% are macrophages, 1% is eosinphils and 1% is neutroplhis. Some of the macrophages contain a phagocytized basophilic material consistent or suggestive of erthrocyte breakdown product. Afew macrophages demonstrating erthrophagia are identified.
Microscopic findings: modified transudate:
Due to the cellularity and protein content of this fluid, it is classified as modified transudate. Cause of modified transudates include cardiac insufficiency, cardiomyopathy, vascula inslts or injury and inflammation or tosion of an organ anong others. A prediminance of the small lyphocytes may suggest a chylous effusion to determine if this fluid is chylous or not. Acholertrol to triglyceride ration can be performed on this fluid. A cholestrol to trigyceride ratio of less that 1 is consistent w/ a chylous effusion. Chylou8s effusions can be seen secondary to rupture or obstruction of lymphatic vessels and can be assoiciated w/ neoplasia and trauma among other causes. The prodiminant lyphcytes are small and appear mature and well differentiated. A small cell lyphoma cannot be completely ruled out. If ther is clinical concern for a small cell lymphoma, flow cytometry is recommended. This may help to characterize these cells as a monciona. or piolcional population. The erthocyte breakdoen material present w/in some of the macrophges indicates mild previous hemorrhage.
After all of that Caleb is on methmazole; enalapril; and furosemide.
What do you think?

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Sent September 01, 2006 5:48 a.m. (21 hours and 32 minutes later)

Relist: No answer yet.

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Answer
September 01, 2006 7:19 a.m. (1 hour and 31 minutes later)

Hi,

I am glad you posted your case on Just Answer and am sorry you and your cat are going through this difficult time. Hyperthyroidism is a common disease in middle age to older cats. It can cause the changes you described above in the heart.

In a nutshell, your cat has some serious, but still treatable changes to the ability of his heart to push blood forward in the normal direction since the muscle's ability to contract has been altered. Cardiomyopathy is a thickening of the heart wall which changes the strength of contraction. That is why there is a buildup of fluid in the thoracic cavity (lungs).

For hyperthyroidism, the best treatment after radiation is methimazole if he is still hyperthyroid. I'm making an assumption that his levels were checked post-radiation and the dosage was based upon the thyroid levels. Enalapril is used commonly to treat early heart failure and furosemide is used to get rid of the excess fluid in the lungs. All of that sounds appropriate.

What I didn't hear in your description was if your vet checked your cat for hypertension (high blood pressure). He/she can do this in house. All cats with hyperthyroidism and cardiac issues should be regularly monitored and if the BP is up, other meds may be indicated.

I hope this is helful. Please let me know if you need more information.

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lboyer

Reply to Dr. Lisa Boyer
Sent September 01, 2006 7:27 a.m. (8 minutes and 2 seconds later)

I already know this. What you gave me is very basic. I was certainly looking for a more indepth analysis.

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Answer
September 01, 2006 7:35 a.m. (7 minutes and 35 seconds later)

OK -- I can help you with that. I wasn't sure based upon your question what you wanted. What specifically would you like to know? Do you want a review of the mechanisms behind the disease or how the medications act to treat this?

I am able to help you, I just need to know what type of information you would like. If you want me to interpret the test results for you line by line, I can do that too.

Edited by lboyer on September 1 2006 at 7:35am

__________________
I share your concerns and am glad you have sought out help. I strive to provide you with excellent service. If this information has been helpful to you, please Accept! Bonuses are ALWAYS APPRECIATED.

lboyer

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