Endocrine Case Report

Case Description, History and Exam

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a 13 yr F/S DSH weighing 7.7lbs (3.5kg) that presented for an annual exam in October 2010.  The previous year’s exam revealed a cat that weighed 7.8 lbs (3.55kg) and no other complaints, or none that was presented by the owner as being significant.  The abnormalities on the 2009 exam were mild tartar and gingivitis and a dull and matted fur coat.  This year the owner claimed that the pet developed polydipsia and polyphagia sometime within the last calendar year.  Upon further questioning the owner disclaimed that the cat’s activity level did not coincide with the pet’s age of 13.  However, the owners felt that the cat slept an adequate amount and was not overtly hyperactive.  This year’s examination revealed a slight weight loss despite an increased appetite, tartar and mild gingivitis that was unchanged from the previous year’s examination, a fur coat that was unkempt and slightly oily, a body condition score of 2/5 and an audible heart murmur that was not ausculted earlier.  No thyroid nodule was evident.  Upon resting, the pet had a loud pur.      

An Eastern examination revealed that the pet’s tongue was red and the pulses were superficial and rapid indicating heat, as well as the gingivitis present.  Phelegm was present due to the oily fur coat, loud purring and heart murmur.

Various diagnostic options were discussed with the owner as well as treatment plans for differing diseases.  The owner declined all diagnostics as well as empirical treatments:  both Eastern and Western.

Diagnosis:  Western and TCM

A Western diagnosis of undiagnosed hyperthyroidism was presumed even though no diagnostic tests were performed.  The presumption was based upon the polydipsia, polyphagia coupled with weight loss, an audible heart murmur, the abnormal activity level of the pet, and the age of the cat. 

An Eastern Diagnosis of Phlegm and Heat were diagnosed.  The Heat signs that were clinically evident were the continued gingivitis, increased thirst, increased hunger, rapid and superficial pulses and red tongue.  The Phlegm signs were the oily fur coat, loud purring and heart murmur.  Coupled with the Western diagnosis of hyperthyroidism, Amber would be classified as a Phase II hyperthyroid cat in which there is accumulation of phlegm and heat in the triple burner

Herbal Prescription

Regardless of the herbal formula chosen, Pet "P"  was in need of a diet change that does not continue to dampen the overtaxed Spleen and Stomach.  A switch from a manufactured kibble that is high in carbohydrates, which are dampening by nature, to a home-made diet low carbohydrate and high protein is essential to the successful treatment of hyperthyroidism in Eastern medicine.   The appropriate herbal formula for this patient is Wen Dan Tang or the Modified Wen Dan Tang in hopes of ceasing the progression of the disease.  The necessity of clearing Heat, moving Blood, dissolving Phlegm and draining Damp are important in Phase II hyperthyroidism.  These objectives are achieved with Wen Dan Tang or the Modified Wen Dan Tang as the following illustrates.  Zhu Ru (Bamboo) clears Heat arising from Phlegm accumulation, Huang Lian (Coptis) and Zhi Zi (Gardenia) cools Heart Fire, thus slowing down tachycardia and the subsequent  murmur, Tao Ren (Persica) and Hong Hua (Carthamus) moves stagnant Blood that has arisen secondary to Phlegm accumulation, Gua Lou (Trichosanthes) and Jiang Can (Bombyx) transforms Phlegm accumulation, Mu Li (Oyster shell) contains iodine that can be used for either hypo or hyperthyroidism, Gan Cao (Licourice root) reduces any harmful side effects of the other herbs, Sheng Jiang (Ginger root) warms the middle jiao and helps in digestion and proper functioning of the Spleen and Stomach, and Chen Pi (Citrus peel) and Zhi Ke (Citrus) eliminates Phlegm accumulations.  Therefore, these herbal formulas are appropriate for Pet "P's"  case of undiagnosed Phase II hyperthyroidism. 

Conclusion

It is unclear from the previous yearly examinations when the pet started to exhibit the Phase I hyperthyroid signs of dampness manifested as abdominal distension, vomiting after meals with a slimy consistency to the vomitus, changes in thirst and appetite, weight gain, lethargy, mucus in the stool, and watery urine.  The environment in which the cat lives in is mainly damp and humid year round, so this benchmark cannot be included in clinical signs and observations.   The undiagnosed Phase I hyperthyroidism misdiagnosis is most likely a consequence of inappropriate questions asked during previous examinations and nondisclosure of perceived “normal” behavior for a geriatric cat from the owner.  Pet "P" is now a Phase II hyperthyroid, geriatric feline that could be helped with a diet change and an herbal formula.