Cushing's and/or hypothyroidism 10 months after IMHA Dx? Really?

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Cushing's and/or hypothyroidism 10 months after IMHA Dx? Really?

Claire

Guest

I’ve been on the IMHA/AIHA roller coaster for 10 months (Dx in March 2017) with my 6 year old, 50-lb Springer Spaniel, Nala. After a blood transfusion and a horrible experience with mycophenolate and cyclosporin in April (GI complications and opportunistic fungal infection with paw lesions!), we got her stabilized on a prednisone & azathioprine treatment and were able to get her PCV up to 36% in August at which time we started to wean her off of the prednisone. About a month ago, at a dosage of 5mg per day, she got up to 38%.

Then, coincident with a prednisone reduction to 5mg EOD (2 weeks later) , her hair started to fall out, her skin started getting flaky and her PCV went down 2 points to 36%. I took her back to the vet today for a T4/free test and they educated me on the possibility of iatrogenic Cushing’s disease. The T4 test results will come back tomorrow and we will try to figure out what is going on with her now.

I’m curious to know how she could develop hyperadrenocorticism on only 5mg of prednisone EOD? She was on a very high dose (30mg BID) for at least 5 months. The vet says that we should reduce her prednisone to 5mg twice a week and her azathioprine (50mg) to twice a week. Why not just withhold the prednisone immediately?

She’s such a fighter. She acts “normal” except for her energy level. Also encouraging is that she regained the 10 lbs that she lost during the mycophenolate/cyclosporine fiasco. I thought that we were seeing the light at the end of the tunnel, but I fear that this nightmare will never end.

Any encouraging words for us?

Details

Vally

Keymaster

Hi Claire, I’m sorry you’re still on the ride.

Has Nala ever been on thyroid medication? I am by no means an expert but it seems odd to me that on a REDUCTION, her hair and skin issues arise. If it was happening whilst on the pred, I’d say, yes, a side effect.

I think the thyroid test is very important and in fact if it were me, I’d get a copy of the blood test results and send them to Dr Jean Dodds. She is an expert in this disease and in particular the thyroid. Her protocol for treating AIHA is to actually use thyroid medication in all cases.

Hair and skin issues really do sound like thyroid issues and it’s possible that with medication, Nala will respond much better.

The reduction of prednisone and azathioprine, I would not do at the same time. Having been on the drugs for a while now, its possible she’s a bit suppressed and that may be holding her back, so the reduction may in fact help. However, only one drug at time. I would also err on the side of caution and not just withhold immediately. The reduction from every other day to twice a week is safer.

Regards, Vally, Angel Bingo and the new pest, Saba

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Vally

Keymaster

Here’s the link to Dr Dodd’s Hemopet. The second item is an owner’s consultation if you’d like to go that way.

https://www.secondchanceaihadogs.com/hemopetresources/

Vally

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Claire

Guest

Nala has never been on thyroid medication. The vet technician called with the T4 test results and they are NORMAL. Now, I’m really confused! Could it be Cushing’s Disease? I will call the vet tomorrow am and if I don’t get anywhere with that, I will consider the consultation with Dr. Dodds.

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Vally

Keymaster

Claire, the prednisone will skew the thyroid test results, but I’m sure the technicians know that. Nala may have a case of Iarogenic Cushings, which is prednisone induced. See this:

https://www.secondchanceaihadogs.com/AIHA_Terms/iatrogenic-cushings-disease/

Regards, Vally

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Claire

Guest

Just to follow up…it seems that I was freaking out unnecessarily (thankfully, as well). Nala hasn’t been groomed since she came down with IMHA 11 months ago. We used to cut her coat down very closely every 8 weeks (we live in south Florida). While she was on prednisone and azathioprine for the last 9 months, her hair stopped growing. I could tell because she was still bare on her tummy where they did an ultrasound and on her forelegs where the IV catheters for her transfusion and fluids were inserted back in February 2017. When we got her prednisone dosage down to every other day (last month), apparently her hair started growing again and she started shedding like mad. So she doesn’t have iatrogenic Cushing’s disease and she (should) be off prednisone next week. I am so relieved!

We will say a prayer for all the pets and pet parents who are going through this terrible ordeal…