Remy is a puzzle. At a little over 2 years old, he became the opposite of your typical dobe. Up till then he was textbook: completely mental, every walk at 100mph, the standard pattern on our countryside walks being Opi running off and him chasing, then her coming back to check in and him chasing, and repeat. Never a hint of a sensible pace. At a little over 2 years old, it just stopped. He started to walk, then plod. He gained weight; he got horribly cold intolerant (he does have alopecia, true, but it was not bad at this point).
We had his thyroid tested twice, after a lot of insistence; nothing (although the tests were utterly substandard, as I now know, and the vet a moron). I moved up here not long afterwards and had his heart ECGd; normal. This was a precaution - if you've read Soli's obituary then you'll understand. If you haven't, you own a dobe and you've not heard of DCM, I suggest you have a read.
I digress. In March 2008, he was finally diagnosed as being ever so slightly hypothyroid. He went on meds. Over the next few years, his dose was increased twice; then reduced earlier this year. His symptoms never wavered with the exception of his lethargy - it just got worse. By last autumn, he was regularly walking 50-100ft behind me at a snail's pace, clearly tired and even panting (Remy doesn't pant. Ever.).
His heart was scanned properly in July last year - the same day that Soli's DCM was diagnosed and the first hints of Paige's future DCM were revealed. His heart, though, was picture-perfect.
In November last year, I had him referred to try and pin down the cause of the lethargy, if it wasn't his thyroid. Mild bronchitis was found, and treated; the panting stopped, as did a very infrequent cough that was so infrequent I thought it was hair in his throat from chews! But, the lethargy continued.
I decided it was time for another full panel a la Dodds; the vets here tend to just test T4 which is wholly inadequate for a proper diagnosis, and many can't interpret the results properly. On top of that, Dr Dodds has breed-specific reference ranges and within that, age, sex, weight and neuter status references as well.
I finally managed it last week - oh boy, the fun we have now!
To reiterate: Remy's symptoms have still not improved. Worsened if anything; he now has hair loss going on on his ears, which are not typically affected by his brand of alopecia, he is more cold intolerant than ever, and the lethargy is still slowly getting worse.
So imagine everyone's shock when his result comes in as severely hypERthyroid - huge overdosing of soloxine! Dose must be reduced immediately, as his T4 level was exactly double the maximum healthy figure. Double. And him, clinically hypOthyroid in every way. Perplexing! Back in August a vet described him as being clearly poorly medicated, and brachycardic (slow heart rate) - hypO. When my vet examined him Monday just gone, she said he wasn't brachycardic (but did allow that this was not a surprise, as he was not only at the vets but had been trying to play with every dog in the waiting room...) but he was just normal - not the racing heart one would expect from such a result.
The notes on the report were minimal; stating the numbers, reduce the dose as follows, not much more. No mention of the A4 page of notes I'd sent with the samples, so I emailed Dr Dodds (she'd been away on business, so the report was done by another vet). She reiterated: the dose must be reduced.
Possibilities for his persistant symptoms were thus: a) his body was trying to excrete the T4 rapidly to prevent toxicosis, and thus he was not getting the benefit of the hormone and so was presenting as underactive; or b) he has a thyroxine-secreting tumour in his neck or chest. Both feasible, although I do wonder about (a) when his symptoms have never improved even at a lower dose.
In any case, her suggestion was to lower the dose as per the report, but add a small dose of T3 (the active hormone that the dog's body actually uses (and ours) - T4 being the inactive form). My vet is currently sourcing that and discussing with Dr Dodds about the case. He'll be retested in the new year.
Should that not work then the mystery will continue, but other options have been suggested to me; a) a pituitary tumour. Not common but not unheard of; and such could easily interfere with the thyroid feedback system, skewing the results. Or b) Plechner's Syndrome. I am still reading up on this but the general gist is a breakdown in the adrenal system; poor feedback, low (or possibly high) cortisol production which would directly interfere with thyroid hormone use by the body, if it is anything like it is in humans (and everything I've read suggests it is) - adrenal fatigue in humans is a nightmare for mucking up the thyroid, whether directly on the gland itself or indirectly by preventing the body being able to use the hormones. It can skew results very easily. Or c), he simply is not doing well on soloxine and could try a different brand - not unheard of. A lot of people don't do well on thyroxine only, regardless of brand so I am keeping that in mind as option d), although the T3 being added should highlight that as a possibility.
Credit where credit's due though, I mentioned it to my vet who immediately had me write it down and is looking into it as a possibility, along with the other things suggested, although I did neglect to mention the soloxine query.
So for the moment I wait. He is on the first lowered dose - down by 0.2mg per day for two weeks, then down by another 0.1mg per day from then on, and the T3 added once it's been organised. He continues oblivious of the fuss he causes, showing off his jammies at the park and peeing on things he shouldn't pee on (this week, a cover for an expensive piece of equipment at the vet, and a gravel bag at a construction area at the park).
Updates to follow as and when the plot twists!
In the meantime, a demonstration that we have at least beaten the weight problem for the most part (well, 'beaten' is not the right word as it is a constant struggle to keep it down, but we have shifted most of the weight he put on after he hurt himself being an idiot in 2006 and took 6 months to heal).
The top photo was him in Summer 2007, at his heaviest of 42kg (he was actually heavier than Soli at her biggest at the same time - and she was a bigger dog than him in structure!). The bottom was him in October this year, a much leaner 32kg - just 1kg off his goal. He is now 33kg, a timely reminder of the ongoing fight I have on my hands to keep him lean. Just a tiny lapse and wumph! On it goes...
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