Bilateral femoral capital physeal fractures in an adult cat
                    with suspected congenital primary hypothyroidism

Marius Diehm; Ricarda Dening; Peter Dziallas; Peter Wohlsein; Marion Schmicke; Reinhard Mischke

doi:10.1055/a-0806-8986

Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere, Table of Contents

Tierarztl Prax Ausg K Kleintiere Heimtiere 2019; 47(01): 48-54
DOI: 10.1055/a-0806-8986

Case Report

Bilateral femoral capital physeal fractures in an adult cat with suspected congenital primary hypothyroidism

Beidseitige Fraktur der proximalen Epiphysenfuge des Femurs bei einer adulten Katze infolge einer vermutlich angeborenen primären Hypothyreose

Marius Diehm

¹Small Animal Clinic, University of Veterinary Medicine Hannover, Germany

,

Ricarda Dening

¹Small Animal Clinic, University of Veterinary Medicine Hannover, Germany

,

Peter Dziallas

¹Small Animal Clinic, University of Veterinary Medicine Hannover, Germany

,

Peter Wohlsein

²Department for Pathology, University of Veterinary Medicine Hannover, Germany

,

Marion Schmicke

³Endocrinology Laboratory, Clinic for Cattle, University of Veterinary Medicine Hannover, Germany

,

Reinhard Mischke

¹Small Animal Clinic, University of Veterinary Medicine Hannover, Germany

› Author Affiliations

Abstract

A 4-year-old, neutered male European shorthair was presented for evaluation of right hind limb lameness. Radiographs revealed bilateral femoral capital physeal fractures, widened vertebral growth plates and constipation. Physical findings included lethargy, mental dullness, mild hypothermia, retarded growth, pharyngeal stridor, moderate muscle atrophy of pelvic limbs, hair coat abnormalities, and lack of defecation and urination. A thyroid panel revealed thyroid hormone values below detection limits and high thyroid stimulation hormone values. A presumptive diagnosis of congenital primary hypothyroidism was made, however also an early onset acquired primary hypothyroidism could not be ruled out. Results of the insulin-like growth factor (IGF-1) and the parathyroid hormone as well as an adrenocorticotropic hormone stimulating test were normal. A bilateral femoral head and neck excision was performed. Levothyroxine supplementation was started at a dosage of 50 µg (11 µg/kg) BID and later adjusted to 100 µg (22 µg/kg) BID based on total thyroxine concentrations. The tomcat showed full clinical recovery and normal clinical behaviour. The case shows that primary hypothyroidism may be considered in cats presented with femoral capital physeal fractures.

Zusammenfassung

Ein 4 Jahre alter, kastrierter Europäisch-Kurzhaar-Kater wurde aufgrund einer Lahmheit der rechten Hintergliedmaße vorgestellt. Die röntgenologische Untersuchung zeigte eine beidseitige Fraktur der proximalen Epiphysenfuge des Femurs, verbreiterte offene Wachstumsfugen der Wirbelkörper und eine Koprostase. In der Allgemeinuntersuchung fielen Lethargie, Abgestumpftheit, geringgradige Hypothermie, Wachstumsverzögerung, pharyngealer Stridor, mittelgradige Muskelatrophie der Hinterextremitäten, Haarkleidveränderungen sowie fehlender Kot- und Urinabsatz auf. Die Konzentration der Schilddrüsenhormone war deutlich erniedrigt, die Thyreotropinkonzentration dagegen erhöht. Es wurde die Verdachtsdiagnose primäre kongenitale Hypothyreose gestellt, wobei differenzialdiagnostisch eine sehr früh vor dem Schluss der Wachstumsfuge erworbene primäre Hypothyreose nicht ausgeschlossen werden konnte. Sowohl der Wert des Insulin-Like Growth Factor (IGF-1) als auch die Parathormonkonzentration lag im Referenzbereich. Der ACTH-Stimulationstest verlief negativ. Es wurde eine bilaterale Femurkopfhalsresektion durchgeführt und eine Therapie mit Levothyroxin eingeleitet. Die initiale Dosis von 50 µg (11 µg/kg) zweimal täglich wurde nach Kontrolle der Thyroxinkonzentration auf 100 µg (22 µg/kg) zweimal täglich erhöht. Die klinischen Symptome des Katers bildeten sich unter der Substitutionstherapie vollständig zurück. Der Fall zeigt, dass bei Katzen mit Fraktur der proximalen Femurepiphysenfuge eine primäre Hypothyreose als Ursache berücksichtigt werden muss.

Key words

Femur - feline - thyroid gland - thyroxine - TSH

Schlüsselwörter

Oberschenkelknochen - felin - Schilddrüse - Thyroxin - TSH

Full Text

References

References
1 Birchard SJ. Thyroidectomy in the cat. Clin Tech Small Anim Pract 2006; 21: 29-33
2 Blois SL, Abrams-Ogg AC, Mitchell C. et al. Use of thyroid scintigraphy and pituitary immunohistochemistry in the diagnosis of spontaneous hypothyroidism in a mature cat. J Feline Med Surg 2010; 12: 156-160
3 Bojanić K, Acke E, Jones BR. Congenital hypothyreoidism of dogs and cats: A review. New Zeal Vet J 2011; 59: 115-122
4 Crowe A. Congenital hypothyroidism in a cat. Can Vet J 2004; 45: 168-170
5 Daminet S. Feline hypothyroidism. In: BSAVA Manual of Canine and Feline Endocrinology. Mooney CT, Peterson ME. eds. 4th ed.. Quedgeley, England: British Small Animal Veterinary Association; 2012: 111-115
6 Daminet S. Feline hypothyroidism. In: Textbook of Veterinary Internal Medicine. Ettinger SJ, Feldman EC, Côté E. eds. St. Louis, USA: Elsevier; 2017: 1743-1747
7 Galgano M, Spalla I, Callegari C. et al. Primary hypothyroidism and thyroid goiter in an adult cat. J Vet Int Med 2014; 28: 682-686
8 Graham P, Refsal K, Nachreiner R. et al. The measurement of feline thyrotropin (TSH) using a commercial canine immunoradio-metric assay (abstract). J Vet Int Med 2000; 14: 342
9 Houlton J, McGlennon N. Castration and physeal closure in the cat. Vet Rec 1992; 131: 466-467
10 Jones B, Gruffydd-Jones T, Sparkes A. et al. Preliminary studies on congenital hypothyroidism in a family of Abyssinian cats. Vet Rec 1992; 131: 145-148
11 Krauß B, Rittmann P, Engelhardt P. et al. Feline kongenitale Hypothyreose. Kleintierprax 2017; 62: 588-599
12 Le Traon G, Burgaud S, Horspool LJ. Pharmacokinetics of total thyroxine in dogs after administration of an oral solution of levothyroxine sodium. J Vet Pharmacol Ther 2008; 31: 95-101
13 Le Traon G, Burgaud S, Horspool LJ. Pharmacokinetics of L-thyroxine after oral administration to healthy cats. Proceedings of the 19th ECVIM-CA congress, Porto, 10–12.09.2009. 209
14 Lieb A, Grooters A, Tyler J. et al. Tetraparesis due to vertebral physeal fracture in an adult dog with congenital hypothyroidism. J Small Anim Pract 1997; 38: 364-367
15 May C, Bennett D, Downham D. Delayed physeal closure associated with castration in cats. J Small Anim Pract 1991; 32: 326-328
16 McNicholas Jr WT, Wilkens BE, Blevins WE. et al. Spontaneous femoral capital physeal fractures in adult cats: 26 cases (1996–2001). J Am Vet Med Assoc 2002; 221: 1731-1736
17 Mellanby RJ, Jeffery ND, Gopal MS. et al. Secondary hypothyroidism following head trauma in a cat. J Feline Med Surg 2005; 7: 135-139
18 Mooney CT, Shiel RE. Canine hypothyreoidism. In: BSAVA Manual of Canine and Feline Endocrinology. Mooney CT, Peterson ME. eds. 4th ed.. Quedgeley, England: British Small Animal Veterinary Association; 2012: 63-85
19 Nykamp SG, Dykes NL, Zarfoss MK. et al. Association of the risk of development of hypothyroidism after iodine 131 treatment with the pretreatment pattern of sodium pertechnetate Tc 99 m uptake in the thyroid gland in cats with hyperthyroidism: 165 cases (1990–2002). J Am Vet Med Assoc 2005; 226: 1671-1675
20 Padgett S. Feline thyroid surgery. Vet Clin North Am Small Anim Pract 2002; 32: 851-859
21 Peterson ME. Feline focus: Diagnostic testing for feline thyroid disease: hypothyroidism. Compend Contin Educ Vet 2013; 35: E1-E6
22 Peterson ME. Primary goitrous hypothyroidism in a young adult domestic longhair cat: diagnosis and treatment monitoring. J Feline Med Surg Open Reports 2015; 1: 1-7
23 Peterson ME, Becker DV. Radioiodine treatment of 524 cats with hyperthyroidism. J Am Vet Med Assoc 1995; 207: 1422-1428
24 Peterson ME, Guterl JN, Nichols R. et al. Evaluation of serum thyroid-stimulating hormone concentration as a diagnostic test for hyperthyroidism in cats. J Vet Intern Med 2015; 29: 1327-1334
25 Quante S, Fracassi F, Gorgas D. et al. Congenital hypothyroidism in a kitten resulting in decreased IGF-I concentration and abnormal liver function tests. J Feline Med Surg 2010; 12: 487-490
26 Queen J, Bennett D, Carmichael S. et al. Femoral neck metaphyseal osteopathy in the cat. Vet Rec 1998; 142: 159-162
27 Rand JS, Levine J, Best SJ. et al. Spontaneous adult-onset hypothyroidism in a cat. J Vet Intern Med 1993; 7: 272-276
28 Saunders HM, Jezyk PK. The radiographic appearance of canine congenital hypothyroidism: Skeletal changes with delayed treatment. Vet Radiol 1991; 32: 171-177
29 Schumm-Draeger PM, Länger F, Caspar G. et al. Spontane Hashimoto-artige Thyreoiditis im Modell der Katze [Spontaneous Hashimoto-like thyroiditis in cats]. Verh Dtsch Ges Pathol 1996; 80: 297-301
30 Scott-Moncrieff JC. Hypothyroidism. In: Textbook of Veterinary Internal Medicine, 7th edn. Ettinger SJ, Feldman EC. eds. St. Louis, Missouri: Saunders; 2010: 1751-1761
31 Scott-Moncrieff JC. Hypothyroidism. In: Canine & Feline Endocrinology, 4th edn.. Feldman EC, Nelson RW, Reuch CE. et al., eds. St. Louis: Elsevier; 2015: 77-135
32 Smith RN. Fusion of ossification centres in the cat. J Small Anim Pract 1969; 10: 523-530
33 Stephan I, Schütt-Mast I. Kongenitale Hypothyreose mit disproportioniertem Zwergwuchs bei einer Katze (Congenital hypothyroidism with disproportional dwarfism in a cat). Kleintierprax 1995; 40: 701-706
34 Szabo SD, Wells KL. What is your diagnosis? Congenital hypothyroidism. J Am Vet Med Assoc 2007; 230: 29-30
35 Traas A, Abbott B, French A. et al. Congenital thyroid hypoplasia and seizures in 2 littermate kittens. J Vet Int Med 2008; 22: 1427-1431
36 Trepanier LA. Applying pharmacokinetics to veterinary clionical practice. Vet Clin Small Anim 2013; 43: 1013-1026
37 van Hoek IM, Vandermeulen E, Peremans K. et al. Thyroid stimulation with recombinant human thyrotropin in healthy cats, cats with non-thyroidal illness and in cats with low serum thyroxin and azotaemia after treatment of hyperthyroidism. J Feline Med Surg 2010; 12: 117-121
38 Wenzel KW, Kirschsieper HE. Aspects of the absorption of oral L-thyroxine in normal man. Metabolism 1977; 26: 1-8
39 Wood M, Panciera D, Berry S. et al. Influence of isoflurane general anesthesia or anesthesia and surgery on thyroid function tests in dogs. J Vet Int Med 2009; 23: 7-15