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Tratamento e prognóstico do hipertiroidismo felino
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Resumo(s)
O hipertiroidismo felino é uma doença endócrina que afeta felinos geriátricos e que afeta
diversos aparelhos e sistemas, dando origem a uma panóplia de sinais clínicos e laboratoriais.
Neste trabalho foram recolhidos dados restrospetivos e prospetivos de 100 gatos
diagnósticados com hipertiroidismo felino na clínica Medivet Greenwich. Este estudo teve
como objetivo analisar: i) a prevalência da idade de diagnóstico, do sexo e da raça dos gatos;
ii) a frequência de demonstração de sinais clínicos e laboratoriais compatíveis com
hipertiroidismo; iii) o tipo de tratamento utilizado; iv) uma possível associação entre o ganho
de peso após o tratamento e a concentração de T4 total; v) a curva de sobrevivência tendo
em conta a idade ao diagnóstico, o sexo do animal, a presença ou ausência de DRC, assim
como a presença de azotémia pré e pós tratamento.
No que diz respeito à identificação do animal a média de idades da amostra foi de 13,92 anos
e não houve predisposição de género. No entanto a raça em que a doença era mais prevalente
em animais sem raça definida de pelo curto (85%). Na anamnese a perda de peso foi o sinal
encontrado mais frequentemente. A poliúria e polidipsia foram identificados em cerca de
41,41% dos gatos. No exame físico, a tiróide palpável, os sinais digestivos, os sinais
comportamentais e os sinais cardíacos foram encontrados menos frequentemente do que se
esperava. A elevação da ALT estava de acordo com os resultados obtidos por outros estudos,
enquanto aquela da FAS foi encontrada em menor número de animais. A frequência de
animais azotémicos antes do tratamento foi ligeiramente superior à da literatura, e após
tratamento estava de acordo ao que se esperava. As opções terapêuticas usadas foram
farmacológicas (Vidalta®, Felimazole® e metimazol transdérmico), cirúrgicas (tiróidectomia
unilateral e bilateral) e dietética (dieta com restrição de iodo – YD Hill’s®). Comparando as
diferentes medicações o Vidalta® foi o tratamento mais utilizado (62%), mas também com
maior número de efeitos adversos (8%). O metimazol transdérmico o menos usado (7%),
talvez por ser um medicamento humano e como tal apenas ser utilizado como último recurso
em caso dos outros medicamentos apresentarem efeitos adversos. A tiróidectomia, única
terapêutica curativa, foi apenas escolhida por 4% dos proprietários. A maior parte destes
apenas recorria a cirurgia se ocorressem efeitos adversos da medicação, não conseguissem
dar os comprimidos ou o hipertiroidismo não estivesse controlado com outro tipo de
tratamento. O tratamento dietético, apesar de não ser curativo, parece ser o tratamento mais
seguro. Este último foi o tratamento mais barato a curto-prazo, sendo a tiróidectomia o mais
barato a longo-prazo. Foi estabelecida uma correlação entre a TT4 e a perda ou ganho de
peso. O tempo de sobrevivência dos animais era significativamente afectado pela idade, sexo
e presença de DRC concomitante. Uma limitação foi o número reduzido de animais em certos
tipos de tratamento.
ABSTRACT - Treatment and Prognosis of Feline Hyperthyroidism - Feline Hyperthyroidism is an endocrine disease which afflicts geriatric cats and affects many organs and systems giving rise to a diversity of clinical and laboratory signs. For this thesis, retrospective and prospective data was collected from 100 cats diagnosed with feline hyperthyroidism in the Medivet Greenwich clinic. This study aimed to analyse: i) the prevalence of age at diagnosis, gender and breed of the cats; ii) the frequency of demonstration of clinical and laboratory signs consistent with hyperthyroidism; iii) the type of treatment used; iv) a possible association between weight gain after treatment and the concentration of total T4; v) the survival curve taking into account the age at diagnosis, the gender of the animal, the presence or absence of CRD, as well as the presence of azotémia pre or post treatment. Regarding the animal’s identification, the average age of the population was 13.92 years, there was no gender predisposition. However, the breed where the disease was more prevalent was the Domestic short-hair (85%). Weight loss was the signal found more often in anamnesis. Polyuria and polydipsia were identified in about 41.41% of cats. During the physical exam, polyphagia, palpable thyroid, digestive signs, behavioural signs and cardiovascular signs were found less frequently than expected. The results of ALT were similar to the ones obtained in other studies, while the results of FAS were found in fewer animals than expected. The frequency of azotemic animals before treatment was slightly higher than the literature suggested and the frequency after treatment was within the expected range. The therapeutic options used were pharmacological (Vidalta®, Felimazole® and transdermal methimazole), surgical (unilateral and bilateral thyroidectomy) and dietetic (diet with iodine restriction – YD Hill’s®). When comparing different medications, Vidalta® was the most common treatment (62%) but also the one with more adverse effects (8%). Transdermal methimazole was the least used (7%), perhaps because it is a human drug and, as such, is only used as a last resort if other drugs present any adverse effects. Thyroidectomy, the only curative option, was chosen by only 4% of animal owners. Most of them only chose thyroidectomy if there were adverse effects due to the medication, if they couldn’t administer the tablets or if there was no control of the disease with other types of treatment. Despite not being curative, the dietetic treatment seems to be the safest option. It was also the cheapest option for short-term management, while the thyroidectomy was the cheapest therapy, long-term. A correlation between TT4 and weight loss or weight gain was established. Survival time was significantly affected by age, gender and concomitant presence of CKD. The low number of animals who underwent certain types of treatment was a limitation for this study.
ABSTRACT - Treatment and Prognosis of Feline Hyperthyroidism - Feline Hyperthyroidism is an endocrine disease which afflicts geriatric cats and affects many organs and systems giving rise to a diversity of clinical and laboratory signs. For this thesis, retrospective and prospective data was collected from 100 cats diagnosed with feline hyperthyroidism in the Medivet Greenwich clinic. This study aimed to analyse: i) the prevalence of age at diagnosis, gender and breed of the cats; ii) the frequency of demonstration of clinical and laboratory signs consistent with hyperthyroidism; iii) the type of treatment used; iv) a possible association between weight gain after treatment and the concentration of total T4; v) the survival curve taking into account the age at diagnosis, the gender of the animal, the presence or absence of CRD, as well as the presence of azotémia pre or post treatment. Regarding the animal’s identification, the average age of the population was 13.92 years, there was no gender predisposition. However, the breed where the disease was more prevalent was the Domestic short-hair (85%). Weight loss was the signal found more often in anamnesis. Polyuria and polydipsia were identified in about 41.41% of cats. During the physical exam, polyphagia, palpable thyroid, digestive signs, behavioural signs and cardiovascular signs were found less frequently than expected. The results of ALT were similar to the ones obtained in other studies, while the results of FAS were found in fewer animals than expected. The frequency of azotemic animals before treatment was slightly higher than the literature suggested and the frequency after treatment was within the expected range. The therapeutic options used were pharmacological (Vidalta®, Felimazole® and transdermal methimazole), surgical (unilateral and bilateral thyroidectomy) and dietetic (diet with iodine restriction – YD Hill’s®). When comparing different medications, Vidalta® was the most common treatment (62%) but also the one with more adverse effects (8%). Transdermal methimazole was the least used (7%), perhaps because it is a human drug and, as such, is only used as a last resort if other drugs present any adverse effects. Thyroidectomy, the only curative option, was chosen by only 4% of animal owners. Most of them only chose thyroidectomy if there were adverse effects due to the medication, if they couldn’t administer the tablets or if there was no control of the disease with other types of treatment. Despite not being curative, the dietetic treatment seems to be the safest option. It was also the cheapest option for short-term management, while the thyroidectomy was the cheapest therapy, long-term. A correlation between TT4 and weight loss or weight gain was established. Survival time was significantly affected by age, gender and concomitant presence of CKD. The low number of animals who underwent certain types of treatment was a limitation for this study.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Hipertiroidismo felino idade sexo raça tipo de tratamento prognóstico Feline hyperthyroidism age gender breed type of treatment prognosis
Contexto Educativo
Citação
Nascimento, D.F.R.C. (2016). Tratamento e prognóstico do hipertiroidismo felino. Dissertação de mestrado. Universidade de Lisboa, Faculdade de Medicina Veterinária, Lisboa.
Editora
Universidade de Lisboa. Faculdade de Medicina Veterinária