Serum thyroxine and thyroid-stimulating hormone concentration in hyperthyroid cats that develop azotaemia after radioiodine therapy.

The objectives of this study were to determine which serum thyroid hormone test best identifies iatrogenic hypothyroidism in cats that develop azotaemia after radioiodine treatment and to determine which thyroid test best differentiates these azotaemic, hypothyroid cats from azotaemic, radioiodine-treated euthyroid cats, as well as from azotaemic cats with chronic kidney disease and no history of thyroid disease. A total of 42 hyperthyroid cats that developed azotaemia (serum creatinine ê220 µmol/L) after radioiodine treatment had serum concentrations of thyroxine and free thyroxine by dialysis and thyroid--stimulating hormone measured at 3, 6 and 12 months. Iatrogenic hypothyroidism was confirmed (n=28) or excluded (n=14) on the basis of thyroid scintigraphy. A total of 14 cats with chronic kidney disease and 166 clinically normal cats underwent similar serum thyroid testing and scintigraphy. Concentrations of thyroxine and free thyroxine were lower and thyroid-stimulating hormone higher in hypothyroid cats than in all three groups of euthyroid cats (P<0·0001). Of the hypothyroid cats, thyroxine and free thyroxine concentrations were low in 15 (53·6%) and seven (25%), respectively. Low serum thyroxine and free thyroxine concentrations were also detected in seven (50%) and two (14·3%) of the cats with chronic kidney disease. Thyroid-stimulating hormone concentrations were elevated in all hypothyroid cats but remained within the reference interval in all three groups of euthyroid cats. Serum thyroid--stimulating hormone had a higher test sensitivity and specificity than either thyroxine or free thyroxine concentration. The finding of high serum thyroid-stimulating hormone concentrations best identifies feline iatrogenic hypothyroidism and differentiates it from non-thyroidal illness syndrome in cats that develop azotaemia after treatment.