周亭宇
执业兽医师
请问是什么宠物?多大年龄?什么时候确诊的甲减?现在都有哪些症状?是否吃过什么药?
若您离开本诊室,稍后可以到官方微信号“蘑菇宠医”内找到问诊订单继续和我沟通。
医生 你好 狗狗得了甲减一直在治疗中,吃着左甲状腺素钠片,开始吃的一颗可是T4值一直上不去,现在变成了两颗,治疗了快一个多月了,刚开始精神都还挺好的,能吃能睡,这两天,食欲没有了,连狗粮和营养膏都不吃了。昨天还抽了两次缓过来,我们这边医生说她吸收不好,如果开始抽的话,就是不好的症状,让我们做好心理准备,可是不是说得甲减的狗狗不会影响寿命吗?该做的项目全都做了,现在该怎么办呀?
只能一次性发五张,发的是最近的几次报告,因为是复印件,所以可能看得不是太清楚。原件在医生那里!
为保护用户隐私不显示图片/视频
周亭宇
执业兽医师
收到图片,抱歉,我不得不中断一下咱们的沟通。我这边突发(急诊)需要耽搁大概二十分钟的时间,请耐心等待一下,非常感谢!
周亭宇
执业兽医师
您好家长,它有可能并不是原发的典型的甲状腺减少症,而很可能是ESS(非甲状腺病态综合症),这种病也是呈现T4的降低,它通过甲状腺素的治疗T4一直没有升起来说明病因并没有找到,很多情况下犬的肝肾功能异常,身体的应激,激素药物的使用等都会导致T4的降低。
结合它生化的数据看, 有明显的肝肾功能异常,还有高磷血症,个人经验,怀疑肾脏的病是原发性的,继发了这个ESS,如果通过肾脏治疗以及保肝的治疗后T4还是升不上来,它的死亡率就很大了,因为长时间的T4降低会引起很多附带的内脏问题,各种代谢紊乱,引起更严重的症状。
那我现在还能为她做什么吗?需要换医院吗?抽搐的原因也是因为这个引起的吗?不过买过来的时候,很小的时候也抽过两次,都不是连续的。她现在不吃东西,药都是灌进去的,怕这样下去又要引起低血糖。以前她喜欢的牛肉,鸡胸肉都没诱惑了。
周亭宇
执业兽医师
可以先不用换医院,它现在肾脏功能不太好,需要控制血磷含量,要用到磷结合剂,先尽量改善肝肾功能,再看看它的临床症状,如果通过保肝护肾的治疗后,它的症状缓解,说明就是肾脏的问题引起的甲减。如果它没有出现呕吐,建议您人工喂它吃一些营养比较好的流食。
这是她第一次的数据报告,当时肝脏这些指标都是好的,吃了左甲差不多半个月的样子开始数据就变了,然后这边医生的治疗方案是吃的左甲片,肝脏这块的只是吃的保肝片和补血液,没有刻意治疗肝脏这块,他们没怀疑她是ESS,有没有好的指导方向,我们这边医生也是说她也不知道她该怎么医治了。说甲减容易误诊,但是说我们家狗狗的症状这些全部又符合,需要给他们说先治肝脏吗?他们也是到处咨询同行医生。
为保护用户隐私不显示图片/视频
周亭宇
执业兽医师
它TSH这个是正常的,加上T4水平低,基本可以判断它并不是原发性的甲减,而就是ESS,至于导致ESS的原因,还需要进一步的排查,目前对比两次血液生化结果,显示肝肾功能的问题,可以超声看看肝肾的情况,看看有没有肝肾的结构性病变,另外它的血磷是在升高的,这个必须要控制,另外就是还是按照我刚刚说的,对症治疗,保肝护肾,超声检查了肝肾如果有其他问题,还需要对应的进行治疗。
我的最后一次追问 我补充一句最后一次检查上次看肝,她的肝增大了不少。
方便提供微信吗?有没有好的药和方式帮助治疗的。
饮食上有没有需要注意的?可以高蛋白这些的吧 。我也担心会不会让她肝脏这些有负担。
最后的最后 谢谢你🙏🙏 辛苦了
为保护用户隐私不显示图片/视频
周亭宇
执业兽医师
家长你好!考虑到目前的问诊暂未沟通出结论,我额外赠送你3次追问次数,以顺利完成本次问诊咨询。
周亭宇
执业兽医师
饮食要低脂肪,低蛋白,蛋白含量太高肾脏负担会加重,这个水飞蓟就挺好的,可以继续喂一段时间看看,其他的医院都有针对性的药物,需要看主治医生怎么用药。
感谢三次的追问,再次谢谢🙏🙏!医生,你们那边有没有好的药方调理之类的,我可以在自己当地这边做检查,然后把报告发给你,药付费的方式用快递寄过来。嗯,护肝的继续吃,甲减的左甲片也继续是吧?就是甲减那个药,计量现在给他吃的是0.06g每天两顿,剂量方面需要调整吗?然后就是治疗ESS吃什么药?我想问的就是这些,当地医疗水平有限,如果可以能开药方吗?
因为当地没有兽药,给她吃的甲减药是这个。我家狗狗3kg。
为保护用户隐私不显示图片/视频
周亭宇
执业兽医师
您好家长,我这边有手术,可能要晚些时候再答复您了,还得麻烦您多耐心等候一下。
周亭宇
执业兽医师
您好,它现在最需要的还是对症治疗,最重要的还是保肝,它现在肝脏很不好,继续下去还会继发肝性脑病,而且很多药会通过肝脏代谢,药也不敢用太多,您手上的***就可以,另外就是饮食,低脂肪,低蛋白的饮食就可以,少食多餐。优甲乐还得继续吃,如果不吃T4还会继续下降,加速它的病危。另外就是问问医院有没有血磷结合剂,需要吃这个来控制血磷,防止高磷血症的恶化。
周亭宇
执业兽医师
***推荐剂量是20微克一公斤,您手上这款药的用量就是一片多一点,每天两次。
医生你好,我已经问过了这边医院没有血磷结合剂,问了其他医院也没有,然后这边医生说血磷指标没问题,但是不排除肾出问题了,这边医生也说确实没找到病因。而且她恶化得很快,一直没好,越来越严重,我们也在考虑是不是肾的问题。肝现在指标是明显有问题的。这个*****,你们医院有卖的吗?如果有,能从你那边买吗?你今天说的我听明白了,***继续吃,***继续吃,***,可以适当在里面添加一点肉吗?打成汁喂给她,我怕她出现低蛋白综合症,她现在的状态不是太好,我怕她熬不住。都这么晚了,已经算是你的休息时间了,确实不好意思,打扰到你休息了,辛苦你了。谢谢🙏再次感谢🙏
周亭宇
执业兽医师
血磷结合剂这个我们医院也没有,如果确实没有这个,可以先不管这个血磷的问题,另外它的肝脏问题,肝脏的问题很可能还是甲减继发引起,肝功能ALT和GGT升高可能与甲减导致的脂质代谢异常和肝脂肪变性有关,这个就吃水飞蓟素先治疗看看,也没有太好的办法。饮食可以适当加一些白肉,一定要瘦肉才行,还需要多喝水,另外建议它日粮换成肾脏处方粮,而且就以肾脏处方粮为主,其他的食物就不要喂了,处方粮少食多餐,另外我再给它开一个肾脏药,来尝试改善它肾损伤的问题,推荐用药如下:
欧博方每天一次,每次一片,连续一个月。
处方粮做为主食,未来三个月就吃这个,少食多餐。
医生建议及处方根据当前病情给出,仅适用于本次问诊
蘑菇宠医处方笺
用法用量需根据患宠的年龄、体重等信息开具,此处方暂不展示
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