More advice please

*Apologies, I initially posted this as a follow up to a thread I started more than 2 years ago and can't seem to find it now* Hello, Hello again, I wonder if I could trouble you for some more advice. Our 10 year old dog has been on Thyforon since December 2021. He was initially on 200 mcg per day split into 2 doses, half a tablet in the morning and half in the evening. Healthwise, he has been fine but a few months ago, we noticed his hair thinning again, particularly on his chest and stomach. I consulted our vet, who recommended increasing the Thyforon dose to three quarters of a tablet twice daily.  He has been on this higher dose for just over 7 weeks. His hair does seem to be growing back, albeit very slowly, but we've noticed that particularly since the increased dosage, he's drinking more, and consequently, urinating more. When increasing his dosage, it was agreed that he'd have another blood test at the beginning of this month. The vet said at the time that his liver enzymes were slightly raised, so it was necessary to keep an eye on his thyroxin levels. This test was done and apparently his liver values are still up a bit. As far as the drinking is concerned, the vet said that  more than .75 litre of water per day for a dog of his size (around 7.7kg) would be regarded as excessive. I said I would monitor his intake but from what I've seen so far, I don't think it is as high as that, more like 500ml. We are also to get a urine sample to take in for analysis. This was all done over the telephone, but from what I've read, Thyforon, particularly when the dosage has been fairly recently increased, can cause a dog to drink more and the medication and thyroid issues can also affect liver enzymes. An ultrasound scan was suggested but I am reluctant to go down that path at the moment.  The reason for this is that in December 2021, a scan showed that the gallbladder and spleen were swollen and exploratory surgery was recommended. As our dog was, to all intents and purposes, well and active, with a good appetite, I questioned this and it was agreed to do a further scan in a couple of weeks. This scan showed that the swelling had gone down and the reason for the swelling was assumed to be the sedative used in the first scan (but not the second). It was also stated that at this stage, his liver was OK. This has knocked my confidence somewhat, as, but for my questioning the recommendation to operate (after receiving invaluable advice from Vet Help Direct), he would have had unnecessary surgery and the vet is aware of my reservations. It has therefore been agreed that we should try a liver supplement for a couple of months, then have a further blood test, to see if there is any improvement in his liver values. The 2 supplements recommended are Hepatosyl and Samilyn, although the vet didn't offer an opinion as to which is more effective. Both are quite expensive, even online, but we obviously, we want to do our best for our dog. Hepatosyl seems to be the best value, but I wondered if it was as effective as Samilyn. Online reviews for both seem generally favourable. Apologies for writing at such length. I would be really grateful to receive your thoughts and for any advice you can give me. Thank you, Bill    

Hello again Bill; it's good to hear back from you.   When a dog might be drinking and urinating too much, this is always worth looking into.  A common early step is that your vet would check a measure called the specific gravity of urine; this requires a urine sample.   This may help to narrow down the cause of the PU PD (stands for polyuria polydipsia ie weeing a lot and drinking a lot); many causes are serious and require early attention.  One concern is that the Thyforon dose might be too high for this particular patient, thus making them artificially hyperthyroid (too much thyroid hormone) instead of hypothyroid (too little).  Commonly, when starting a dog on this drug, a relatively low dose is decided upon depending on the patient's weight and tests are carried out to ensure that the dose is correct, with incremental changes if necessary. Details of this can usually be found on the insert in the tablet box or again, obtained from your vet or their book of drug data sheets.  Other possibilities might include concurrent Cushings disease, for example.  Good questions for your vet include:  what are the potential causes of these symptoms?  What are the side effects of the drug dose being wrong?  Is there anything else that we should be doing or looking out for?  As ever, we would reccommend having this case triaged; if your vet wants you to be seen sooner rather than later or temporary stop the tablets for example, then this can be arranged.  Always check any supplements with your vet, in light of pre-existing conditions or drugs (such as a Thyforon). Please will you let us know what was found and how you get on?

Hello Liz, Thank you very much for your helpful reply. Looking back, my original query was so rambling, i fear I wasn't very clear on certain points but just to clarify further; 1) Our vet has requested a urine sample, which we will try to collect (!) and take in early next week. 2) We are monitoring our dog's water intake. It does vary: yesterday he only drank around 400ml in 24 hours but today, it's been warmer. He's been sunbathing in the window and we also took him for a walk of around 3 miles, so he's drunk about double that - some of it on the walk. 3) His thirst does seem to have increased since his Thyforon dose went up around 7 weeks ago (pls see 4)) 4) He was started on 200mcg per day Thyforon in Dec 2021 and as we reported further hair thinning, the dose was increased to 300mcg per day. His hair seems to be growing back very slowly. 5) His last blood test was said to be within the 'reference range', so assume the dose is not too high? 6) I understand symptoms such as increased thirst can occur when dosage is first increased but can then settle down. Is this likely? 7) The vet has said that a liver supplement is an option to try for 2 months or so and then re-check his liver enzymes level, which was 'up a bit' on his last test. I'm unsure which of the 2 supplements recommended to go for (Hepatosyl or Samilyn)? Is there a difference in your view? 8) Our dog remains active and alert, loves his walks and has a good appetite. He is very rarely sickly. I'm sorry my original post was unclear in parts. I do appreciate your time and would be grateful for your further thoughts. Regards, Bill    

Thanks, Bill.  I will come back and answer these later but feel that the triage and the urine sample could be more urgent and need to take place in the very short term if possible.