# Maltese Liver Enzymes & Cushing's



## Furbaby's Mommie (Jul 10, 2004)

For the last 3 mo. Frosty (age 13) has been undergoing a lot of tests. We're trying to figure out if he needs thyroid or has Cushing's disease. It is all very complicated so I won't go into all the tests. I read somewhere that there is some question about Maltese sometimes being put on thyroid when not necessary, and also about liver enzymes in Maltese possibly running a higher normal. I don't remember where I saw it, so thought I'd ask you guys if you've heard any of this. His liver enzymes have been slowly climbing over the last 4 years or so, but particularly the last few months. Last test, yesterday, the ALT is 114 (normal 5-60), and the ALK is 540 (normal 10-150). Everything else is pretty good except for his slightly low thyroid (we are increasing his dose) and a heart murmur.
Anybody had similar liver and thyroid issues with their furkids?


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## jmm (Nov 23, 2004)

Some people in Collies and Shelties started using thyroid supplements to grow coat on their dogs. It has been done in a number of breeds (though it is not a good idea).

If your Maltese is hypothyroid, thyroid supplementation should help. Liver values can be elevated due to a number of issues. Thyroid issues can elevate them. ALKP is often elevated in Cushing's dogs but can also be elevated as a normal aging change. The ALT isn't all that high but again could be secondary to another problem or represent primary liver disease. 

A Maltese may have slightly elevated bile acids done by the regular method and be normal. They may also indicate pathology. If a dog has slightly elevated bile acids and normal liver enzymes, further testing can be done to determine if liver function is truly a problem. Elevated liver enzymes are indicative of a problem in a Maltese and are NOT normal. 

I take it your dog had a low dose dex suppression test or ACTH stim for Cushing's. Does the dog have dental disease? Was the dog placed on antibiotics and then retested liver values? 

An abdominal ultrasound would provide the most information about the appearance of the liver and adrenal glands. Again, it could simply be benign geriatric changes or secondary to thyroid, but ideally an ultrasound would be +/- fine needle aspirate of the liver to be sure.


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## Furbaby's Mommie (Jul 10, 2004)

JMM: Thank you, I have a feeling we are doubling up here. I am new to another forum, MF, and I think you gave me the same answer over there! Sorry about that.

Frosty does need his teeth cleaned and the vet did say that could be effecting the liver enzymes. He wants to use the newest, EXPENSIVE, anthesetic--so it will be $360. even though we have already done $700. worth of blood work and ECG and X-rays. Hard on the budget! If we do it within the month he won't repeat the blood work.

We have not done the ACTH stim test yet. His symptoms are mild so far as are the blood test indicators. They want to get the thyroid normal first. It was only in the grey area without meds. But first retest of T4 after starting Soloxine was 1, so then increased for a month and this one was 2. They want it on med to be 3-7.5. So we have increased it again for a month and will retest. If his symptoms worsen and blood tests after cleaning teeth and the thyroid still show increase signs for Cushing's, then he'll do the ACTH stim.

My next question is....which one on the test is the bile acids?? Is it the total Bilirubin and Direct Bilirubin? We did do a morning urine for cortisol:creatinine (ratio) which was 14. Lab said <13.5 was elevated, but may be adrenal or NON-adrenal illness---and it was so borderline.

All his tests for indicators are either borderline or not terribly high, but increasing.

Marilyn: Thanks for the website. It's good to have. All this "borderline" and "false-positive" stuff is so frustrating!!


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## jmm (Nov 23, 2004)

> _Originally posted by Frosty's Mom_@Apr 2 2005, 01:35 PM
> *JMM: Thank you, I have a feeling we are doubling up here. I am new to another forum, MF, and I think you gave me the same answer over there! Sorry about that.
> 
> Frosty does need his teeth cleaned and the vet did say that could be effecting the liver enzymes. He wants to use the newest, EXPENSIVE, anthesetic--so it will be $360. even though we have already done $700. worth of blood work and ECG and X-rays. Hard on the budget! If we do it within the month he won't repeat the blood work.
> ...


[/QUOTE]

I use only Isoflurane for anesthesia. I will not touch Sevo. I would clean his teeth as many of his problems may even out once all of that bacteria is taken care of. 

Bile acid assay is one blood sample drawn after a 12 hour fast, the dog is fed, and another sample is drawn. Bilirubin is a different value. Bile acids are used to assess liver function. In Maltese, they can sometimes be mildly elevated and the dog is normal. That is why you might hear about Maltese having an elevated liver test. They may not have done bile acids as they are suspecting thyroid/Cushings as the cause rather than primary liver disease.


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