Multiple conditions in Alfie the Border Terrier

First Published: December 2024

Quite often animals come in with signs that point a clinician to one particular area of interest, which can then be investigated and treated as necessary. When an animal presents with multiple issues that cannot be explained by just one condition this poses much more of a diagnostic conundrum. We have to pick apart which signs might be related to which underlying issues. This was indeed the case with Alfie, an elderly and lovely Border Terrier who we saw and treated this year.

He first came in just for a check up and injections for his arthritis and allergies, however his owners mentioned at the time that he was perhaps a little thirstier than normal and panting a bit more. There wasn’t anything particularly obvious on examination to explain these changes, so we opted to perform a blood sample to look for any underlying causes. This threw up several abnormalities: low thyroid hormone levels, significantly elevated liver values and elevated calcium levels. Additional thyroid blood tests were performed which suggested the low thyroid values were due to a separate illness reducing their production, rather than a genuine thyroid problem. We then began focusing on the liver values – these could be elevated by a genuine liver issue (such as a tumour, hepatitis, gall stones) or hormonal conditions, in particular hyperadrenocorticism (known as Cushings). A test looking at stress hormone levels in the urine effectively ruled out Cushings therefore a liver ultrasound was performed. This showed some significant changes within Alfie’s gall bladder. The gall bladder normally stores bile and secretes it into the small intestine to help with digestion when needed. Occasionally, and especially in border terriers, this bile can thicken over time and become solidified, affecting its secretion. This causes a build up of bile within the liver where it is made resulting in liver damage – a good explanation for the elevated liver values seen on Alfie’s bloods. This is known as a gall bladder mucocoele and can be managed medically or surgically if severe. High blood calcium levels are not generally a feature of this condition, in fact if anything it can cause calcium levels to drop. Repeated blood tests showed the calcium was persistently high so there must be something else going on. Elevated calcium often causes increased thrist and panting, the changes mentioned by the owners at his check up. We have an acronym for conditions that cause elevated calcium – HARD IONS G. I won’t go through what each of these are, but it helps give us a good framework to base further tests around. Blood calcium is regulated by a hormone called parathyroid hormone, produced unsurprisingly by the parathyroid glands. Small lumps can form on these glands and cause increased production of parathyroid hormone, leading to elevated calcium levels – a condition known as hyperparathyroidism. This was confirmed in Alfie by finding high levels of parathyroid hormone in his blood and then placing the ultrasound scanner on his neck to see a lump on one of his parathyroid glands (there are 4 parathyroid glands in total).

Alfie therefore had two concurrent conditions – a gall bladder mucocoele and hyperparathyroidism. Of these it was actually the hyperparathyroidism that was causing the signs noted by the owners. If untreated hyperparathyroidism can cause muscle weakness, vomiting, inappetence and kidney failure. Whilst not a simple surgery the affected gland can be removed and Martin, our surgical certificate holder, was happy to proceed. Alfie went on some vitamin D tablets before and after the operation as these help regulate calcium levels to prevent a sudden drop in normally seen immediately after removal of a parathyroid gland. Surgery went well and Alfie went home the next day. He had repeated checks of his calcium levels to ensure they normalised and the vitamin D tablets were slowly withdrawn. He is now doing extremely well and the owners have no further concerns. He is currently taking medication to help with bile flow to try and manage his gall bladder mucocoele to prevent it causing any problems.