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Large lymph nodes.

Species: Dog
Breed: shih tzu
Age: 11-15 years
I spoke with you on sunday night about my shih tzu., I brought him to the vet on monday. To refresh your memory. My dog had fallen over a couple of times, had lost control of his front legs a few times. You thought that it might be a nervous system problem. He also had hair loss around his groin and his legs. The hair had gone and crusty dry skin was left that was black in color. I also noticed that his tail was down for several weeks and he had a bow in his back. He was eating and peeing/pooing. At night he has had some very difficult times breathing. At times shallow breath, other times panting, then deep breath etc.
The dog is 14 years old.

When I brought him to the vet. The vet found the following items on him. His weight was 15 lbs. His thyroid glands (both of them) are enlarged. 6 of his lymph nodes are enlarged. The one on the left side of his neck is about 2-3 inches in size. He also found that the dog had a slight temperature and had an irregular heartbeat.

He did blood work. I have a copy of the blood work. The three items that are irregular are potassium levels. more then 9, normal levels are 3.9-5.3.
Calcium, less then .05, normal levels 2.20 to 3. alp was 452. normal levels are 24-141.
Hemaglobin was 127, normal is 135-205. Hematocrit was .35, normal is .39-.60

please let me know your thoughts.

Online vet, Dr. Marie

Dr. Marie replied:

It's good to hear from you again Robert. The findings on the physical exam from the vet are unusual.

It is really really uncommon to be able to feel a dog's thyroid gland. The only times that I have felt an enlarged gland are if there is a tumor in the thyroid gland or if there is a parathyroid tumor. (The parathyroid gland sits on top of the thyroid gland. But dogs with a parathyroid tumor usually have a very high calcium level.)

It's also uncommon to feel enlarged lymph nodes. Lymph nodes are usually enlarged either because of rampant infection or because of cancer. Unfortunately with Edward's age, cancer sounds most likely. If there was an infection he should have a really high white blood cell count.

It is really unusual to have a potassium level this high. It's possible that this is lab error. This can happen sometimes if the blood sample gets hemolyzed which can happen quite easily. It can also happen if we accidentaly used the wrong type of blood tube. We can see high potassium with a condition called addison's disease but the symptoms really don't fit. And, usually the sodium level is really low with Addison's.

A high ALP can be relatively normal in an elderly dog. Or, it can be a sign of liver problems. But if I have a high ALP and the rest of the liver enzymes are ok I don't get too worried about it.

If this were my case I would likely be recommending a fine needle aspirate of the lymph nodes. I'm concerned that he may have lymphoma which is a cancer affecting the lymph nodes. This cancer may also be affecting his thyroid gland.
An xray of the chest is a good idea as well.

But, I think we really really need to prepare ourselves for bad news. This is looking more and more like cancer.

What does your vet think is going on?

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Customer reply:

I respect what you are stating. Please let me povide you with more information. About an inch below his jaw on either side of his trachea? are two growths. The vet felt these were thyroid. They are about an inch or more in size. One slightly larger then the other. The vet thinks he has hyperparathyroid problem, due to hair loss, skin black and crusty skin.

On the back of each of his hind legs I was told was the lymph node. It felt like a hard egg like item about half an inch ish. Both hard, both sides. Also in front of his leg under his belly, same feeling. The one on his left side, above his should, is hard, and big.

the blood test indicated the following as well.

wbc morphology
few reactive lymphocites

rbc morphology
anemia mild
polychromasia 2-5/hpf
response to anemia is good

plt morphology

If you want to know a specific test on the blood exam, pls let me know as I have it here and can give you the numbers.
sodium was 149, normal 143-153.

The vet als said that his falling down problem and loss of limb control was versticular.

The vet thinks he has hyperparathyroidism. might have a tumor on his liver, has a tumor on his lymph node.

Also said his breathing problem might be because his lymph node near his lungs might be enlarged.

He recommended a liver xray.

Please let me know your thoughts.

Online vet, Dr. Marie

Dr. Marie replied:

The area you are describing certainly does sound like the thyroid area. It's sounding more to me like thyroid tumors rather than parathyroid tumors. Dogs with parathyroid cancer almost always have an increased calcium level, not a decreased level. Do you have a T4 level on the bloodwork?

In either case though this is not good news. If there is a tumor on the thyroid or the parathyroid and it has spread to lymph nodes then the chances of treating it successfully are really small.

Were any tests done on his lymph nodes? I think this is likely to give you an answer as to what is going on. If I was going to xray I would definitely want to see the lungs to see if there is evidence of cancer there.

Customer reply:

free t4
7.7-14.6 normal

Both thyroids can be felt.

Lymphocytes 26.7% abs=2.3 1.0-4.8 normal

Would you agree that there is a strong chance that something in interferring with his breathing at night? He has had 2 separate really rough nights with his breather. I have felt 6 of his lymph nodes and they are all solid and enlarged. Please let me know what other items you would look for on the blood test.

In referrence to the potassium levels being too high and perhaps a lab error. He has an irregular heartbeat and this might support the high potassium levels?

Online vet, Dr. Marie

Dr. Marie replied:

Well, a potassium level this high could cause the heart rate to be slower than usual. But, an irregular heart rate would not cause a change in his potassium level.

I can think of a few reasons for his breathing to be off. It's possible that there is cancer inside of the chest. Or, here's another possibility - it's possible that the tumors that your vet is feeling are actually on the larynx. If this is the case then they can be constricting the trachea and this can definitely cause breathing issues. Realistically if this was a thyroid tumor we should be seeing a high thyroid level which is not the case.

I don't think there is anything else on the blood tests that can help us here. I think an aspirate of the lymph nodes can really help and additionally chest xrays will tell us a lot.

Customer reply:

I will get the xray tomorrow.

This problem, the hair loss, losing balance, growths and so forth. did not exist a month ago. In my mind, they appear to be linked. They seem to have grown at a very quick rate. Do you think my though process is correct?

He has had 2 really rough nights in 5 days. In my mind, this issue with his body, cancer or not and so forth is huge, however, I am more concerned with his breathing at night. I am thinking if he has several of these in a row, I am thinking that is enough.

Am I wrong to concentrate on this?

Online vet, Dr. Marie

Dr. Marie replied:

The hair loss could be related to cancer. If the body is fighting cancer then the coat suffers.

Similarly, the balance loss could be due to spread of cancer to the vestibular part of the brain. While dogs can get "idiopathic vestibular syndrome" which they recover from, this wouldn't account for any of the other symptoms he has.

I don't think you're wrong to concentrate on his breathing. Really, we're concentrating on his overall quality of life. If he is struggling and if we can't cure him then it is right to start thinking about euthanasia.

I'll be heading offline soon (it's bedtime!), but feel free to reply tomorrow if you have more concerns after the xray is done.

Customer reply:

thank you

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

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