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Following a test for blood serum thyroxine levels thyrotropin-releasing hormone can be administered to cats intravenously and after 4 hours another blood test can be taken to measure thyroxine serum levels. If the thyroxine levels have increased this indicates the cat is euthyroid but if levels remain stagnant it suggests hyperthyroidism.
Hyperthyroidism may be assumed due to decreased TSH and a transient fT4 increase. In some cases, this can be distinguished from NTIS by a thyroid ultrasound, which is commonly available in the hospital intensive care unit. [2] NTIS looks similar to central hypopituitarism; both frequently have reduced TSH and thyroid hormone levels. [2]
High blood levels of thyroid hormones (most accurately termed hyperthyroxinemia) can occur for a number of other reasons: Inflammation of the thyroid is called thyroiditis. There are several different kinds of thyroiditis including Hashimoto's thyroiditis (Hypothyroidism immune-mediated), and subacute thyroiditis (de Quervain's).
To understand how high levels of thyroxine can be toxic and lead to thyrotoxic myopathy physiologically, consider basic neuromuscular junction function. Under normal circumstances, muscle contraction occurs when electrical impulses travel down descending axons from the brain or spinal cord towards the neuromuscular junction.
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The abnormality in the channel is thought to lead to shifts of potassium into cells, under conditions of high thyroxine (thyroid hormone) levels, usually with an additional precipitant. Treatment of the low levels of potassium in the blood, followed by correction of the hyperthyroidism, leads to complete resolution of the attacks.
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