Clinical Sciences and Services, Royal Veterinary College, University of London, London, UK.
Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, UK.
J Feline Med Surg. 2022 Jul;24(7):641-650. doi: 10.1177/1098612X221090390. Epub 2022 Apr 28.
Both hyperthyroidism and chronic kidney disease (CKD) are common long-term conditions in older cats, which might be diagnosed concurrently or develop at different times. Hyperthyroidism may mask the presence of CKD, and vice versa, by various mechanisms that are described in this review. Hyperthyroidism treatment options should be carefully considered when CKD has also been diagnosed.
Although it can be difficult to diagnose hyperthyroidism and CKD simultaneously, given that one condition may mask the other, it is important to consider the presence of both diseases when examining an older cat presenting with vomiting, weight loss, polyuria/ polydipsia, anorexia or sarcopenia. The concurrent presence of hyperthyroidism and CKD requires careful monitoring of glomerular filtration rate biomarkers, and adequate and prompt support of kidney function when normal thyroid function is re-established. Iatrogenic hypothyroidism is a recognised complication of all of the treatment options for hyperthyroidism, and increases the risk of azotaemia. Therapy with levothyroxine is recommended for cats that are hypothyroid and azotaemic.
The information in this review draws on current literature and guidelines related to the pathophysiology, diagnosis and treatment recommendations for feline hyperthyroidism and CKD.
甲状腺功能亢进症和慢性肾脏病（CKD）都是老年猫常见的长期疾病，可能同时诊断或不同时发生。甲状腺功能亢进症可能通过各种机制掩盖 CKD 的存在，反之亦然，本综述中对此进行了描述。当 CKD 也被诊断时，应仔细考虑甲状腺功能亢进症的治疗选择。
尽管由于一种疾病可能掩盖另一种疾病，因此同时诊断甲状腺功能亢进症和 CKD 可能具有挑战性，但当检查出现呕吐、体重减轻、多尿/多饮、厌食或肌肉减少症的老年猫时，考虑到两种疾病的存在非常重要。甲状腺功能亢进症和 CKD 的同时存在需要仔细监测肾小球滤过率生物标志物，并在恢复正常甲状腺功能时充分和及时地支持肾功能。所有甲状腺功能亢进症治疗选择的医源性甲状腺功能减退症是一种公认的并发症，会增加氮血症的风险。对于甲状腺功能减退症和氮血症的猫，建议使用左甲状腺素进行治疗。
本综述中的信息取自与猫甲状腺功能亢进症和 CKD 的病理生理学、诊断和治疗建议相关的当前文献和指南。
