Signalment and History: "Jasper," a 13-year-old male neutered Domestic Shorthair cat, is presented for his annual exam. The owner mentions that for his age, Jasper has been unusually active lately. Over the past six months, he has lost a noticeable amount of weight despite having what the owner describes as a "ferocious" appetite. He constantly begs for food, steals food from the other cat's bowl, and has even started getting into the trash.
His water consumption has also increased, and he has been having occasional bouts of vomiting for the past few weeks. The most significant change for the owner is behavioral; Jasper has become restless and irritable. He yowls loudly at night and paces through the house, which is very uncharacteristic.
Physical Exam:
T: 102.8°F
P: 235 bpm (Tachycardia)
R: 40 bpm
BCS: 3/9 (Thin)
Blood Pressure (Doppler): 180 mmHg systolic [Ref: <160 mmHg]
Jasper is restless and slightly agitated during the exam. He is markedly thin, with palpable muscle wasting over his spine and hips. His hair coat is unkempt and mildly greasy.
Cardiovascular: A significant tachycardia is present. Auscultation reveals a Grade II/VI systolic heart murmur best heard at the left sternal border.
Cervical Palpation: Careful palpation of the ventral neck reveals a small, firm, pea-sized nodule that "slips" between the fingers just to the left of the trachea. This is consistent with an enlarged thyroid gland.
Initial Diagnostic Workup: A senior wellness panel was performed.
Complete Blood Count (CBC): A mild erythrocytosis (elevated red blood cell count) is present (PCV: 49% [Ref: 29-45%]).
Serum Biochemistry Profile:
Alanine Aminotransferase (ALT): Moderately elevated at 195 U/L [Ref: 12-130 U/L]
Alkaline Phosphatase (ALP): Mildly elevated at 110 U/L [Ref: 14-111 U/L]
Creatinine and BUN are in the high-normal range.
Urinalysis (Cystocentesis):
Urine Specific Gravity (USG): 1.025 (inadequately concentrated)
All other findings are unremarkable.
What will be your tentative and differential diagnosis?
What further diagnostic test(s) you will perform to confirm your diagnosis?
What will be your treatment plan(s)?
Solution for Case 34 will be posed on Oct 3
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