C10012943 / invoice 10000

PHONE COMMUNICATION 7/03/26 TM
TM spoke with O on phone @ 11:15AM to communicate recent blood work to assess T4 medication dose. 
Total T4 remains elevated 90nmol/L (previously 62nmol/L) consistent with hyperthyroidism.
Other abnormalities include mild neutropenia 1.91X10^9 (2.3-10.2 normal ramge), mild elvation in ALT 178 U/L (12-130 normal range) and suspect artificial thrombocytopenia (note: blood smear was not performed for platelet count). Hypokalaemia as resolved since last bloodwork with oral supplementation. 
O repots Zuri is going well however is more clingly than usual and has an eye with discharge. No reported respiratory concerns. 

Plan:
Increase dose of Thyronorm (2.5mg/ml oral suspension) from 0.5mls (2.5mg) to 0.75mls (3.75mg) PO BID (~7.5mg total daily dose). 
Repeat T4 in 4 weeks
Discontinue oral potassium spplementation
Recommend vet visit for eye 
If Zuri becomes lethargic or inappeteent please contact MVC/ Discussed medication may cause hypothyroidism if dose is too high. 

Reason: Complete Blood Test + T4 
KA

Notes:
- O mentioned they had been under dosing with thyroid medication as they incorrectly read dosage
- This blood test was to monitor progress and help determine correct dosages for medication
- Other concerns recently has been a "gooey" left eye. Eye appears to have some brown discharge below it but otherwise normal
- Blood test ran in-house. Advised O that TM would contact on 07/03 with updated blood test results and plan regarding medication doses

HISTORY
Worm: 
Flea/mites: 
Heartworm:
Food:
Eating: 
Drinking: 
V:
D: 
Other concerns:
Was seen by cat clinic

EXAMINATION
Mentation: BAR
BCS: /9 
HR RR Temp 
Mouth: MM pink and moist, CRT<2, no pain opening the mouth, dental grade /4
Eyes: No blepharospasm, no discharge, no epiphora, normal pupil size 
Ears: Externally the ears show no discharge, no erythema 
Chest: The lung fields are normal. No upper respiratory noise. 
Cardiac: No murmur, no arrhythmia
Abdomen: Comfortable, no masses or organomegaly detected 
Urinary: Kidneys are symmetrical, bladder is comfortable
Lnn: Symmetrical, no enlargement
Skin: Good hair coat, no ectoparasites, normal skin turgor
Musculoskeletal: No lameness, good ROM stifles/hips, no stifle effusion/buttress, no spinal pain

ASSESSMENT

BLOODS
T4 has remain unchanged 62nmol/L
K+ has remained unchanged 3.3mmol/L
ALT slightly more elevated 184 U/L


Problem List: 
DDx: 

TREATMENT


PLAN