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2016 AAFP Guidelines for the Management of Feline Hyperthyroidism
2016 年美國家庭醫學學會貓類甲狀腺功能亢進症管理指導方針
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Hazel C Carney, Cynthia R Ward, […], 和 A Renee Rucinsky+5 查看所有作者和隸屬機構
Hazel C Carney, Cynthia R Ward, […], 和 A Renee Rucinsky+5 查看所有作者和隸屬機構
Abstract 摘要
Clinical context: 臨床背景：
Since 1979 and 1980 when the first reports of clinical feline hyperthyroidism (FHT) appeared in the literature, our understanding of the disease has evolved tremendously. Initially, FHT was a disease that only referral clinicians treated. Now it is a disease that primary clinicians routinely manage.
自 1979 年和 1980 年首次出現臨床貓甲狀腺功能亢進症（FHT）的報告以來，我們對這種疾病的理解已經有了巨大的進步。最初，FHT 是一種只有轉診臨床醫生治療的疾病。現在，它已成為初級臨床醫生常規管理的疾病。
Inclusion of the measurement of total thyroxine concentration in senior wellness panels, as well as in diagnostic work-ups for sick cats, now enables diagnosis of the condition long before the cat becomes the classic scrawny, unkempt, agitated patient with a bulge in its neck.
在老年健康檢查中以及對生病貓咪的診斷檢查中納入總甲狀腺素濃度的測量，現在使得在貓咪變成典型的瘦弱、邋遢、焦躁且脖子有腫塊的病患之前，就能夠早期診斷這種情況。
However, earlier recognition of the problem has given rise to several related questions: how to recognize the health significance of the early presentations of the disease; how early to treat the disease; whether to treat FHT when comorbid conditions are present; and how to manage comorbid conditions such as chronic kidney disease and cardiac disease with treatment of FHT.
然而，對問題的早期識別引發了幾個相關問題：如何識別疾病早期表現的健康意義；何時開始治療疾病；在合併症存在時是否應該治療貓甲狀腺功能亢進症；以及如何在治療貓甲狀腺功能亢進症的同時管理慢性腎病和心臟病等合併症。
The 2016 AAFP Guidelines for the Management of Feline Hyperthyroidism (hereafter referred to as the Guidelines) will shed light on these questions for the general practitioner and suggest when referral may benefit the cat.
2016 年 AAFP 貓甲狀腺功能亢進症管理指導方針（以下簡稱為指導方針）將為一般執業獸醫解答這些問題，並建議何時轉診可能對貓咪有益。
自 1979 年和 1980 年首次出現臨床貓甲狀腺功能亢進症（FHT）的報告以來，我們對這種疾病的理解已經有了巨大的進步。最初，FHT 是一種只有轉診臨床醫生治療的疾病。現在，它已成為初級臨床醫生常規管理的疾病。
Inclusion of the measurement of total thyroxine concentration in senior wellness panels, as well as in diagnostic work-ups for sick cats, now enables diagnosis of the condition long before the cat becomes the classic scrawny, unkempt, agitated patient with a bulge in its neck.
在老年健康檢查中以及對生病貓咪的診斷檢查中納入總甲狀腺素濃度的測量，現在使得在貓咪變成典型的瘦弱、邋遢、焦躁且脖子有腫塊的病患之前，就能夠早期診斷這種情況。
However, earlier recognition of the problem has given rise to several related questions: how to recognize the health significance of the early presentations of the disease; how early to treat the disease; whether to treat FHT when comorbid conditions are present; and how to manage comorbid conditions such as chronic kidney disease and cardiac disease with treatment of FHT.
然而，對問題的早期識別引發了幾個相關問題：如何識別疾病早期表現的健康意義；何時開始治療疾病；在合併症存在時是否應該治療貓甲狀腺功能亢進症；以及如何在治療貓甲狀腺功能亢進症的同時管理慢性腎病和心臟病等合併症。
The 2016 AAFP Guidelines for the Management of Feline Hyperthyroidism (hereafter referred to as the Guidelines) will shed light on these questions for the general practitioner and suggest when referral may benefit the cat.
2016 年 AAFP 貓甲狀腺功能亢進症管理指導方針（以下簡稱為指導方針）將為一般執業獸醫解答這些問題，並建議何時轉診可能對貓咪有益。
Scope: 範圍：
The Guidelines explain FHT as a primary disease process with compounding factors, and provide a concise explanation of what we know to be true about the etiology and pathogenesis of the disease.
指導方針將貓甲狀腺功能亢進症解釋為一種主要疾病過程，並提供了我們對該疾病的病因和發病機制的真實認識的簡明解釋。
指導方針將貓甲狀腺功能亢進症解釋為一種主要疾病過程，並提供了我們對該疾病的病因和發病機制的真實認識的簡明解釋。
The Guidelines also: 指導方針還：
•
Distill the current research literature into simple recommendations for testing sequences that will avoid misdiagnosis and separate an FHT diagnosis into six clinical categories with associated management strategies.
將當前的研究文獻提煉成簡單的建議，以避免誤診的檢測序列，並將 FHT 診斷分為六個臨床類別及相關的管理策略。
將當前的研究文獻提煉成簡單的建議，以避免誤診的檢測序列，並將 FHT 診斷分為六個臨床類別及相關的管理策略。
•
Emphasize the importance of treating all hyperthyroid cats, regardless of comorbidities, and outline the currently available treatments for the disease.
強調治療所有甲狀腺功能亢進的貓的重要性，無論是否有合併症，並概述目前可用的疾病治療方法。
強調治療所有甲狀腺功能亢進的貓的重要性，無論是否有合併症，並概述目前可用的疾病治療方法。
•
Explain how to monitor the treated cat to help avoid exacerbating comorbid diseases.
解釋如何監測接受治療的貓，以幫助避免加重合併疾病。
解釋如何監測接受治療的貓，以幫助避免加重合併疾病。
•
Dispel some of the myths surrounding certain aspects of FHT and replace them with an evidence-based narrative that veterinarians and their practice teams can apply to feline patients and communicate to their owners.
消除圍繞某些貓甲狀腺功能亢進症（FHT）方面的一些迷思，並用基於證據的敘述取而代之，讓獸醫及其診所團隊能夠應用於貓咪患者並與其主人溝通。
消除圍繞某些貓甲狀腺功能亢進症（FHT）方面的一些迷思，並用基於證據的敘述取而代之，讓獸醫及其診所團隊能夠應用於貓咪患者並與其主人溝通。
Evidence base: 證據基礎：
To help ensure better case outcomes, the Guidelines reflect currently available, evidenced-based knowledge. If research is lacking, or if a consensus does not exist, the expert panel of authors has made recommendations based on their extensive, cumulative clinical experience.
為了確保更好的案例結果，指導方針反映了目前可用的基於證據的知識。如果研究不足，或如果不存在共識，專家小組的作者根據他們廣泛的累積臨床經驗提出了建議。
為了確保更好的案例結果，指導方針反映了目前可用的基於證據的知識。如果研究不足，或如果不存在共識，專家小組的作者根據他們廣泛的累積臨床經驗提出了建議。
Feline hyperthyroidism: an overview
貓咪甲狀腺功能亢進症：概述
Feline hyperthyroidism (FHT) first became evident about 35 years ago, when the initial reports appeared in the literature.1,2 It was apparent that this was a ‘new’, not just an undiagnosed, disease because pathological studies within the prior decade showed a very low incidence of thyroid adenomas in cats.1,6,7 The prevalence of FHT has steadily increased worldwide since those first reports, and the disease is now diagnosed in 1.5–11.4% of older cats around the world.3,8–11 FHT is the most common endocrine disorder in middle-aged or older cats in the US,3,12 where its prevalence is up to 10% of cats older than 10 years.3
貓甲狀腺功能亢進症（FHT）約在 35 年前首次顯現，當時文獻中出現了最初的報告。 1,2 顯然這是一種「新」疾病，而不僅僅是未被診斷的疾病，因為在前十年內的病理研究顯示貓的甲狀腺腺瘤發生率非常低。 1,6,7 自從那些最初的報告以來，FHT 的流行率在全球穩步上升，目前在全球老年貓中診斷率為 1.5%至 11.4%。 3,8–11 FHT 是美國中年或老年貓中最常見的內分泌疾病， 3,12 其流行率高達 10%的貓年齡超過 10 歲。 3
貓甲狀腺功能亢進症（FHT）約在 35 年前首次顯現，當時文獻中出現了最初的報告。 1,2 顯然這是一種「新」疾病，而不僅僅是未被診斷的疾病，因為在前十年內的病理研究顯示貓的甲狀腺腺瘤發生率非常低。 1,6,7 自從那些最初的報告以來，FHT 的流行率在全球穩步上升，目前在全球老年貓中診斷率為 1.5%至 11.4%。 3,8–11 FHT 是美國中年或老年貓中最常見的內分泌疾病， 3,12 其流行率高達 10%的貓年齡超過 10 歲。 3
Clinical reports from the early 1980s described what is now known as the classic, severely hypermetabolic clinical presentation (Figure 1). The most important comorbidities were cardiorespiratory diseases.13 In the 1980s, the greatest advances were in laboratory, radiographic and echocardiographic evaluation of the disease, and treatment focused on antithyroid drugs and surgery. In the 1990s, reports of ‘apathetic’, ‘occult’ (euthyroxinemic goiter) and ‘subclinical’ hyperthyroidism emerged.
1980 年代初期的臨床報告描述了現在所稱的經典、嚴重的高代謝臨床表現（圖 1）。最重要的合併症是心肺疾病。 13 在 1980 年代，對於該疾病的實驗室、放射學和超聲心動圖評估取得了最大的進展，治療重點在於抗甲狀腺藥物和手術。在 1990 年代，出現了“無精打采”、“隱匿性”（甲狀腺素正常的甲狀腺腫）和“亞臨床”甲狀腺功能亢進的報告。
The inclusion of total serum thyroxine concentration (abbreviated to T4 in these Guidelines) in feline geriatric screening panels has increased the recognition of these other forms. Research centers began routinely offering radioactive iodine (131I) therapy in the early 1990s, with the first significant report describing this therapy being published in 1995,14 which coincided with the emergence of private treatment centers.
在貓咪老年篩檢面板中納入總血清甲狀腺素濃度（在本指導中簡稱為 T4）已增加對這些其他形式的認識。研究中心在 1990 年代初期開始常規提供放射性碘（ 131 I）療法，第一篇描述這種療法的重要報告於 1995 年發表， 14 這與私人治療中心的出現相吻合。
1980 年代初期的臨床報告描述了現在所稱的經典、嚴重的高代謝臨床表現（圖 1）。最重要的合併症是心肺疾病。 13 在 1980 年代，對於該疾病的實驗室、放射學和超聲心動圖評估取得了最大的進展，治療重點在於抗甲狀腺藥物和手術。在 1990 年代，出現了“無精打采”、“隱匿性”（甲狀腺素正常的甲狀腺腫）和“亞臨床”甲狀腺功能亢進的報告。
The inclusion of total serum thyroxine concentration (abbreviated to T4 in these Guidelines) in feline geriatric screening panels has increased the recognition of these other forms. Research centers began routinely offering radioactive iodine (131I) therapy in the early 1990s, with the first significant report describing this therapy being published in 1995,14 which coincided with the emergence of private treatment centers.
在貓咪老年篩檢面板中納入總血清甲狀腺素濃度（在本指導中簡稱為 T4）已增加對這些其他形式的認識。研究中心在 1990 年代初期開始常規提供放射性碘（ 131 I）療法，第一篇描述這種療法的重要報告於 1995 年發表， 14 這與私人治療中心的出現相吻合。
圖 1 嚴重虛弱的甲狀腺功能亢進貓：這在 1980 年代和 1990 年代初期是一種非常常見的臨床表現。感謝 Hazel Carney 醫生提供。
Some cats have a cystic enlargement of the thyroid gland without hyperthyroxemia.15,16 Histopathology shows that most hyperthyroid cats suffer from a form of toxic nodular goiter, similar to Plummer’s disease seen in man. This is a benign condition in which growth and function are autonomous.17,18 To date there are no known reports of cats exhibiting thyroid autoantibodies, as are present in Graves’ disease in humans.
一些貓的甲狀腺腫大是囊性增大，並且沒有高甲狀腺素血症。 15,16 組織病理學顯示，大多數甲狀腺功能亢進的貓患有一種毒性結節性甲狀腺腫，類似於人類的普拉默病。這是一種良性狀況，其中生長和功能是自主的。 17,18 到目前為止，尚無已知報告顯示貓有甲狀腺自體抗體，這在人的格雷夫斯病中是存在的。
一些貓的甲狀腺腫大是囊性增大，並且沒有高甲狀腺素血症。 15,16 組織病理學顯示，大多數甲狀腺功能亢進的貓患有一種毒性結節性甲狀腺腫，類似於人類的普拉默病。這是一種良性狀況，其中生長和功能是自主的。 17,18 到目前為止，尚無已知報告顯示貓有甲狀腺自體抗體，這在人的格雷夫斯病中是存在的。
The majority of hyperthyroid cats have bilateral disease. Early experience indicated that removal of a functional adenoma might be followed by development of a contralateral one.
大多數甲狀腺功能亢進的貓咪都有雙側疾病。早期經驗表明，去除一個功能性腺瘤可能會隨之發展出對側的腺瘤。
If ablative surgery or radioiodine was not chosen for management of the initial mass, scintigraphic evidence suggested that the adenoma could continue to grow, possibly leading to malignancy, as occurs in human patients.3,19–22 Of importance to the practitioner, only 2% of hyperthyroid cats have malignant carcinomas at the time of initial diagnosis.23,24
如果未選擇切除手術或放射性碘來處理初始腫塊，閃爍攝影的證據顯示腺瘤可能會繼續增長，可能導致惡性腫瘤，這在人體患者中也會發生。對於執業者來說，只有 2%的甲狀腺功能亢進貓在初次診斷時有惡性腫瘤。
大多數甲狀腺功能亢進的貓咪都有雙側疾病。早期經驗表明，去除一個功能性腺瘤可能會隨之發展出對側的腺瘤。
If ablative surgery or radioiodine was not chosen for management of the initial mass, scintigraphic evidence suggested that the adenoma could continue to grow, possibly leading to malignancy, as occurs in human patients.3,19–22 Of importance to the practitioner, only 2% of hyperthyroid cats have malignant carcinomas at the time of initial diagnosis.23,24
如果未選擇切除手術或放射性碘來處理初始腫塊，閃爍攝影的證據顯示腺瘤可能會繼續增長，可能導致惡性腫瘤，這在人體患者中也會發生。對於執業者來說，只有 2%的甲狀腺功能亢進貓在初次診斷時有惡性腫瘤。
We do not yet have a clear picture of the causes of FHT in its current presentation. Multiple factors play a role but the relative importance of each is unknown.20,25–27 Our current understanding can be summarized as follows. Genetics may influence susceptibility: in one study, Siamese and Burmese breeds had a decreased risk of developing the disease.26 Changes in cat husbandry since the 1970s to the present day, including a higher percentage of indoor cats, increased utilization of commercial cat foods and longer life spans, may influence the prevalence.25–27 Age has long been understood to be a risk factor for thyroid nodule development in humans. Bilateral disease strengthens the hypotheses of dietary and environmental etiologies rather than mutational causes alone.18
我們目前對於 FHT 在當前表現形式的原因尚未有清晰的了解。多種因素在其中發揮作用，但每個因素的相對重要性尚不清楚。 20,25–27 我們目前的理解可以總結如下。遺傳可能影響易感性：在一項研究中，暹羅貓和緬甸貓的發病風險較低。 26 自 1970 年代以來，貓的飼養方式發生了變化，包括室內貓的比例增加、商業貓糧的使用增加以及壽命延長，這些可能影響了流行率。 25–27 年齡長期以來被認為是人類甲狀腺結節發展的風險因素。雙側疾病加強了飲食和環境病因的假設，而不僅僅是突變原因。 18
我們目前對於 FHT 在當前表現形式的原因尚未有清晰的了解。多種因素在其中發揮作用，但每個因素的相對重要性尚不清楚。 20,25–27 我們目前的理解可以總結如下。遺傳可能影響易感性：在一項研究中，暹羅貓和緬甸貓的發病風險較低。 26 自 1970 年代以來，貓的飼養方式發生了變化，包括室內貓的比例增加、商業貓糧的使用增加以及壽命延長，這些可能影響了流行率。 25–27 年齡長期以來被認為是人類甲狀腺結節發展的風險因素。雙側疾病加強了飲食和環境病因的假設，而不僅僅是突變原因。 18
Epidemiologic studies have produced a list of ‘guilt by association’ compounds, many of which are phenols or halogenated hydrocarbons. More hyperthyroid cats use deodorized kitty litter and/or eat food from cans that may contain bisphenol A and phthalates.3,28–33 Soy isoflavones, a component of many cat foods, and the common environmental contaminant fire-retardant PBDEs (polybrominated diphenyl ethers) may act as goitrogens via thyroid-stimulating hormone (TSH) stimulation or as direct mitogens.31–34 Variable iodine content of cat foods also seems to have an influence on the development of the disease.35–37 Because no studies have prospectively evaluated lifelong exposure to a specific compound in hyperthyroid cats, advise cautious cat owners that all associations are conjecture, and not proven fact.
流行病學研究產生了一份「因聯而罪」的化合物清單，其中許多是酚類或卤化碳氫化合物。更多的甲狀腺功能亢進貓使用去味貓砂和/或食用可能含有雙酚 A 和鄰苯二甲酸酯的罐頭食品。 3,28–33 大豆異黃酮是許多貓糧的成分，而常見的環境污染物阻燃劑 PBDEs（多溴聯苯醚）可能通過刺激甲狀腺刺激激素（TSH）或作為直接的有絲分裂促進劑來作為甲狀腺腫物質。 31–34 貓糧中碘的變化含量似乎也對疾病的發展有影響。 35–37 由於沒有研究前瞻性地評估甲狀腺功能亢進貓對特定化合物的終生暴露，建議謹慎的貓主人，所有的聯繫都是推測，而不是已證實的事實。
流行病學研究產生了一份「因聯而罪」的化合物清單，其中許多是酚類或卤化碳氫化合物。更多的甲狀腺功能亢進貓使用去味貓砂和/或食用可能含有雙酚 A 和鄰苯二甲酸酯的罐頭食品。 3,28–33 大豆異黃酮是許多貓糧的成分，而常見的環境污染物阻燃劑 PBDEs（多溴聯苯醚）可能通過刺激甲狀腺刺激激素（TSH）或作為直接的有絲分裂促進劑來作為甲狀腺腫物質。 31–34 貓糧中碘的變化含量似乎也對疾病的發展有影響。 35–37 由於沒有研究前瞻性地評估甲狀腺功能亢進貓對特定化合物的終生暴露，建議謹慎的貓主人，所有的聯繫都是推測，而不是已證實的事實。
Diagnosis 診斷
Because thyroid hormone affects various body systems, the clinical presentation of a hyperthyroid cat can include a variety of signs. No single clinical presentation is pathognomonic for FHT. Also, as FHT is being diagnosed earlier in its progression, clinical signs may be subtle in many cats.
因為甲狀腺激素影響各種身體系統，甲狀腺功能亢進的貓的臨床表現可能包括多種徵兆。沒有單一的臨床表現是甲狀腺功能亢進的特異性指標。此外，隨著甲狀腺功能亢進在其進展早期被診斷，許多貓的臨床徵兆可能較為微妙。
For this reason, diligence in obtaining historical and physical exam findings in middle-aged to older cats is important. Many of these patients will have comorbidities that can complicate diagnosis or treatment.
因此，對於中年到老年的貓咪，仔細獲取病史和身體檢查結果是非常重要的。這些患者中許多會有合併症，可能會使診斷或治療變得複雜。
因為甲狀腺激素影響各種身體系統，甲狀腺功能亢進的貓的臨床表現可能包括多種徵兆。沒有單一的臨床表現是甲狀腺功能亢進的特異性指標。此外，隨著甲狀腺功能亢進在其進展早期被診斷，許多貓的臨床徵兆可能較為微妙。
For this reason, diligence in obtaining historical and physical exam findings in middle-aged to older cats is important. Many of these patients will have comorbidities that can complicate diagnosis or treatment.
因此，對於中年到老年的貓咪，仔細獲取病史和身體檢查結果是非常重要的。這些患者中許多會有合併症，可能會使診斷或治療變得複雜。
Presenting signs, differential diagnoses and diagnostic confirmation
呈現症狀、鑑別診斷和診斷確認
The classic signs of FHT are weight loss, polyphagia, polyuria, polydipsia, increased vocalization, agitation, increased activity, tachypnea, tachycardia, vomiting, diarrhea and an unkempt hair coat (Figure 2). Differential diagnoses for cats with clinical signs similar to hyperthyroidism should include diabetes mellitus, gastrointestinal malabsorption or maldigestion, neoplasia (especially gastrointestinal lymphosarcoma), chronic kidney disease (CKD) and parasitism.
FHT 的經典症狀包括體重減輕、異常食慾、多尿、多飲、聲音增多、煩躁、活動增加、呼吸急促、心跳過速、vomiting、腹瀉以及毛髮凌亂（圖 2）。對於臨床症狀類似於甲狀腺功能亢進的貓，鑑別診斷應包括糖尿病、腸道吸收不良或消化不良、腫瘤（特別是腸道淋巴肉瘤）、慢性腎病（CKD）和寄生蟲感染。
FHT 的經典症狀包括體重減輕、異常食慾、多尿、多飲、聲音增多、煩躁、活動增加、呼吸急促、心跳過速、vomiting、腹瀉以及毛髮凌亂（圖 2）。對於臨床症狀類似於甲狀腺功能亢進的貓，鑑別診斷應包括糖尿病、腸道吸收不良或消化不良、腫瘤（特別是腸道淋巴肉瘤）、慢性腎病（CKD）和寄生蟲感染。
圖 2 一隻貓在患有甲狀腺功能亢進症之前（a）和期間（b）。注意體重減輕和毛髮凌亂。感謝史蒂文·貝利醫生提供。
A definitive diagnosis of FHT requires demonstration of persistently elevated thyroid hormone concentrations (T4, or T4 plus free T4 by equilibrium dialysis [fT4ed]) occurring concurrently with one or more of the typical clinical signs.
確診貓甲狀腺功能亢進症（FHT）需要證明持續升高的甲狀腺激素濃度（T4，或通過平衡透析測得的 T4 加游離 T4 [fT4ed]）與一個或多個典型臨床症狀同時出現。
確診貓甲狀腺功能亢進症（FHT）需要證明持續升高的甲狀腺激素濃度（T4，或通過平衡透析測得的 T4 加游離 T4 [fT4ed]）與一個或多個典型臨床症狀同時出現。
Signalment, history and physical examination
信號、病史和身體檢查
The classic presentation for a hyperthyroid cat is a patient that is greater than 8 years of age, is active, has a good appetite and demonstrates some weight loss. The owner may also notice some degree of polyuria indicated by the need to clean the litter box more often.
甲狀腺功能亢進的貓咪經典表現為年齡超過 8 歲的患者，活躍，食慾良好，並顯示出一定程度的體重減輕。主人也可能會注意到某種程度的多尿，這表現為需要更頻繁地清理貓砂盆。
Behavioral patterns such as drinking from a dripping faucet or from drip containers used for indoor plants may suggest the cat is thirsty.
行為模式，例如從滴水的水龍頭或用於室內植物的滴水容器中飲水，可能表明貓咪口渴。
甲狀腺功能亢進的貓咪經典表現為年齡超過 8 歲的患者，活躍，食慾良好，並顯示出一定程度的體重減輕。主人也可能會注意到某種程度的多尿，這表現為需要更頻繁地清理貓砂盆。
Behavioral patterns such as drinking from a dripping faucet or from drip containers used for indoor plants may suggest the cat is thirsty.
行為模式，例如從滴水的水龍頭或用於室內植物的滴水容器中飲水，可能表明貓咪口渴。
During the examination, owners of hyperthyroid cats will often make comments such as:
在檢查過程中，甲狀腺功能亢進貓的主人經常會發表以下評論：
在檢查過程中，甲狀腺功能亢進貓的主人經常會發表以下評論：
•
‘I think my cat is senile.’
「我覺得我的貓變得老糊塗了。」
「我覺得我的貓變得老糊塗了。」
•
‘My cat is starving all the time.’
「我的貓一直在餓。」
「我的貓一直在餓。」
•
‘My cat feels great and is acting like a kitten again.’
「我的貓感覺很好，像小貓一樣活潑。」
「我的貓感覺很好，像小貓一樣活潑。」
•
‘I can’t believe this cat is 16 years old.’
「我無法相信這隻貓已經 16 歲了。」
「我無法相信這隻貓已經 16 歲了。」
•
‘My cat is losing weight because it is so much more active.’
「我的貓正在減肥，因為牠變得更加活躍。」
「我的貓正在減肥，因為牠變得更加活躍。」
•
‘The diet is finally working.’
「這個飲食終於有效了。」
「這個飲食終於有效了。」
If a suspicion of FHT exists, asking the following questions when obtaining the patient’s history may elicit answers that increase the index of suspicion for the disease:
如果懷疑存在貓甲狀腺功能亢進症，詢問以下問題以獲取病歷可能會引出增加對該疾病懷疑的答案：
如果懷疑存在貓甲狀腺功能亢進症，詢問以下問題以獲取病歷可能會引出增加對該疾病懷疑的答案：
A thorough physical exam is important because findings in hyperthyroid cats can vary significantly. Classically, weight loss and muscle loss, affecting the epaxial muscles especially, is notable. The cat may appear unkempt (Figure 2). Palpably enlarged thyroid glands are suggestive, but not necessarily indicative, of clinical hyperthyroidism.40 Heart murmurs and arrhythmias are often auscultated in FHT. Abnormal size, shape or consistency of the kidneys or intestinal tract may suggest comorbidities.
徹底的身體檢查是重要的，因為甲狀腺功能亢進的貓咪的檢查結果可能會有顯著差異。典型的情況是體重減輕和肌肉流失，特別是影響到背部肌肉。貓咪可能看起來不修邊幅（圖 2）。可觸及的甲狀腺腺體腫大是有提示性的，但不一定表示臨床甲狀腺功能亢進。 40 心雜音和心律不整在甲狀腺功能亢進的貓中常常被聽到。腎臟或腸道的異常大小、形狀或質地可能暗示合併症。
徹底的身體檢查是重要的，因為甲狀腺功能亢進的貓咪的檢查結果可能會有顯著差異。典型的情況是體重減輕和肌肉流失，特別是影響到背部肌肉。貓咪可能看起來不修邊幅（圖 2）。可觸及的甲狀腺腺體腫大是有提示性的，但不一定表示臨床甲狀腺功能亢進。 40 心雜音和心律不整在甲狀腺功能亢進的貓中常常被聽到。腎臟或腸道的異常大小、形狀或質地可能暗示合併症。
The identification of hypertension in cats with FHT is critical for their health. Monitoring blood pressure in suspect and diagnosed cats at every visit is optimal. Because systemic blood pressure can be difficult to assess in a cat out of its normal environment, performing a complete fundic exam may determine whether hypertensive retinopathy is present (Figure 3). Monitoring blood pressure and retinal anatomy throughout treatment of FHT is important because, if hypertension does not resolve with control of FHT, the cat will require additional diagnostic testing for such conditions as chronic renal disease, diabetes mellitus, hyperaldosteronism and hyperadrenocorticism, as well as need specific antihypertensive management.
在患有貓甲狀腺功能亢進症的貓中，識別高血壓對其健康至關重要。在每次就診時，對可疑和已診斷的貓進行血壓監測是最佳做法。由於在貓的正常環境之外評估全身血壓可能會很困難，因此進行完整的眼底檢查可能會確定是否存在高血壓性視網膜病變（圖 3）。在貓甲狀腺功能亢進症的治療過程中監測血壓和視網膜解剖結構非常重要，因為如果高血壓在控制貓甲狀腺功能亢進症後未能緩解，則該貓將需要進一步的診斷檢測，以排除慢性腎病、糖尿病、醛固酮增多症和腎上腺皮質功能亢進等病症，並需要特定的抗高血壓管理。
Additionally, some cats can develop hypertension after re-establishment of euthyroidism.41
此外，一些貓在重新建立甲狀腺功能正常後可能會發展出高血壓。
在患有貓甲狀腺功能亢進症的貓中，識別高血壓對其健康至關重要。在每次就診時，對可疑和已診斷的貓進行血壓監測是最佳做法。由於在貓的正常環境之外評估全身血壓可能會很困難，因此進行完整的眼底檢查可能會確定是否存在高血壓性視網膜病變（圖 3）。在貓甲狀腺功能亢進症的治療過程中監測血壓和視網膜解剖結構非常重要，因為如果高血壓在控制貓甲狀腺功能亢進症後未能緩解，則該貓將需要進一步的診斷檢測，以排除慢性腎病、糖尿病、醛固酮增多症和腎上腺皮質功能亢進等病症，並需要特定的抗高血壓管理。
Additionally, some cats can develop hypertension after re-establishment of euthyroidism.41
此外，一些貓在重新建立甲狀腺功能正常後可能會發展出高血壓。
圖 3 甲狀腺功能亢進貓的雙側視網膜脫落。感謝 Cynthia Ward 醫生提供。
For any cat that you suspect is hyperthyroid, obtain a minimum database both to diagnose FHT and identify any potential comorbidities. Include a CBC, serum chemistry, urinalysis and T4 assay. Definitive diagnosis of FHT may require additional testing using fT4ed and TSH with T4, use of 99Tc scintigraphy (Figure 4) or a T3 suppression test. Chest radiographs, echocardiography and abdominal imaging will further evaluate the extent of non-thyroidal disease.
對於任何你懷疑有甲狀腺功能亢進的貓，應獲取最少的數據庫，以診斷 FHT 並識別任何潛在的共病。包括 CBC、血清化學、尿液分析和 T4 測定。FHT 的確診可能需要額外的測試，使用 fT4ed 和 TSH 與 T4，使用 99 Tc 掃描（圖 4）或 T3 抑制測試。胸部 X 光、心臟超聲檢查和腹部影像學將進一步評估非甲狀腺疾病的程度。
對於任何你懷疑有甲狀腺功能亢進的貓，應獲取最少的數據庫，以診斷 FHT 並識別任何潛在的共病。包括 CBC、血清化學、尿液分析和 T4 測定。FHT 的確診可能需要額外的測試，使用 fT4ed 和 TSH 與 T4，使用 99 Tc 掃描（圖 4）或 T3 抑制測試。胸部 X 光、心臟超聲檢查和腹部影像學將進一步評估非甲狀腺疾病的程度。
圖 4 99Tc 螢光影像顯示雙側但不對稱的頸部甲狀腺腫大。感謝 Hazel Carney 醫生提供。
Managing hyperthyroid cats with concurrent CKD
同時患有慢性腎病的甲狀腺功能亢進貓的管理
Panel members have observed that many clinicians believe that an elevated T4 supports renal function. Recent literature suggests that treatment of FHT while avoiding hypothyroidism is desirable in cats with renal insufficiency (Figure 5).12,42 The Panel recommends treatment of hyperthyroid patients regardless of concurrent disease (eg, Group 5 cats). This includes cats with pre-existing CKD and those that develop azotemia after initiation of FHT treatment.
小組成員觀察到，許多臨床醫生認為升高的 T4 支持腎功能。最近的文獻建議，在腎功能不全的貓中，治療貓甲狀腺功能亢進症同時避免甲狀腺功能低下是可取的（圖 5）。小組建議無論是否有合併疾病（例如，第 5 組貓），都應治療甲狀腺功能亢進的患者。這包括有既往慢性腎病的貓和在開始貓甲狀腺功能亢進症治療後發展出氮血症的貓。
These patients will require careful monitoring in order to achieve and maintain a euthyroid state while at the same time preventing hypothyroidism or mild hyperthyroidism.
這些患者需要仔細監測，以達到並維持正常甲狀腺功能，同時防止甲狀腺功能低下或輕度甲狀腺功能亢進。
小組成員觀察到，許多臨床醫生認為升高的 T4 支持腎功能。最近的文獻建議，在腎功能不全的貓中，治療貓甲狀腺功能亢進症同時避免甲狀腺功能低下是可取的（圖 5）。小組建議無論是否有合併疾病（例如，第 5 組貓），都應治療甲狀腺功能亢進的患者。這包括有既往慢性腎病的貓和在開始貓甲狀腺功能亢進症治療後發展出氮血症的貓。
These patients will require careful monitoring in order to achieve and maintain a euthyroid state while at the same time preventing hypothyroidism or mild hyperthyroidism.
這些患者需要仔細監測，以達到並維持正常甲狀腺功能，同時防止甲狀腺功能低下或輕度甲狀腺功能亢進。
圖 5 腎功能不全對甲狀腺功能亢進貓隻生存率的影響。該圖表是根據 Milner 等人的研究數據推斷而來的 99
Treatment recommendations differ depending on the degree of underlying renal disease. Therefore, it is important to fully determine the renal status of the patient prior to initiating FHT treatment.
治療建議根據潛在腎病的程度而有所不同。因此，在開始進行貓甲狀腺功能亢進症治療之前，充分確定患者的腎臟狀況是很重要的。
The Panel recommends using the staging guidelines set out by the International Renal Interest Society (IRIS), including determination of blood pressure and urine protein quantification.43 Note that cachexia will affect the serum urea nitrogen level (elevated due to increased protein turnover) and creatinine level (decreased due to loss of muscle mass).44 Recording a body condition score and muscle condition score at each physical exam will help to document progressive changes.45
小組建議使用國際腎臟利益協會（IRIS）制定的分期指導方針，包括血壓測定和尿蛋白定量。 43 注意，惡病質會影響血清尿素氮水平（由於蛋白質周轉增加而升高）和肌酐水平（由於肌肉質量喪失而降低）。 44 在每次身體檢查中記錄身體狀況評分和肌肉狀況評分將有助於記錄進展性變化。 45
治療建議根據潛在腎病的程度而有所不同。因此，在開始進行貓甲狀腺功能亢進症治療之前，充分確定患者的腎臟狀況是很重要的。
The Panel recommends using the staging guidelines set out by the International Renal Interest Society (IRIS), including determination of blood pressure and urine protein quantification.43 Note that cachexia will affect the serum urea nitrogen level (elevated due to increased protein turnover) and creatinine level (decreased due to loss of muscle mass).44 Recording a body condition score and muscle condition score at each physical exam will help to document progressive changes.45
小組建議使用國際腎臟利益協會（IRIS）制定的分期指導方針，包括血壓測定和尿蛋白定量。 43 注意，惡病質會影響血清尿素氮水平（由於蛋白質周轉增加而升高）和肌酐水平（由於肌肉質量喪失而降低）。 44 在每次身體檢查中記錄身體狀況評分和肌肉狀況評分將有助於記錄進展性變化。 45
Managing the cat that is non-azotemic at initiation of treatment for hyperthyroidism
管理在甲狀腺功能亢進治療開始時非氮毒性的貓咪
The Panel recommends the same monitoring for non-azotemic hyperthyroid cats as for Group 1 cats. Azotemia may develop subsequent to treatment of FHT. If that occurs, survival time decreases significantly.12,46–49 Avoid causing iatrogenic hypothyroidism. Evaluation of serial concomitant creatinine, T4 and TSH tests may help to determine whether T4 supplementation is necessary.49 Utilize the IRIS guidelines for staging and treatment, including management of hypertension and proteinuria if those abnormalities do not resolve upon returning to euthyroidism.
小組建議對非氮血症的甲狀腺功能亢進貓進行與第一組貓相同的監測。氮血症可能在 FHT 治療後發展。如果發生這種情況，生存時間會顯著減少。 12,46–49 避免造成醫源性甲狀腺功能減退。評估連續的肌酐、T4 和 TSH 檢測可能有助於確定是否需要 T4 補充。 49 利用 IRIS 指導方針進行分期和治療，包括在這些異常在恢復至正常甲狀腺功能後仍未解決的情況下管理高血壓和蛋白尿。
小組建議對非氮血症的甲狀腺功能亢進貓進行與第一組貓相同的監測。氮血症可能在 FHT 治療後發展。如果發生這種情況，生存時間會顯著減少。 12,46–49 避免造成醫源性甲狀腺功能減退。評估連續的肌酐、T4 和 TSH 檢測可能有助於確定是否需要 T4 補充。 49 利用 IRIS 指導方針進行分期和治療，包括在這些異常在恢復至正常甲狀腺功能後仍未解決的情況下管理高血壓和蛋白尿。
Keeping cats with azotemia ‘a little bit’ hyperthyroid to increase renal perfusion and lower creatinine levels is deleterious. This approach can exacerbate renal damage while giving a false sense of security based on an artificially lowered creatinine level.
將有氮血症的貓咪保持「稍微」甲狀腺功能亢進以增加腎臟灌注和降低肌酐水平是有害的。這種方法可能會加劇腎臟損傷，同時基於人為降低的肌酐水平給予錯誤的安全感。
Elevated T4 causes increased beta-adrenergic activity and activation of the renin–angiotensin– aldosterone system, leading to increased cardiac output, volume overload, sodium retention, renal hypertension and glomerular sclerosis, ultimately progressing to, or worsening, CKD.50,51
升高的 T4 會導致β-腎上腺素能活性增加和腎素-血管緊張素-醛固酮系統的激活，導致心輸出量增加、容量過載、鈉潴留、腎高血壓和腎小球硬化，最終進展或加重慢性腎病（CKD）。
將有氮血症的貓咪保持「稍微」甲狀腺功能亢進以增加腎臟灌注和降低肌酐水平是有害的。這種方法可能會加劇腎臟損傷，同時基於人為降低的肌酐水平給予錯誤的安全感。
Elevated T4 causes increased beta-adrenergic activity and activation of the renin–angiotensin– aldosterone system, leading to increased cardiac output, volume overload, sodium retention, renal hypertension and glomerular sclerosis, ultimately progressing to, or worsening, CKD.50,51
升高的 T4 會導致β-腎上腺素能活性增加和腎素-血管緊張素-醛固酮系統的激活，導致心輸出量增加、容量過載、鈉潴留、腎高血壓和腎小球硬化，最終進展或加重慢性腎病（CKD）。
Managing the cat that is azotemic at initiation of treatment for hyperthyroidism
管理在甲狀腺功能亢進治療開始時有氮血症的貓咪
Cats that are identified as hyperthyroid with concurrent renal azotemia fall into the Group 5 category and should be monitored accordingly. Comorbidity of azotemia with FHT is common.
被確診為甲狀腺功能亢進且同時有腎性氮血症的貓屬於第 5 組，應根據情況進行監測。氮血症與貓甲狀腺功能亢進的共病情況很常見。
被確診為甲狀腺功能亢進且同時有腎性氮血症的貓屬於第 5 組，應根據情況進行監測。氮血症與貓甲狀腺功能亢進的共病情況很常見。
The Panel recommends treating FHT in cats with pre-existing CKD. Treat both diseases concurrently. Manage IRIS stage 1 and 2 cases as though they are non-azotemic. If the patient responds favorably and renal function is stable using a reversible treatment, then consider an irreversible FHT treatment.47 IRIS stage 3 and 4 patients warrant a more prudent approach consistent with Group 5 status; for example, using lower doses of methimazole and more aggressive management of CKD.47 If a permanent treatment for FHT is pursued, careful monitoring and aggressive kidney support may be required during the period of regeneration of previously suppressed normal thyroid tissue.
小組建議對已有慢性腎病的貓進行甲狀腺功能亢進症的治療。兩種疾病應同時治療。對於 IRIS 第 1 和第 2 期的病例，應像對待非氮毒性病例一樣管理。如果患者反應良好且腎功能穩定，使用可逆治療，則考慮不可逆的甲狀腺功能亢進症治療。 47 IRIS 第 3 和第 4 期的患者需要更謹慎的方法，與第 5 組的狀態一致；例如，使用較低劑量的美托咪唑和更積極的慢性腎病管理。 47 如果追求甲狀腺功能亢進症的永久性治療，則在之前被抑制的正常甲狀腺組織再生期間，可能需要仔細監測和積極的腎臟支持。
小組建議對已有慢性腎病的貓進行甲狀腺功能亢進症的治療。兩種疾病應同時治療。對於 IRIS 第 1 和第 2 期的病例，應像對待非氮毒性病例一樣管理。如果患者反應良好且腎功能穩定，使用可逆治療，則考慮不可逆的甲狀腺功能亢進症治療。 47 IRIS 第 3 和第 4 期的患者需要更謹慎的方法，與第 5 組的狀態一致；例如，使用較低劑量的美托咪唑和更積極的慢性腎病管理。 47 如果追求甲狀腺功能亢進症的永久性治療，則在之前被抑制的正常甲狀腺組織再生期間，可能需要仔細監測和積極的腎臟支持。
Typically the thyroxine nadir occurs 2 weeks after radioiodine treatment, with T4 normalization occurring around 4 weeks after treatment.52 Supplementation with levothyroxine during this period will resolve iatrogenic hypothyroidism and may be necessary in clinically hypothyroid patients.48 However, this treatment will also suppress pituitary TSH, which is needed to stimulate regeneration of atrophied thyroid tissue. In such cases, it is imperative to establish euthyroidism in order to avoid renal hypertension and further glomerular damage, while at the same time avoiding iatrogenic hypothyroidism.
通常，甲狀腺素的最低點在放射性碘治療後的兩週出現，T4 的正常化大約在治療後的四週發生。 52 在此期間補充左甲狀腺素將解決醫源性甲狀腺功能低下，並可能在臨床上甲狀腺功能低下的患者中是必要的。 48 然而，這種治療也會抑制垂體的 TSH，這是刺激萎縮的甲狀腺組織再生所需的。在這種情況下，建立甲狀腺功能正常是至關重要的，以避免腎高血壓和進一步的腎小球損傷，同時避免醫源性甲狀腺功能低下。
Just as in those cats that develop azotemia after treatment of FHT, the evaluation of serial concomitant creatinine, T4 and TSH tests may help to determine whether T4 supplementation is necessary.49 The Panel generally recommends testing post-surgical and post-radioiodine patients at 30, 60, 90 and 180 days after treatment.
就像那些在治療 FHT 後發展出氮血症的貓一樣，連續的肌酐、T4 和 TSH 測試的評估可能有助於確定是否需要 T4 補充。 49 小組通常建議在治療後的 30、60、90 和 180 天對手術和放射碘治療的患者進行測試。
通常，甲狀腺素的最低點在放射性碘治療後的兩週出現，T4 的正常化大約在治療後的四週發生。 52 在此期間補充左甲狀腺素將解決醫源性甲狀腺功能低下，並可能在臨床上甲狀腺功能低下的患者中是必要的。 48 然而，這種治療也會抑制垂體的 TSH，這是刺激萎縮的甲狀腺組織再生所需的。在這種情況下，建立甲狀腺功能正常是至關重要的，以避免腎高血壓和進一步的腎小球損傷，同時避免醫源性甲狀腺功能低下。
Just as in those cats that develop azotemia after treatment of FHT, the evaluation of serial concomitant creatinine, T4 and TSH tests may help to determine whether T4 supplementation is necessary.49 The Panel generally recommends testing post-surgical and post-radioiodine patients at 30, 60, 90 and 180 days after treatment.
就像那些在治療 FHT 後發展出氮血症的貓一樣，連續的肌酐、T4 和 TSH 測試的評估可能有助於確定是否需要 T4 補充。 49 小組通常建議在治療後的 30、60、90 和 180 天對手術和放射碘治療的患者進行測試。
Managing hyperthyroid cats with concurrent heart disease
同時患有心臟病的甲狀腺亢進貓的管理
Concurrent heart disease is common in hyperthyroid cats, and may or may not be a direct effect of FHT. As with other concurrent diseases, first correct the hyperthyroidism and then evaluate the heart disease once the cat is euthyroid. Correction of the thyrotoxicity and systemic hypertension can improve cardiac disease in some cats.
同時心臟病在甲狀腺功能亢進的貓中很常見，可能是甲狀腺功能亢進的直接影響，也可能不是。與其他同時存在的疾病一樣，首先要糾正甲狀腺功能亢進，然後在貓咪恢復正常甲狀腺功能後評估心臟病。糾正甲狀腺毒症和全身性高血壓可以改善某些貓的心臟病。
For several months following successful resolution of the hyperthyroid state there can be echocardiographic abnormalities that both emerge and resolve.53 Serially evaluate cats with documented echocardiographic changes prior to achieving euthyroidism, as well as cats with emerging clinical signs. N-terminal probrain natriuretic peptide (NT-proBNP) values increase in cats with FHT and in cats with hypertrophic cardiomyopathy (HCM), but typically decrease within 3 months of achieving a euthyroid state.54 If NT-proBNP remains elevated after 3 months, further evaluate the cat for HCM.
在成功解決甲狀腺功能亢進狀態後的幾個月內，可能會出現和消失的心臟超聲異常。 53 對於在達到正常甲狀腺功能之前有記錄的心臟超聲變化的貓，以及出現臨床症狀的貓，進行連續評估。N-末端腦利鈉肽（NT-proBNP）在患有甲狀腺功能亢進（FHT）和肥厚型心肌病（HCM）的貓中會增加，但通常在達到正常甲狀腺功能的 3 個月內會減少。 54 如果 NT-proBNP 在 3 個月後仍然升高，則需進一步評估該貓是否患有 HCM。
同時心臟病在甲狀腺功能亢進的貓中很常見，可能是甲狀腺功能亢進的直接影響，也可能不是。與其他同時存在的疾病一樣，首先要糾正甲狀腺功能亢進，然後在貓咪恢復正常甲狀腺功能後評估心臟病。糾正甲狀腺毒症和全身性高血壓可以改善某些貓的心臟病。
For several months following successful resolution of the hyperthyroid state there can be echocardiographic abnormalities that both emerge and resolve.53 Serially evaluate cats with documented echocardiographic changes prior to achieving euthyroidism, as well as cats with emerging clinical signs. N-terminal probrain natriuretic peptide (NT-proBNP) values increase in cats with FHT and in cats with hypertrophic cardiomyopathy (HCM), but typically decrease within 3 months of achieving a euthyroid state.54 If NT-proBNP remains elevated after 3 months, further evaluate the cat for HCM.
在成功解決甲狀腺功能亢進狀態後的幾個月內，可能會出現和消失的心臟超聲異常。 53 對於在達到正常甲狀腺功能之前有記錄的心臟超聲變化的貓，以及出現臨床症狀的貓，進行連續評估。N-末端腦利鈉肽（NT-proBNP）在患有甲狀腺功能亢進（FHT）和肥厚型心肌病（HCM）的貓中會增加，但通常在達到正常甲狀腺功能的 3 個月內會減少。 54 如果 NT-proBNP 在 3 個月後仍然升高，則需進一步評估該貓是否患有 HCM。
Newly diagnosed, unregulated hyperthyroid cats with concurrent congestive heart failure (CHF) require simultaneous treatment for both diseases as well as regular monitoring of CHF status as the cat becomes euthyroid.
新診斷的、未受控制的甲狀腺功能亢進貓隻若同時患有充血性心臟衰竭（CHF），則需要同時治療這兩種疾病，並在貓隻恢復正常甲狀腺功能的過程中定期監測 CHF 狀態。
新診斷的、未受控制的甲狀腺功能亢進貓隻若同時患有充血性心臟衰竭（CHF），則需要同時治療這兩種疾病，並在貓隻恢復正常甲狀腺功能的過程中定期監測 CHF 狀態。
Treatment modalities 治療方式
Hyperthyroidism in cats is a life-threatening disease requiring prompt veterinary attention. After establishing a diagnosis of FHT, the clinician and client are faced with multiple treatment options.
貓的甲狀腺功能亢進是一種危及生命的疾病，需要及時的獸醫關注。在確診為貓甲狀腺功能亢進後，臨床醫生和客戶面臨多種治療選擇。
The choice of therapy often depends on factors such as the cat’s age, comorbidities, treatment cost, availability of treatment options, and the clinician’s recommendation and expertise. The goal of therapy is to restore euthyroidism, avoid hypothyroidism and minimize side effects of treatment. In general, treat all cats diagnosed with FHT and monitor prudently.
治療的選擇通常取決於貓的年齡、合併症、治療成本、治療選擇的可用性以及臨床醫生的建議和專業知識。治療的目標是恢復甲狀腺功能正常，避免甲狀腺功能低下，並最小化治療的副作用。一般來說，對所有被診斷為貓甲狀腺亢進症的貓進行治療並謹慎監測。
貓的甲狀腺功能亢進是一種危及生命的疾病，需要及時的獸醫關注。在確診為貓甲狀腺功能亢進後，臨床醫生和客戶面臨多種治療選擇。
The choice of therapy often depends on factors such as the cat’s age, comorbidities, treatment cost, availability of treatment options, and the clinician’s recommendation and expertise. The goal of therapy is to restore euthyroidism, avoid hypothyroidism and minimize side effects of treatment. In general, treat all cats diagnosed with FHT and monitor prudently.
治療的選擇通常取決於貓的年齡、合併症、治療成本、治療選擇的可用性以及臨床醫生的建議和專業知識。治療的目標是恢復甲狀腺功能正常，避免甲狀腺功能低下，並最小化治療的副作用。一般來說，對所有被診斷為貓甲狀腺亢進症的貓進行治療並謹慎監測。
Four common treatment options for FHT are available: treatment with radioactive iodine, medical management with methimazole or carbimazole, surgical thyroidectomy and dietary therapy using an iodine-restricted food. Rarely used therapies include percutaneous ethanol or thermal ablation of the cat’s thyroid.55–57 The four principal treatments are discussed in turn in the following sections of the Guidelines. Each modality has advantages and disadvantages, as summarized on page 407 and also described elsewhere.47,58
四種常見的貓甲狀腺功能亢進症（FHT）治療選擇可用：放射性碘治療、使用美克咪唑或卡比咪唑的藥物管理、外科甲狀腺切除術以及使用限制碘食物的飲食療法。很少使用的療法包括經皮乙醇或貓甲狀腺的熱消融。 55–57 四種主要治療方法在指南的後續部分中依次討論。每種方式都有其優缺點，詳見第 407 頁，並在其他地方也有描述。 47,58
四種常見的貓甲狀腺功能亢進症（FHT）治療選擇可用：放射性碘治療、使用美克咪唑或卡比咪唑的藥物管理、外科甲狀腺切除術以及使用限制碘食物的飲食療法。很少使用的療法包括經皮乙醇或貓甲狀腺的熱消融。 55–57 四種主要治療方法在指南的後續部分中依次討論。每種方式都有其優缺點，詳見第 407 頁，並在其他地方也有描述。 47,58
Radioactive iodine 放射性碘
Experts generally agree that radioiodine is the treatment of choice for most cats with FHT.The distinct advantages of 131I treatment include:
專家普遍認為，放射性碘是大多數患有貓甲狀腺功能亢進症（FHT）貓咪的首選治療。 131 I 治療的明顯優勢包括：
專家普遍認為，放射性碘是大多數患有貓甲狀腺功能亢進症（FHT）貓咪的首選治療。 131 I 治療的明顯優勢包括：
•
The potential to eliminate benign thyroid tumors or hyperplastic thyroid tissue with a single treatment.
有潛力通過單次治療消除良性甲狀腺腫瘤或增生的甲狀腺組織。
有潛力通過單次治療消除良性甲狀腺腫瘤或增生的甲狀腺組織。
•
•
No general anesthesia. 無全身麻醉。
•
Minimal side effects. 最小的副作用。
Physiologically stable cats respond best. Those with clinically significant cardiovascular, renal, gastrointestinal or endocrine disease (eg, diabetes mellitus) may not be good candidates for this approach, especially in the light of the time necessary for isolation after treatment.64
生理穩定的貓咪反應最佳。那些有臨床顯著的心血管、腎臟、胃腸或內分泌疾病（例如，糖尿病）的貓咪可能不適合這種方法，特別是在考慮到治療後所需的隔離時間。
生理穩定的貓咪反應最佳。那些有臨床顯著的心血管、腎臟、胃腸或內分泌疾病（例如，糖尿病）的貓咪可能不適合這種方法，特別是在考慮到治療後所需的隔離時間。
After administration, the thyroid gland actively concentrates 131I. Although 131I has a physical half-life (t1/2) of 8 days, the biological t1/2 is much shorter, generally 1.5–4 days. 131I emits both beta particles and gamma radiation. The beta particles are responsible for the majority of tissue destruction, but are only locally destructive, traveling a maximum of 2 mm. Therefore, no significant damage to adjacent parathyroid tissue, atrophic thyroid tissue or other cervical structures occurs.
在給藥後，甲狀腺會積極集中 131 I。雖然 131 I 的物理半衰期(t 1/2 )為 8 天，但生物半衰期 t 1/2 則短得多，通常為 1.5–4 天。 131 I 同時發出β粒子和伽馬輻射。β粒子負責大部分的組織破壞，但僅在局部造成破壞，最大可行進 2 毫米。因此，對相鄰的副甲狀腺組織、萎縮的甲狀腺組織或其他頸部結構不會造成重大損害。
The main limitations to widespread use of radioactive iodine are the requirement for special licensure and isolation of the cat for variable periods after treatment. This can range from 3 days to 4 weeks depending on regional radiation regulations and the dose administered.65
放射性碘廣泛使用的主要限制是需要特殊的執照以及治療後對貓咪進行隔離的時間長短。這段時間可以從 3 天到 4 週不等，具體取決於地區的輻射法規和施用的劑量。
在給藥後，甲狀腺會積極集中 131 I。雖然 131 I 的物理半衰期(t 1/2 )為 8 天，但生物半衰期 t 1/2 則短得多，通常為 1.5–4 天。 131 I 同時發出β粒子和伽馬輻射。β粒子負責大部分的組織破壞，但僅在局部造成破壞，最大可行進 2 毫米。因此，對相鄰的副甲狀腺組織、萎縮的甲狀腺組織或其他頸部結構不會造成重大損害。
The main limitations to widespread use of radioactive iodine are the requirement for special licensure and isolation of the cat for variable periods after treatment. This can range from 3 days to 4 weeks depending on regional radiation regulations and the dose administered.65
放射性碘廣泛使用的主要限制是需要特殊的執照以及治療後對貓咪進行隔離的時間長短。這段時間可以從 3 天到 4 週不等，具體取決於地區的輻射法規和施用的劑量。
Expected outcomes 預期結果
The goal of treatment is to restore euthyroidism with the smallest possible single dose of 131I, while at the same time avoiding development of hypothyroidism.54 Controversy exists as to the best method of calculating the optimum 131I dose for individual cats.64,65 No dose selection method guarantees a successful dose. In spite of the various dose selection methods, however, the success rate of a single 131I treatment is very high – over 95% in most studies.14,44,66,67 T4 declines into the reference interval by 4–12 weeks post-treatment.44,68 Complete resolution of clinical signs of FHT may take several months. The 5% of cats that do not achieve euthyroidism with one dose of 131I are usually those with larger tumors, more severe clinical signs, higher T4 values or carcinomas.67 Cats that do not have carcinomas generally respond favorably to a second dose of 131I.50,58 Conventional low dose 131I fails to cure thyroid carcinomas because malignant cells do not concentrate iodine as efficiently as do hyperplastic or adenomatous cells.68 A very high dose of 131I, or a combination of surgical debulking and high dose 131I, is the most successful option for the treatment of thyroid carcinoma.24,68
治療的目標是以最小的單次劑量恢復甲狀腺功能正常，同時避免發展為甲狀腺功能低下。對於如何計算個別貓咪的最佳劑量存在爭議。沒有任何劑量選擇方法能保證成功的劑量。然而，儘管有各種劑量選擇方法，單次治療的成功率仍然非常高——在大多數研究中超過 95%。T4 在治療後 4 至 12 週內下降至參考範圍。完全解決 FHT 的臨床症狀可能需要幾個月。那 5%未能在一次劑量下達到甲狀腺功能正常的貓咪通常是腫瘤較大、臨床症狀較嚴重、T4 值較高或為癌症患者。沒有癌症的貓咪通常對第二次劑量反應良好。傳統的低劑量治療無法治癒甲狀腺癌，因為惡性細胞的碘濃縮效率不如增生或腺瘤細胞。 68 非常高劑量的 131 I，或手術減瘤與高劑量 131 I 的組合，是治療甲狀腺癌的最成功選擇。 24,68
治療的目標是以最小的單次劑量恢復甲狀腺功能正常，同時避免發展為甲狀腺功能低下。對於如何計算個別貓咪的最佳劑量存在爭議。沒有任何劑量選擇方法能保證成功的劑量。然而，儘管有各種劑量選擇方法，單次治療的成功率仍然非常高——在大多數研究中超過 95%。T4 在治療後 4 至 12 週內下降至參考範圍。完全解決 FHT 的臨床症狀可能需要幾個月。那 5%未能在一次劑量下達到甲狀腺功能正常的貓咪通常是腫瘤較大、臨床症狀較嚴重、T4 值較高或為癌症患者。沒有癌症的貓咪通常對第二次劑量反應良好。傳統的低劑量治療無法治癒甲狀腺癌，因為惡性細胞的碘濃縮效率不如增生或腺瘤細胞。 68 非常高劑量的 131 I，或手術減瘤與高劑量 131 I 的組合，是治療甲狀腺癌的最成功選擇。 24,68
Depending on the treatment dose of 131I, up to 75% of cats may become hypothyroid for some interval post-therapy.48,69–71 Because 131I predominantly damages hyperactive cells, permanent post-treatment hypothyroidism is an uncommon sequela.44 Cats treated with higher doses of 131I may suffer damage to normal thyroid cells and are more likely to experience post-treatment hypothyroidism that may require hormone replacement.72 In 2–7% of cases it is transient, causes no clinical signs and the cat requires no supplementation with thyroid hormone.14,69–71 Up to 30% of cats remain hypothyroid 3 months after radioiodine treatment, with approximately half of those exhibiting clinical signs or experiencing a worsening of renal function and requiring hormone supplementation.73 Hyperthyroid cats with carcinomas that receive high doses of 131I are at the greatest risk of clinical hypothyroidism post-therapy.68
根據治療劑量的 131 I，最多有 75%的貓在治療後的某段時間內可能會變得甲狀腺功能低下。 48,69–71 因為 131 I 主要損害過度活躍的細胞，治療後持續的甲狀腺功能低下是一種不常見的後遺症。 44 接受較高劑量的 131 I 治療的貓可能會損害正常的甲狀腺細胞，並且更有可能經歷治療後的甲狀腺功能低下，可能需要激素替代療法。 72 在 2-7%的案例中，它是暫時性的，沒有臨床症狀，貓不需要補充甲狀腺激素。 14,69–71 在放射性碘治療後，最多有 30%的貓在 3 個月後仍然保持甲狀腺功能低下，其中大約一半的貓出現臨床症狀或腎功能惡化，並需要激素補充。 73 接受高劑量 131 I 治療的甲狀腺功能亢進貓，罹患癌瘤的貓在治療後面臨臨床甲狀腺功能低下的風險最大。 68
根據治療劑量的 131 I，最多有 75%的貓在治療後的某段時間內可能會變得甲狀腺功能低下。 48,69–71 因為 131 I 主要損害過度活躍的細胞，治療後持續的甲狀腺功能低下是一種不常見的後遺症。 44 接受較高劑量的 131 I 治療的貓可能會損害正常的甲狀腺細胞，並且更有可能經歷治療後的甲狀腺功能低下，可能需要激素替代療法。 72 在 2-7%的案例中，它是暫時性的，沒有臨床症狀，貓不需要補充甲狀腺激素。 14,69–71 在放射性碘治療後，最多有 30%的貓在 3 個月後仍然保持甲狀腺功能低下，其中大約一半的貓出現臨床症狀或腎功能惡化，並需要激素補充。 73 接受高劑量 131 I 治療的甲狀腺功能亢進貓，罹患癌瘤的貓在治療後面臨臨床甲狀腺功能低下的風險最大。 68
Thyroid hormone replacement may also be needed in cats with concurrent kidney disease. Advise owners of this possibility, particularly if their motivation is to avoid long-term oral medication.
在同時患有腎臟疾病的貓中，可能也需要甲狀腺激素替代療法。建議飼主考慮這種可能性，特別是如果他們的動機是避免長期口服藥物。
在同時患有腎臟疾病的貓中，可能也需要甲狀腺激素替代療法。建議飼主考慮這種可能性，特別是如果他們的動機是避免長期口服藥物。
Medical therapy 醫療療法
Antithyroid drugs can be used long term as a sole treatment or short term to stabilize the patient before any surgery or anesthesia or if radioiodine therapy is not immediately available.44,74,75 A methimazole trial prior to 131I or bilateral surgery may predict the risk of significant renal compromise after definitive therapy for FHT.
抗甲狀腺藥物可以長期作為唯一治療，或短期用於在任何手術或麻醉之前穩定病人，或在放射性碘治療尚不可用的情況下。 44,74,75 在 131 I 或雙側手術之前進行甲硫咪唑試驗可能預測在 FHT 的確定性治療後出現重大腎功能損害的風險。
抗甲狀腺藥物可以長期作為唯一治療，或短期用於在任何手術或麻醉之前穩定病人，或在放射性碘治療尚不可用的情況下。 44,74,75 在 131 I 或雙側手術之前進行甲硫咪唑試驗可能預測在 FHT 的確定性治療後出現重大腎功能損害的風險。
Two pharmacologically active ingredients are available as licensed veterinary drugs for treatment of hyperthyroidism, methimazole (Felimazole; Dechra Veterinary Products)76 and carbimazole (Vidalta; MSD Animal Health). Carbimazole is not currently available in the US but is utilized in other countries. It is a metabolite of methimazole that has a similar mechanism of action as well as side effects; dosing is similar as well.77 Methimazole acts by blocking thyroid peroxidase, thus inhibiting biosynthesis of thyroid hormones.78 As in humans, methimazole is thought to accumulate in the thyroid glands of cats.78,79 In healthy cats, oral methimazole is well absorbed and the pharmacokinetic parameters are not significantly altered by hyperthyroidism.78
有兩種藥理活性成分作為獲得許可的獸醫藥物可用於治療甲狀腺功能亢進，分別是美替咪唑（Felimazole；Dechra Veterinary Products）和卡比咪唑（Vidalta；MSD Animal Health）。卡比咪唑目前在美國不可用，但在其他國家有使用。它是美替咪唑的代謝物，具有類似的作用機制和副作用；劑量也相似。美替咪唑通過阻止甲狀腺過氧化酶的作用，從而抑制甲狀腺激素的生物合成。與人類一樣，据信美替咪唑會在貓的甲狀腺中積累。在健康的貓中，口服美替咪唑的吸收良好，且藥物動力學參數不會因甲狀腺功能亢進而顯著改變。
有兩種藥理活性成分作為獲得許可的獸醫藥物可用於治療甲狀腺功能亢進，分別是美替咪唑（Felimazole；Dechra Veterinary Products）和卡比咪唑（Vidalta；MSD Animal Health）。卡比咪唑目前在美國不可用，但在其他國家有使用。它是美替咪唑的代謝物，具有類似的作用機制和副作用；劑量也相似。美替咪唑通過阻止甲狀腺過氧化酶的作用，從而抑制甲狀腺激素的生物合成。與人類一樣，据信美替咪唑會在貓的甲狀腺中積累。在健康的貓中，口服美替咪唑的吸收良好，且藥物動力學參數不會因甲狀腺功能亢進而顯著改變。
Methimazole should be started at a dose of 1.25–2.5 mg per cat twice daily (q12h). Twice daily dosing is associated with less serious side effects than a higher dose once daily (q24h).44,78–80 After the cat becomes euthyroid with q12h dosing, giving the total daily dose q24h may maintain euthyroidism and increase owner compliance.80,81 Transdermal methimazole preparations, when available, can be useful for uncooperative cats. In such cases, the same or a slightly higher starting dose than for the oral route should be used.80
美克咪唑應以每隻貓每日兩次（每 12 小時）1.25–2.5 毫克的劑量開始。每日兩次的劑量與每日一次（每 24 小時）較高劑量相比，副作用較輕微。 44,78–80 當貓在每 12 小時的劑量下變為甲狀腺功能正常後，將每日總劑量改為每 24 小時給予可能維持甲狀腺功能正常並提高飼主的依從性。 80,81 當可用時，經皮美克咪唑製劑對於不合作的貓可能會有幫助。在這種情況下，應使用與口服途徑相同或稍高的起始劑量。 80
美克咪唑應以每隻貓每日兩次（每 12 小時）1.25–2.5 毫克的劑量開始。每日兩次的劑量與每日一次（每 24 小時）較高劑量相比，副作用較輕微。 44,78–80 當貓在每 12 小時的劑量下變為甲狀腺功能正常後，將每日總劑量改為每 24 小時給予可能維持甲狀腺功能正常並提高飼主的依從性。 80,81 當可用時，經皮美克咪唑製劑對於不合作的貓可能會有幫助。在這種情況下，應使用與口服途徑相同或稍高的起始劑量。 80
Most hyperthyroid cats are euthyroid within 2–3 weeks of commencing treatment with antithyroid drugs,44,65,82,83 and so T4 should be monitored after that time period. If the cat is still hyperthyroid, methimazole dose adjustments can be made in increments of 1.25–2.5 mg/day until euthyroidism is achieved.44 When maintenance doses in excess of 10 mg/day are required, compliance should be questioned.44 If T4 drops below the lower end of the reference interval, the methimazole dosage should be reduced in decrements of 1.25–2.5 mg/day and the T4 and renal parameters rechecked in 1 week. Treatment with transdermal methimazole can utilize a similar scheme as for oral methimazole. In cases of local skin irritation, switching to oral administration should be considered.
大多數甲狀腺功能亢進的貓在開始使用抗甲狀腺藥物治療後的 2-3 週內會恢復為正常甲狀腺功能，因此應在該時間段後監測 T4。如果貓仍然是甲狀腺功能亢進，可以將美克洛咪唑的劑量調整為每天增加 1.25-2.5 毫克，直到達到正常甲狀腺功能。當維持劑量超過每天 10 毫克時，應質疑依從性。如果 T4 降至參考範圍的下限以下，應將美克洛咪唑的劑量減少 1.25-2.5 毫克/天，並在 1 週內重新檢查 T4 和腎臟參數。使用經皮美克洛咪唑的治療可以採用與口服美克洛咪唑相似的方案。在局部皮膚刺激的情況下，應考慮改為口服給藥。
大多數甲狀腺功能亢進的貓在開始使用抗甲狀腺藥物治療後的 2-3 週內會恢復為正常甲狀腺功能，因此應在該時間段後監測 T4。如果貓仍然是甲狀腺功能亢進，可以將美克洛咪唑的劑量調整為每天增加 1.25-2.5 毫克，直到達到正常甲狀腺功能。當維持劑量超過每天 10 毫克時，應質疑依從性。如果 T4 降至參考範圍的下限以下，應將美克洛咪唑的劑量減少 1.25-2.5 毫克/天，並在 1 週內重新檢查 T4 和腎臟參數。使用經皮美克洛咪唑的治療可以採用與口服美克洛咪唑相似的方案。在局部皮膚刺激的情況下，應考慮改為口服給藥。
Side effects of methimazole
美克咪唑的副作用
The most severe, but rare, side effects observed with methimazole are hepatopathy and marked blood dyscrasias (severe leukopenia, anemia and thrombocytopenia). Gastrointestinal upset, lethargy and facial pruritus (Figure 6) occur at variable frequency. Occurrence, frequency and severity of side effects have not been shown to be dose related.60,84 Gastrointestinal upset may be less frequent with transdermal preparations.84 Most side effects appear within the first 4–6 weeks of therapy and are less common after 2 or 3 months of treatment.60
甲硫咪唑最嚴重但罕見的副作用是肝病和明顯的血液異常（嚴重白血球減少症、貧血和血小板減少症）。腸胃不適、嗜睡和面部瘙癢（圖 6）發生的頻率各異。副作用的發生、頻率和嚴重程度並未顯示與劑量有關。 60,84 使用經皮製劑時，腸胃不適的發生可能較少。 84 大多數副作用在治療的前 4-6 週內出現，並且在治療 2 或 3 個月後較不常見。 60
甲硫咪唑最嚴重但罕見的副作用是肝病和明顯的血液異常（嚴重白血球減少症、貧血和血小板減少症）。腸胃不適、嗜睡和面部瘙癢（圖 6）發生的頻率各異。副作用的發生、頻率和嚴重程度並未顯示與劑量有關。 60,84 使用經皮製劑時，腸胃不適的發生可能較少。 84 大多數副作用在治療的前 4-6 週內出現，並且在治療 2 或 3 個月後較不常見。 60
圖 6 面部病變是接受美替咪唑治療的貓可能出現的副作用。感謝 Cynthia Ward 醫生提供。
Expected outcomes 預期結果
Overall, almost all hyperthyroid cats treated with methimazole will experience successful control of their disease.67 T4 responds to methimazole administration within 1 week of treatment. However, clinical response to therapy may not be seen until T4 is maintained within the reference interval for 2–6 weeks.44 Because methimazole does not destroy hyperplastic or adenomatous thyroid tissue, abnormal tissue will progressively grow over time if methimazole is used as a long-term treatment.46,82 The size, volume and number of functional thyroid nodules will increase proportionally with the duration of disease, so that the dose of methimazole necessary to control thyrotoxicosis may need to be progressively increased.84 Eventually, some cats will not tolerate the dose of methimazole necessary to control FHT or will become completely resistant to methimazole therapy, necessitating the need to explore alternative treatment methods.82
總體而言，幾乎所有接受美克洛咪唑治療的甲狀腺功能亢進貓都會成功控制其疾病。 67 T4 在治療後 1 週內對美克洛咪唑的給予有反應。然而，臨床對治療的反應可能要等到 T4 在參考範圍內維持 2-6 週後才會顯現。 44 由於美克洛咪唑不會摧毀增生或腺瘤性甲狀腺組織，如果將美克洛咪唑用作長期治療，異常組織將隨著時間的推移而逐漸增長。 46,82 功能性甲狀腺結節的大小、體積和數量將隨著疾病的持續時間成比例增加，因此控制甲狀腺毒症所需的美克洛咪唑劑量可能需要逐漸增加。 84 最終，一些貓將無法耐受控制 FHT 所需的美克洛咪唑劑量，或將對美克洛咪唑治療完全產生抗藥性，這就需要探索替代治療方法。 82
總體而言，幾乎所有接受美克洛咪唑治療的甲狀腺功能亢進貓都會成功控制其疾病。 67 T4 在治療後 1 週內對美克洛咪唑的給予有反應。然而，臨床對治療的反應可能要等到 T4 在參考範圍內維持 2-6 週後才會顯現。 44 由於美克洛咪唑不會摧毀增生或腺瘤性甲狀腺組織，如果將美克洛咪唑用作長期治療，異常組織將隨著時間的推移而逐漸增長。 46,82 功能性甲狀腺結節的大小、體積和數量將隨著疾病的持續時間成比例增加，因此控制甲狀腺毒症所需的美克洛咪唑劑量可能需要逐漸增加。 84 最終，一些貓將無法耐受控制 FHT 所需的美克洛咪唑劑量，或將對美克洛咪唑治療完全產生抗藥性，這就需要探索替代治療方法。 82
Surgical thyroidectomy 外科甲狀腺切除術
Thyroidectomy is an established surgical technique that may be curative. Surgical options include bilateral thyroidectomy with an intracapsular or extracapsular approach, unilateral thyroidectomy (reserved for cats with true unilateral disease) and staged bilateral thyroidectomy.
甲狀腺切除術是一種已確立的外科技術，可能具有治癒效果。外科選擇包括雙側甲狀腺切除術，採用腔內或腔外方法，單側甲狀腺切除術（僅適用於有真正單側疾病的貓）以及分階段雙側甲狀腺切除術。
Surgery and anesthesia are sometimes associated with substantial procedural morbidity and mortality.83,85 Hypocalcemia occurs in a widely varying range (6–82%) of thyroidectomy patients, depending on the surgical method chosen.44 In cats that have had unilateral or bilateral thyroidectomy with careful preservation of the parathyroid glands, hypocalcemia may be mild and transient, and not require treatment.44 Severe hypocalcemia associated with hypoparathyroidism may be transient (lasting days, weeks or months) or permanent.44 Other complications of thyroidectomy include Horner’s syndrome, laryngeal nerve paralysis and recurrence of hyperthyroidism.86,87
手術和麻醉有時與相當大的程序性發病率和死亡率相關。 83,85 甲狀腺切除術患者中，低鈣血症的發生率範圍廣泛（6–82%），這取決於所選擇的手術方法。 44 在那些經過小心保留副甲狀腺的單側或雙側甲狀腺切除術的貓中，低鈣血症可能是輕微且短暫的，並且不需要治療。 44 與低副甲狀腺功能症相關的重度低鈣血症可能是短暫的（持續幾天、幾週或幾個月）或永久性的。 44 甲狀腺切除術的其他併發症包括霍納氏綜合症、喉神經麻痺和甲狀腺功能亢進的復發。 86,87
甲狀腺切除術是一種已確立的外科技術，可能具有治癒效果。外科選擇包括雙側甲狀腺切除術，採用腔內或腔外方法，單側甲狀腺切除術（僅適用於有真正單側疾病的貓）以及分階段雙側甲狀腺切除術。
Surgery and anesthesia are sometimes associated with substantial procedural morbidity and mortality.83,85 Hypocalcemia occurs in a widely varying range (6–82%) of thyroidectomy patients, depending on the surgical method chosen.44 In cats that have had unilateral or bilateral thyroidectomy with careful preservation of the parathyroid glands, hypocalcemia may be mild and transient, and not require treatment.44 Severe hypocalcemia associated with hypoparathyroidism may be transient (lasting days, weeks or months) or permanent.44 Other complications of thyroidectomy include Horner’s syndrome, laryngeal nerve paralysis and recurrence of hyperthyroidism.86,87
手術和麻醉有時與相當大的程序性發病率和死亡率相關。 83,85 甲狀腺切除術患者中，低鈣血症的發生率範圍廣泛（6–82%），這取決於所選擇的手術方法。 44 在那些經過小心保留副甲狀腺的單側或雙側甲狀腺切除術的貓中，低鈣血症可能是輕微且短暫的，並且不需要治療。 44 與低副甲狀腺功能症相關的重度低鈣血症可能是短暫的（持續幾天、幾週或幾個月）或永久性的。 44 甲狀腺切除術的其他併發症包括霍納氏綜合症、喉神經麻痺和甲狀腺功能亢進的復發。 86,87
If the surgeon fails to remove all abnormal thyroid tissue, the cat will require revision surgery. 99Tc imaging prior to surgery will decrease the number of subtotal thyroidectomies by revealing multinodular disease and bilateral involvement.86,88 Imaging will also identify cats with ectopic tissue or a large goiter that descends through the thoracic inlet into the chest.
如果外科醫生未能去除所有異常的甲狀腺組織，貓將需要修正手術。 99 在手術前進行 Tc 成像將通過顯示多結節性疾病和雙側受累來減少部分甲狀腺切除術的次數。 86,88 成像還將識別具有異位組織或大型甲狀腺腫的貓，該腫瘤會通過胸口進入胸腔。
如果外科醫生未能去除所有異常的甲狀腺組織，貓將需要修正手術。 99 在手術前進行 Tc 成像將通過顯示多結節性疾病和雙側受累來減少部分甲狀腺切除術的次數。 86,88 成像還將識別具有異位組織或大型甲狀腺腫的貓，該腫瘤會通過胸口進入胸腔。
In cats with substernal disease, surgical removal may be difficult. Approximately 4–9% of hyperthyroid cats have adenomatous tissue in ectopic sites (sublingual or substernal sites are most common), which a surgeon would likely miss at surgery.22,89
在有胸骨下疾病的貓中，外科切除可能會很困難。大約 4-9%的甲狀腺功能亢進貓在異位部位（最常見的是舌下或胸骨下部位）有腺瘤組織，外科醫生在手術中可能會錯過這些組織。 22,89
在有胸骨下疾病的貓中，外科切除可能會很困難。大約 4-9%的甲狀腺功能亢進貓在異位部位（最常見的是舌下或胸骨下部位）有腺瘤組織，外科醫生在手術中可能會錯過這些組織。 22,89
Expected outcomes 預期結果
Surgical thyroidectomy is associated with a high rate of both short- and long-term success, with most studies showing >90% of cats achieving euthyroidism postoperatively, with a relapse rate approaching 5% within 3 years.89 The success of the procedure is highly dependent on presurgical stabilization of the patient and the surgeon’s expertise.44 Because of the short t1/2 of T4 in cats,90 euthyroidism after successful thyroidectomy usually occurs within 24–48 h of surgery. Unilateral thyroidectomy is associated with transient hypothyroidism that resolves within 1–3 months as remaining thyroid tissue recovers function.44 Bilateral thyroidectomy may result in clinical hypothyroidism that requires hormonal supplementation.44 Persistence or recurrence of post-surgical hyperthyroidism is associated with incompletely removed abnormal tissue.44
手術性甲狀腺切除術與高短期和長期成功率相關，大多數研究顯示超過 90%的貓在手術後達到正常甲狀腺功能，復發率在 3 年內接近 5%。手術的成功高度依賴於術前病人的穩定性和外科醫生的專業技術。由於貓的 T4 半衰期較短，成功的甲狀腺切除術後通常在手術後 24 至 48 小時內達到正常甲狀腺功能。單側甲狀腺切除術與短暫的甲狀腺功能低下相關，通常在 1 至 3 個月內隨著剩餘甲狀腺組織恢復功能而解決。雙側甲狀腺切除術可能導致臨床甲狀腺功能低下，需要激素補充。術後甲狀腺功能亢進的持續或復發與未完全切除的異常組織有關。
手術性甲狀腺切除術與高短期和長期成功率相關，大多數研究顯示超過 90%的貓在手術後達到正常甲狀腺功能，復發率在 3 年內接近 5%。手術的成功高度依賴於術前病人的穩定性和外科醫生的專業技術。由於貓的 T4 半衰期較短，成功的甲狀腺切除術後通常在手術後 24 至 48 小時內達到正常甲狀腺功能。單側甲狀腺切除術與短暫的甲狀腺功能低下相關，通常在 1 至 3 個月內隨著剩餘甲狀腺組織恢復功能而解決。雙側甲狀腺切除術可能導致臨床甲狀腺功能低下，需要激素補充。術後甲狀腺功能亢進的持續或復發與未完全切除的異常組織有關。
Dietary therapy 飲食療法
Production of thyroid hormone requires uptake by the thyroid gland of sufficient amounts of dietary iodine. The only function of ingested iodine is for thyroid hormone synthesis. This finding led to the hypothesis that limiting dietary iodine intake could be used to control thyroid hormone production and potentially manage FHT.35,90 A restricted-iodine diet (Hill’s Prescription Diet y/d Feline; Hill’s Pet Nutrition) containing 0.2 ppm (mg/kg) iodine on a dry matter basis is currently available for the management of FHT.
甲狀腺激素的產生需要甲狀腺攝取足夠的膳食碘。攝取的碘唯一的功能是用於甲狀腺激素的合成。這一發現導致了限制膳食碘攝入量可以用來控制甲狀腺激素的產生，並可能管理貓咪甲狀腺功能亢進的假設。 35,90 目前可用於管理貓咪甲狀腺功能亢進的限制碘飲食（Hill’s Prescription Diet y/d Feline；Hill’s Pet Nutrition）含有 0.2 ppm（mg/kg）碘，基於乾物質計算。
甲狀腺激素的產生需要甲狀腺攝取足夠的膳食碘。攝取的碘唯一的功能是用於甲狀腺激素的合成。這一發現導致了限制膳食碘攝入量可以用來控制甲狀腺激素的產生，並可能管理貓咪甲狀腺功能亢進的假設。 35,90 目前可用於管理貓咪甲狀腺功能亢進的限制碘飲食（Hill’s Prescription Diet y/d Feline；Hill’s Pet Nutrition）含有 0.2 ppm（mg/kg）碘，基於乾物質計算。
Expected outcome 預期結果
With good client compliance, 75% of cats have significantly reduced T4 and improvement of clinical signs within 28 days of starting the diet.62,91 Normalization may require up to 180 days in cats with severe elevations in T4, and some fail ever to reach euthyroidism.62 In a 1 year study, 83% of hyperthyroid cats went into remission on the diet.62
在良好的客戶遵從下，75%的貓在開始飲食後 28 天內 T4 顯著降低，臨床症狀改善。 62,91 對於 T4 嚴重升高的貓，正常化可能需要長達 180 天，有些甚至無法達到甲狀腺功能正常。 62 在一項為期 1 年的研究中，83%的甲狀腺功能亢進貓在飲食中達到了緩解。 62
在良好的客戶遵從下，75%的貓在開始飲食後 28 天內 T4 顯著降低，臨床症狀改善。 62,91 對於 T4 嚴重升高的貓，正常化可能需要長達 180 天，有些甚至無法達到甲狀腺功能正常。 62 在一項為期 1 年的研究中，83%的甲狀腺功能亢進貓在飲食中達到了緩解。 62
A limitation of a restricted-iodine diet is lack of palatability, affecting up to 12% of cats studied.91 Also, dietary management may be difficult or contraindicated in the following scenarios:
限制碘飲食的一個限制是缺乏可口性，影響了多達 12%的研究貓隻。 91 此外，在以下情況下，飲食管理可能會困難或禁忌：
限制碘飲食的一個限制是缺乏可口性，影響了多達 12%的研究貓隻。 91 此外，在以下情況下，飲食管理可能會困難或禁忌：
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Patients in multi-cat households.
多貓家庭中的病人。
多貓家庭中的病人。
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Hyperthyroid cats with concurrent disease requiring other nutritional management.
同時患有其他疾病的甲狀腺亢進貓需要其他營養管理。
同時患有其他疾病的甲狀腺亢進貓需要其他營養管理。
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Cats taking compounded flavored medications or supplements that contain iodine.
服用含碘的調配風味藥物或補充劑的貓。
服用含碘的調配風味藥物或補充劑的貓。
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Indoor–outdoor cats. 室內–室外貓。
The long-term consequence of a restricted-iodine diet in hyperthyroid cats is unknown. The iodine concentration of the restricted diet (0.2 ppm) is lower than the iodine requirement of euthyroid adult cats (0.46 ppm).35 This may not cause problems because cats fed an even more iodine-restricted diet (0.17 ppm) for 1 year did not show signs of deficiency.35
在甲狀腺功能亢進的貓咪中，限制碘飲食的長期後果尚不清楚。限制飲食中的碘濃度（0.2 ppm）低於正常甲狀腺成年貓的碘需求（0.46 ppm）。 35 這可能不會造成問題，因為曾經餵食更低碘飲食（0.17 ppm）達一年之久的貓咪並未顯示出缺乏的跡象。 35
在甲狀腺功能亢進的貓咪中，限制碘飲食的長期後果尚不清楚。限制飲食中的碘濃度（0.2 ppm）低於正常甲狀腺成年貓的碘需求（0.46 ppm）。 35 這可能不會造成問題，因為曾經餵食更低碘飲食（0.17 ppm）達一年之久的貓咪並未顯示出缺乏的跡象。 35
In addition to efficacy in restoring euthyroidism, three studies showed reductions in serum creatinine concentrations together with stable or increasing bodyweights in hyperthyroid cats eating the iodine-restricted diet. The mechanisms behind these effects are currently unknown.62,91,92
除了恢復甲狀腺功能正常的療效外，三項研究顯示，食用限制碘飲食的甲狀腺功能亢進貓的血清肌酐濃度降低，同時體重穩定或增加。這些效果背後的機制目前尚不清楚。
除了恢復甲狀腺功能正常的療效外，三項研究顯示，食用限制碘飲食的甲狀腺功能亢進貓的血清肌酐濃度降低，同時體重穩定或增加。這些效果背後的機制目前尚不清楚。
A cat may undergo surgical excision of a thyroid tumor while on an iodine-restricted diet, but if an owner subsequently wants the cat to undergo 131I therapy, the optimum withdrawal time from the diet is unknown. Limited-iodine diets increase iodine uptake in the autonomous thyroid glands of hyperthyroid cats. Further studies are necessary to determine whether consumption of a limited-iodine diet changes sensitivity of the thyroid gland to 131I treatment.93
貓在限制碘飲食的情況下可以進行甲狀腺腫瘤的外科切除，但如果主人隨後希望貓接受 131 I 治療，則最佳的停藥時間尚不清楚。限制碘飲食會增加甲狀腺功能亢進貓的自主甲狀腺對碘的攝取。進一步的研究是必要的，以確定限制碘飲食的攝取是否會改變甲狀腺對 131 I 治療的敏感性。 93
貓在限制碘飲食的情況下可以進行甲狀腺腫瘤的外科切除，但如果主人隨後希望貓接受 131 I 治療，則最佳的停藥時間尚不清楚。限制碘飲食會增加甲狀腺功能亢進貓的自主甲狀腺對碘的攝取。進一步的研究是必要的，以確定限制碘飲食的攝取是否會改變甲狀腺對 131 I 治療的敏感性。 93
Monitoring hyperthyroid patients
監測甲狀腺功能亢進症患者
Monitor all cats with hyperthyroidism, both to control the disease effectively and to avoid iatrogenic hypothyroidism. Close monitoring of hyperthyroid cats as they become regulated will allow for recognition of comorbidities and exacerbation or improvement of already identified concurrent disease.
監測所有患有甲狀腺功能亢進的貓，以有效控制疾病並避免醫源性甲狀腺功能減退。隨著甲狀腺功能亢進的貓逐漸穩定，進行密切監測將有助於識別合併症以及已識別的併發疾病的加重或改善。
監測所有患有甲狀腺功能亢進的貓，以有效控制疾病並避免醫源性甲狀腺功能減退。隨著甲狀腺功能亢進的貓逐漸穩定，進行密切監測將有助於識別合併症以及已識別的併發疾病的加重或改善。
Regardless of the treatment method, evaluation of multiple parameters (see below) when monitoring newly diagnosed and treated hyperthyroid cats will optimize the cat’s healthcare.
無論治療方法如何，監測新診斷和治療的甲狀腺功能亢進貓時評估多個參數（見下文）將優化貓的健康護理。
無論治療方法如何，監測新診斷和治療的甲狀腺功能亢進貓時評估多個參數（見下文）將優化貓的健康護理。
Initial follow-up testing after starting treatment is conducted at 2–4 weeks. Subsequent testing occurs 2–4 weeks after any change in dose. Stable, uncomplicated hyperthyroid cats are then monitored every 4–6 months via T4 assay, CBC, chemistry panel and urinalysis. Cats with concurrent disease may require other laboratory testing or imaging at a different monitoring interval.
治療開始後的初步隨訪檢測在 2 至 4 週內進行。隨後的檢測在任何劑量變更後的 2 至 4 週內進行。穩定且無併發症的甲狀腺功能亢進貓隻則每 4 至 6 個月通過 T4 檢測、CBC、化學面板和尿液分析進行監測。患有併發疾病的貓可能需要在不同的監測間隔進行其他實驗室檢測或影像學檢查。
Clinical improvement in hyperthyroid cats can be expected when T4 levels are within the reference interval. However, to achieve adequate control in cats with renal insufficiency, serum T4 should be maintained in the upper half of the reference interval.59
當甲狀腺功能亢進的貓咪的 T4 水平在參考範圍內時，可以預期臨床改善。然而，為了在腎功能不全的貓咪中達到適當的控制，血清 T4 應維持在參考範圍的上半部分。
治療開始後的初步隨訪檢測在 2 至 4 週內進行。隨後的檢測在任何劑量變更後的 2 至 4 週內進行。穩定且無併發症的甲狀腺功能亢進貓隻則每 4 至 6 個月通過 T4 檢測、CBC、化學面板和尿液分析進行監測。患有併發疾病的貓可能需要在不同的監測間隔進行其他實驗室檢測或影像學檢查。
Clinical improvement in hyperthyroid cats can be expected when T4 levels are within the reference interval. However, to achieve adequate control in cats with renal insufficiency, serum T4 should be maintained in the upper half of the reference interval.59
當甲狀腺功能亢進的貓咪的 T4 水平在參考範圍內時，可以預期臨床改善。然而，為了在腎功能不全的貓咪中達到適當的控制，血清 T4 應維持在參考範圍的上半部分。
Prognosis 預後
Although older studies report survival times of 2 years after diagnosis,44 more recent data show that cats without concurrent CKD have a median survival of up to 5.3 years.99 Thanks to better awareness of the disease, routine screening tests and a variety of readily available treatment options, the hyperthyroid cat will often live for an extended period in a properly managed case. Untreated FHT is a progressive disease that can lead to significant morbidity and mortality.
雖然較早的研究報告顯示診斷後的生存時間為 2 年，但 44 最近的數據顯示，沒有合併慢性腎病的貓咪中位生存期可達 5.3 年。 99 由於對該疾病的認識提高、常規篩檢測試以及各種隨手可得的治療選擇，經過妥善管理的甲狀腺功能亢進貓咪通常能夠長期生存。未經治療的甲狀腺功能亢進症是一種進行性疾病，可能導致顯著的發病率和死亡率。
Morbidity and mortality in the well-managed hyperthyroid cat are more strongly influenced by the presence and severity of the comorbid disease than by FHT itself.44
在管理良好的甲狀腺功能亢進貓中，發病率和死亡率更受合併疾病的存在和嚴重程度影響，而非甲狀腺功能亢進本身。 44
雖然較早的研究報告顯示診斷後的生存時間為 2 年，但 44 最近的數據顯示，沒有合併慢性腎病的貓咪中位生存期可達 5.3 年。 99 由於對該疾病的認識提高、常規篩檢測試以及各種隨手可得的治療選擇，經過妥善管理的甲狀腺功能亢進貓咪通常能夠長期生存。未經治療的甲狀腺功能亢進症是一種進行性疾病，可能導致顯著的發病率和死亡率。
Morbidity and mortality in the well-managed hyperthyroid cat are more strongly influenced by the presence and severity of the comorbid disease than by FHT itself.44
在管理良好的甲狀腺功能亢進貓中，發病率和死亡率更受合併疾病的存在和嚴重程度影響，而非甲狀腺功能亢進本身。 44
FHT secondary to thyroid carcinoma carries a slightly less favorable prognosis than hyperplasia or adenoma due to the pathology of neoplastic disease.44 However, with appropriate treatment, even cats with thyroid carcinomas often die from unrelated non-thyroidal illness than from consequences of their thyroid tumor.68
由於腫瘤性疾病的病理，繼發於甲狀腺癌的甲狀腺功能亢進症預後略不如增生或腺瘤。 44 然而，通過適當的治療，即使是患有甲狀腺癌的貓，通常也死於與甲狀腺腫瘤無關的其他疾病，而不是因為甲狀腺腫瘤的後果。 68
由於腫瘤性疾病的病理，繼發於甲狀腺癌的甲狀腺功能亢進症預後略不如增生或腺瘤。 44 然而，通過適當的治療，即使是患有甲狀腺癌的貓，通常也死於與甲狀腺腫瘤無關的其他疾病，而不是因為甲狀腺腫瘤的後果。 68
Summary Points 摘要要點
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Feline hyperthyroidism (FHT) is increasing in prevalence and is now the most common endocrine disorder in middle-aged and older cats, occurring in about 10% of US feline patients >10 years of age.
貓甲狀腺功能亢進症（FHT）正在增加，現在是中年及老年貓最常見的內分泌疾病，約有 10%的美國貓患者年齡超過 10 歲。
貓甲狀腺功能亢進症（FHT）正在增加，現在是中年及老年貓最常見的內分泌疾病，約有 10%的美國貓患者年齡超過 10 歲。
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No one has verified any definitive cause, although epidemiological studies suggest both genetic and environmental influences.
目前尚無人驗證任何明確的原因，儘管流行病學研究表明遺傳和環境因素均有影響。
目前尚無人驗證任何明確的原因，儘管流行病學研究表明遺傳和環境因素均有影響。
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Feline geriatric screening panels now routinely include serum T4, which allows detection of elevated T4 levels at an early stage in disease progression and helps enable timely diagnosis and intervention.
貓咪老年篩檢面板現在常規包括血清 T4，這使得在疾病進展的早期階段檢測到 T4 水平升高成為可能，並有助於及時診斷和干預。
貓咪老年篩檢面板現在常規包括血清 T4，這使得在疾病進展的早期階段檢測到 T4 水平升高成為可能，並有助於及時診斷和干預。
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Because older age is a risk factor for FHT, clinicians should anticipate the presence of other age-related comorbidities such as heart disease, diabetes mellitus, gastrointestinal dysfunction and CKD in a certain percentage of hyperthyroid patients. FHT case presentations may be ambiguous due to the presence of concurrent diseases or diagnostic inconsistencies.
因為年齡較大是貓甲狀腺功能亢進症的風險因素，臨床醫生應預期某些比例的甲狀腺功能亢進患者會出現其他與年齡相關的共病，如心臟病、糖尿病、腸胃功能障礙和慢性腎病。由於同時存在其他疾病或診斷不一致，貓甲狀腺功能亢進症的病例表現可能會模糊不清。
因為年齡較大是貓甲狀腺功能亢進症的風險因素，臨床醫生應預期某些比例的甲狀腺功能亢進患者會出現其他與年齡相關的共病，如心臟病、糖尿病、腸胃功能障礙和慢性腎病。由於同時存在其他疾病或診斷不一致，貓甲狀腺功能亢進症的病例表現可能會模糊不清。
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A systematic approach to FHT diagnosis will categorize suspected cases into one of six diagnostic groups, each of which has an associated management strategy.
對於貓甲狀腺功能亢進症（FHT）診斷的系統性方法將把懷疑的病例分類為六個診斷組別中的一個，每個組別都有相應的管理策略。
對於貓甲狀腺功能亢進症（FHT）診斷的系統性方法將把懷疑的病例分類為六個診斷組別中的一個，每個組別都有相應的管理策略。
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The four common therapeutic modalities, implemented individually or in combination, are radioactive iodine, pharmaceutical therapy, surgical thyroidectomy and dietary therapy.
四種常見的治療方式，單獨或結合使用，包括放射性碘、藥物治療、外科甲狀腺切除術和飲食療法。
四種常見的治療方式，單獨或結合使用，包括放射性碘、藥物治療、外科甲狀腺切除術和飲食療法。
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Because FHT is life-threatening, the Panel recommends treatment of all hyperthyroid cats with concurrent management of any comorbidities.
因為貓甲狀腺功能亢進症是危及生命的，專家小組建議對所有有合併症的甲狀腺功能亢進貓進行治療。
因為貓甲狀腺功能亢進症是危及生命的，專家小組建議對所有有合併症的甲狀腺功能亢進貓進行治療。
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Overall success of management of FHT is 83–99%, depending on the patient’s clinical status and treatment modality. Radioiodine and surgery are potentially permanent cures for both adenomas and carcinomas. Methimazole/carbimazole and dietary therapy will control clinical disease in milder cases and in cats with significant comorbidities.
FHT 管理的整體成功率為 83–99%，取決於患者的臨床狀態和治療方式。放射性碘和手術對於腺瘤和癌瘤都是潛在的永久治療方法。美克咪唑/卡比咪唑和飲食療法將在較輕的病例和有顯著合併症的貓中控制臨床疾病。
FHT 管理的整體成功率為 83–99%，取決於患者的臨床狀態和治療方式。放射性碘和手術對於腺瘤和癌瘤都是潛在的永久治療方法。美克咪唑/卡比咪唑和飲食療法將在較輕的病例和有顯著合併症的貓中控制臨床疾病。
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Regular monitoring of a hyperthyroid cat is important not only to assess therapeutic efficacy but also to detect iatrogenic hypothyroidism and to confirm comorbidities that become evident with resolution of the hyperthyroid state.
定期監測甲狀腺功能亢進的貓咪不僅對評估治療效果重要，還能檢測醫源性甲狀腺功能減退症，並確認隨著甲狀腺功能亢進狀態的解決而顯現的共病。
定期監測甲狀腺功能亢進的貓咪不僅對評估治療效果重要，還能檢測醫源性甲狀腺功能減退症，並確認隨著甲狀腺功能亢進狀態的解決而顯現的共病。
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Morbidity and mortality in the well-managed hyperthyroid cat are more strongly influenced by the presence and severity of the comorbid disease than by FHT itself.
在良好管理的甲狀腺功能亢進貓中，疾病的發病率和死亡率更受合併疾病的存在和嚴重程度的影響，而非甲狀腺功能亢進本身。
在良好管理的甲狀腺功能亢進貓中，疾病的發病率和死亡率更受合併疾病的存在和嚴重程度的影響，而非甲狀腺功能亢進本身。
Acknowledgments 致謝
The AAFP Panel gratefully acknowledges the contributions of Dr Ed Kanara and Mark Dana of the Kanara Consulting Group, LLC in the preparation of the Guidelines.
AAFP 小組感謝 Kanara Consulting Group, LLC 的 Ed Kanara 博士和 Mark Dana 在準備指導方針中的貢獻。
AAFP 小組感謝 Kanara Consulting Group, LLC 的 Ed Kanara 博士和 Mark Dana 在準備指導方針中的貢獻。
Conflict of interest 利益衝突
Duncan Ferguson, through a patent held by the University of Georgia, USA, has inventor rights over the molecular genetic sequence of feline TSH, and also gains some royalties from a monoclonal antibody against ovine/canine TSH that can be used in feline TSH immunoassays, but is not commercially available as such.
鄧肯·費格森（Duncan Ferguson）透過美國喬治亞大學持有的專利，擁有貓類甲狀腺刺激激素（TSH）分子遺傳序列的發明權，並且從一種針對羊/犬 TSH 的單克隆抗體中獲得一些版稅，該抗體可用於貓類 TSH 免疫測定，但並未以此形式商業化。
The other AAFP Task Force members have no conflicts of interest to declare.
其他 AAFP 工作小組成員沒有需要聲明的利益衝突。
鄧肯·費格森（Duncan Ferguson）透過美國喬治亞大學持有的專利，擁有貓類甲狀腺刺激激素（TSH）分子遺傳序列的發明權，並且從一種針對羊/犬 TSH 的單克隆抗體中獲得一些版稅，該抗體可用於貓類 TSH 免疫測定，但並未以此形式商業化。
The other AAFP Task Force members have no conflicts of interest to declare.
其他 AAFP 工作小組成員沒有需要聲明的利益衝突。
Funding 資助
The AAFP received no financial support for the authorship and/or publication of these Guidelines.
AAFP 未對這些指導方針的撰寫和/或出版提供任何財務支持。
AAFP 未對這些指導方針的撰寫和/或出版提供任何財務支持。
Appendix : Client brochure
附錄：客戶手冊
References 參考文獻
1. Peterson ME, Johnson JG, Andrews LK. Spontaneous hyperthyroidism in the cat. Proceedings of the American College of Veterinary Internal Medicine; Seattle, USA; 1979, p 108.
1. Peterson ME, Johnson JG, Andrews LK. 貓的自發性甲狀腺功能亢進症。美國獸醫內科醫學會會議紀錄；美國西雅圖；1979 年，第 108 頁。
1. Peterson ME, Johnson JG, Andrews LK. 貓的自發性甲狀腺功能亢進症。美國獸醫內科醫學會會議紀錄；美國西雅圖；1979 年，第 108 頁。
2. Holzworth J, Theran P, Carpenter JL, et al. Hyperthyroidism in the cat: ten cases. J Am Vet Med Assoc 1980; 176: 345–353.
2. Holzworth J, Theran P, Carpenter JL, 等。貓的甲狀腺功能亢進：十個案例。美國獸醫醫學協會雜誌 1980; 176: 345–353。
2. Holzworth J, Theran P, Carpenter JL, 等。貓的甲狀腺功能亢進：十個案例。美國獸醫醫學協會雜誌 1980; 176: 345–353。
3. Peterson ME. Hyperthyroidism in cats: what’s causing this epidemic of thyroid disease and can we prevent it? J Feline Med Surg 2012; 14: 804–818.
3. Peterson ME. 貓的甲狀腺功能亢進：這場甲狀腺疾病的流行是什麼原因，我們能否預防？貓科醫學與外科雜誌 2012; 14: 804–818。
3. Peterson ME. 貓的甲狀腺功能亢進：這場甲狀腺疾病的流行是什麼原因，我們能否預防？貓科醫學與外科雜誌 2012; 14: 804–818。
4. Peterson ME. Feline hyperthyroidism: an animal model for toxic nodular goiter. J Endocrinol 2014; 223: T97–T114.
4. Peterson ME. 貓咪甲狀腺功能亢進：一種毒性結節性甲狀腺腫的動物模型。J Endocrinol 2014; 223: T97–T114.
4. Peterson ME. 貓咪甲狀腺功能亢進：一種毒性結節性甲狀腺腫的動物模型。J Endocrinol 2014; 223: T97–T114.
5. McLean JL, Lobetti RG, Schoeman JP. Worldwide prevalence and risk factors for feline hyperthyroidism: a review. J S Afr Vet Assoc 2014; 85: 1097.
5. McLean JL, Lobetti RG, Schoeman JP. 全球貓甲狀腺功能亢進的流行率和風險因素：一項回顧。南非獸醫協會雜誌 2014; 85: 1097。
5. McLean JL, Lobetti RG, Schoeman JP. 全球貓甲狀腺功能亢進的流行率和風險因素：一項回顧。南非獸醫協會雜誌 2014; 85: 1097。
6. Lucke VM. A histological study of thyroid abnormalities in the domestic cat. J Small Anim Pract 1964; 5: 351–358.
6. Lucke VM. 一項對家貓甲狀腺異常的組織學研究。小動物實踐雜誌 1964; 5: 351–358。
6. Lucke VM. 一項對家貓甲狀腺異常的組織學研究。小動物實踐雜誌 1964; 5: 351–358。
7. Leav I, Schiller AL, Rijnberk A, et al. Adenomas and carcinomas of the canine and feline thyroid. Am J Pathol 1976; 83: 61–122.
8. Wakeling J, Melian C, Font A, et al. Evidence for differing incidences of feline hyperthyroidism in London UK and Spain. Proceedings of the 15th ECVIM-CA congress; 2005 Sept 1–3; Glasgow, p 220.
9. Sassnau R. Epidemiologic investigation on the prevalence of feline hyperthyroidism in an urban population in Germany. Tierarztl Prax Ausg K Kleintiere Heimtiere 2006; 34: 450–457.
9. Sassnau R. 在德國城市人口中貓甲狀腺功能亢進的流行病學調查。Tierarztl Prax Ausg K Kleintiere Heimtiere 2006; 34: 450–457.
9. Sassnau R. 在德國城市人口中貓甲狀腺功能亢進的流行病學調查。Tierarztl Prax Ausg K Kleintiere Heimtiere 2006; 34: 450–457.
10. Miyamoto T, Miyata I, Kurobane K, et al. Prevalence of feline hyperthyroidism in Osak and the Chugoku Region. J Jpn Vet Med Assoc 2002; 55: 289–292.
10. 宮本 T，宮田 I，黑羽 K 等。大阪及中國地區貓甲狀腺功能亢進症的流行率。日本獸醫醫學會雜誌 2002；55：289–292。
10. 宮本 T，宮田 I，黑羽 K 等。大阪及中國地區貓甲狀腺功能亢進症的流行率。日本獸醫醫學會雜誌 2002；55：289–292。
11. De Wet CS, Mooney CT, Thompson PN, et al. Prevalence of and risk factors for feline hyperthyroidism in Hong Kong. J Feline Med Surg 2009; 11: 315–321.
11. De Wet CS, Mooney CT, Thompson PN, 等。香港貓甲狀腺功能亢進的流行率及風險因素。J Feline Med Surg 2009; 11: 315–321。
11. De Wet CS, Mooney CT, Thompson PN, 等。香港貓甲狀腺功能亢進的流行率及風險因素。J Feline Med Surg 2009; 11: 315–321。
12. Vaske HH, Schermerhorn T, Grauer GF. Effects of feline hyperthyroidism on kidney function: a review. J Feline Med Surg 2016; 18: 55–59.
12. Vaske HH, Schermerhorn T, Grauer GF. 貓甲狀腺功能亢進對腎功能的影響：一項回顧。J Feline Med Surg 2016; 18: 55–59.
12. Vaske HH, Schermerhorn T, Grauer GF. 貓甲狀腺功能亢進對腎功能的影響：一項回顧。J Feline Med Surg 2016; 18: 55–59.
13. Fox PR, Peterson ME, Broussard JD. Electrocardiographic and radiographic changes in cats with hyperthyroidism: comparison of populations evaluated during 1992–1993 vs. 1979–1982. J Am Anim Hosp Assoc 1999; 35: 27–31.
13. Fox PR, Peterson ME, Broussard JD. 甲狀腺功能亢進貓隻的心電圖和放射學變化：1992–1993 年與 1979–1982 年評估的群體比較。美國動物醫院協會雜誌 1999; 35: 27–31。
13. Fox PR, Peterson ME, Broussard JD. 甲狀腺功能亢進貓隻的心電圖和放射學變化：1992–1993 年與 1979–1982 年評估的群體比較。美國動物醫院協會雜誌 1999; 35: 27–31。
14. Peterson ME, Becker DV. Radioiodine treatment of 524 cats with hyperthyroidism. J Am Vet Med Assoc 1995; 207: 1422–1428.
14. Peterson ME, Becker DV. 對 524 隻患有甲狀腺功能亢進的貓進行放射性碘治療。美國獸醫醫學協會雜誌 1995; 207: 1422–1428。
14. Peterson ME, Becker DV. 對 524 隻患有甲狀腺功能亢進的貓進行放射性碘治療。美國獸醫醫學協會雜誌 1995; 207: 1422–1428。
15. Hoenig M, Goldschmidt MH, Ferguson DC, et al. Toxic nodular goitre in the cat. J Small Anim Pract 1982; 23: 1–12.
15. Hoenig M, Goldschmidt MH, Ferguson DC, 等。貓的毒性結節性甲狀腺腫。小動物實踐雜誌 1982; 23: 1–12。
15. Hoenig M, Goldschmidt MH, Ferguson DC, 等。貓的毒性結節性甲狀腺腫。小動物實踐雜誌 1982; 23: 1–12。
16. Ferguson DC, Freeman R. Goite in apparently euthyroid cats. In: August JR (ed). Consultations in feline internal medicine, 5th ed. St Louis, MO: Elsevier Saunders, 2006, pp 207–215.
16. Ferguson DC, Freeman R. 在表現為正常甲狀腺功能的貓中使用 Goite。收錄於：August JR (編)。貓內科醫學諮詢，第 5 版。聖路易斯，密蘇里州：Elsevier Saunders，2006 年，第 207–215 頁。
16. Ferguson DC, Freeman R. 在表現為正常甲狀腺功能的貓中使用 Goite。收錄於：August JR (編)。貓內科醫學諮詢，第 5 版。聖路易斯，密蘇里州：Elsevier Saunders，2006 年，第 207–215 頁。
17. Gerber H, Peter H, Studer H, et al. Autonomy of growth of and iodine metabolism of hyperthyroid feline goiters transplanted into nude mice. J Clin Invest 1987; 80: 491–498.
17. Gerber H, Peter H, Studer H, et al. 自體生長及碘代謝的甲狀腺功能亢進貓甲狀腺腫移植至無毛小鼠的自主性。J Clin Invest 1987; 80: 491–498.
17. Gerber H, Peter H, Studer H, et al. 自體生長及碘代謝的甲狀腺功能亢進貓甲狀腺腫移植至無毛小鼠的自主性。J Clin Invest 1987; 80: 491–498.
18. Hammer KB, Holt DE, Ward CR. Altered suppression of G proteins in thyroid gland adenomas obtained from hyperthyroid cats. Am J Vet Res 2000; 61: 874–879.
18. Hammer KB, Holt DE, Ward CR. 從甲狀腺功能亢進的貓獲得的甲狀腺腺瘤中 G 蛋白的抑制改變。美國獸醫研究雜誌 2000; 61: 874–879。
18. Hammer KB, Holt DE, Ward CR. 從甲狀腺功能亢進的貓獲得的甲狀腺腺瘤中 G 蛋白的抑制改變。美國獸醫研究雜誌 2000; 61: 874–879。
19. Wakeling J, Smith K, Scase T, et al. Subclinical hyperthyroidism in cats: a spontaneous model of subclinical toxic nodular goiter in humans? Thyroid 2007; 17: 1201–1209.
19. Wakeling J, Smith K, Scase T, et al. 貓的亞臨床甲狀腺功能亢進：人類亞臨床毒性結節性甲狀腺腫的自發模型？ 甲狀腺 2007; 17: 1201–1209.
19. Wakeling J, Smith K, Scase T, et al. 貓的亞臨床甲狀腺功能亢進：人類亞臨床毒性結節性甲狀腺腫的自發模型？ 甲狀腺 2007; 17: 1201–1209.
20. Wakeling J, Elliott J, Syme H. Evaluation of predictors for the diagnosis of hyperthyroidism in cats. J Vet Intern Med 2011; 25: 1057–1065.
20. Wakeling J, Elliott J, Syme H. 評估貓咪甲狀腺功能亢進症診斷的預測因子。J Vet Intern Med 2011; 25: 1057–1065.
20. Wakeling J, Elliott J, Syme H. 評估貓咪甲狀腺功能亢進症診斷的預測因子。J Vet Intern Med 2011; 25: 1057–1065.
21. Peterson ME, Broome MR. Thyroid scintigraphic findings in 917 cats with hyperthyroidism. J Vet Intern Med 2012; 26: 754.
22. Peterson ME, Broome MR. Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. Vet Radiol Ultrasound 2015; 56: 84–95.
22. Peterson ME, Broome MR. 2096 隻患有甲狀腺功能亢進的貓咪的甲狀腺掃描結果。獸醫放射學與超聲學 2015; 56: 84–95。
22. Peterson ME, Broome MR. 2096 隻患有甲狀腺功能亢進的貓咪的甲狀腺掃描結果。獸醫放射學與超聲學 2015; 56: 84–95。
23. Turrel JM, Feldman EC, Nelson RW, et al. Thyroid carcinoma causing hyperthyroidism in cats: 14 cases (1981–1986). J Am Vet Med Assoc 1988; 193: 359–364.
23. Turrel JM, Feldman EC, Nelson RW, et al. 甲狀腺癌引起貓咪甲狀腺功能亢進：14 例（1981–1986）。美國獸醫醫學協會雜誌 1988; 193: 359–364。
23. Turrel JM, Feldman EC, Nelson RW, et al. 甲狀腺癌引起貓咪甲狀腺功能亢進：14 例（1981–1986）。美國獸醫醫學協會雜誌 1988; 193: 359–364。
24. Hibbert A, Gruffydd-Jones T, Barrett EL, et al. Feline thyroid carcinoma: diagnosis and response to high-dose radioactive iodine treatment. J Feline Med Surg 2009; 11: 116–124.
24. Hibbert A, Gruffydd-Jones T, Barrett EL, et al. 貓類甲狀腺癌：診斷及對高劑量放射性碘治療的反應。貓科醫學與外科雜誌 2009; 11: 116–124。
24. Hibbert A, Gruffydd-Jones T, Barrett EL, et al. 貓類甲狀腺癌：診斷及對高劑量放射性碘治療的反應。貓科醫學與外科雜誌 2009; 11: 116–124。
25. Scarlett JM, Moise NS, Rayl J. Feline hyperthyroidism: a descriptive and case control study. Prev Vet Med 1988; 7: 295–310.
25. Scarlett JM, Moise NS, Rayl J. 貓咪甲狀腺功能亢進症：一項描述性和病例對照研究。Prev Vet Med 1988; 7: 295–310.
25. Scarlett JM, Moise NS, Rayl J. 貓咪甲狀腺功能亢進症：一項描述性和病例對照研究。Prev Vet Med 1988; 7: 295–310.
26. Kass PH, Peterson ME, Levy J, et al. Evaluation of environmental, nutritional, and host factors in cats with hyperthyroidism. J Vet Intern Med 1999; 13: 323–329.
26. Kass PH, Peterson ME, Levy J, et al. 評估貓咪甲狀腺功能亢進的環境、營養和宿主因素。J Vet Intern Med 1999; 13: 323–329.
26. Kass PH, Peterson ME, Levy J, et al. 評估貓咪甲狀腺功能亢進的環境、營養和宿主因素。J Vet Intern Med 1999; 13: 323–329.
27. Wakeling J, Everard A, Brodbelt D, et al. Risk factors for feline hyperthyroidism in the UK. J Small Anim Pract 2009; 50: 406–414.
27. Wakeling J, Everard A, Brodbelt D, et al. 英國貓甲狀腺功能亢進的風險因素。小動物實踐雜誌 2009; 50: 406–414。
27. Wakeling J, Everard A, Brodbelt D, et al. 英國貓甲狀腺功能亢進的風險因素。小動物實踐雜誌 2009; 50: 406–414。
28. Edinboro C, Scott-Moncrieff J, Janovitz E, et al. Epidemiologic study of relationships between consumption of commercial canned food and risk of hyperthyroidism in cats. J Am Vet Med Assoc 2004; 224: 879–886.
28. Edinboro C, Scott-Moncrieff J, Janovitz E, 等。商業罐頭食品消費與貓咪甲狀腺功能亢進風險之間關係的流行病學研究。美國獸醫醫學協會雜誌 2004; 224: 879–886。
28. Edinboro C, Scott-Moncrieff J, Janovitz E, 等。商業罐頭食品消費與貓咪甲狀腺功能亢進風險之間關係的流行病學研究。美國獸醫醫學協會雜誌 2004; 224: 879–886。
29. Kang JH, Kondo F. Determination of bisphenol A in canned pet foods. Res Vet Sci 2002; 73: 177–182.
29. Kang JH, Kondo F. 確定罐裝寵物食品中的雙酚 A。Res Vet Sci 2002; 73: 177–182。
29. Kang JH, Kondo F. 確定罐裝寵物食品中的雙酚 A。Res Vet Sci 2002; 73: 177–182。
30. Dye JA, Venier M, Zhu L, et al. Elevated PBDE levels in pet cats: sentinels for humans? Environ Sci Technol 2007; 15: 6350–6356.
30. Dye JA, Venier M, Zhu L, et al. 寵物貓中 PBDE 水平升高：人類的哨兵？環境科學與技術 2007; 15: 6350–6356。
30. Dye JA, Venier M, Zhu L, et al. 寵物貓中 PBDE 水平升高：人類的哨兵？環境科學與技術 2007; 15: 6350–6356。
31. Guo W, Park JS, Wang Y, et al. High polybrominated diphenyl ether levels in California house cats: house dust a primary source? Environ Toxicol Chem 2012; 31: 301–306.
31. Guo W, Park JS, Wang Y, et al. 加州家貓中的高溴化二苯醚水平：家中灰塵是主要來源？環境毒理學與化學 2012; 31: 301–306.
31. Guo W, Park JS, Wang Y, et al. 加州家貓中的高溴化二苯醚水平：家中灰塵是主要來源？環境毒理學與化學 2012; 31: 301–306.
32. Mensching DA, Slater J, Scott JW, et al. The feline thyroid gland: a model for endocrine disruption by polybrominated diphenyl ethers (PBDEs)? J Toxicol Environ Health A 2012; 75: 201–212.
32. Mensching DA, Slater J, Scott JW, et al. 貓的甲狀腺：多溴聯苯醚（PBDEs）引起內分泌干擾的模型？ J Toxicol Environ Health A 2012; 75: 201–212.
32. Mensching DA, Slater J, Scott JW, et al. 貓的甲狀腺：多溴聯苯醚（PBDEs）引起內分泌干擾的模型？ J Toxicol Environ Health A 2012; 75: 201–212.
33. Norrgran J, Jones B, Lindquist NG, et al. Decabromobiphenyl, polybrominated diphenyl ethers, and brominated phenolic compounds in serum of cats diagnosed with the endocrine disease feline hyperthyroidism. Arch Environ Contam Toxicol 2012; 63: 161–168.
33. Norrgran J, Jones B, Lindquist NG, et al. 在被診斷為內分泌疾病貓甲狀腺功能亢進症的貓血清中發現的十溴聯苯、多溴聯苯醚和溴化酚類化合物。Arch Environ Contam Toxicol 2012; 63: 161–168.
33. Norrgran J, Jones B, Lindquist NG, et al. 在被診斷為內分泌疾病貓甲狀腺功能亢進症的貓血清中發現的十溴聯苯、多溴聯苯醚和溴化酚類化合物。Arch Environ Contam Toxicol 2012; 63: 161–168.
34. Court MH, Freeman LM. Identification and concentration of soy isoflavones in commercial cat foods. Am J Vet Res 2002; 63: 181–185.
34. Court MH, Freeman LM. 在商業貓糧中識別和濃縮大豆異黃酮。美國獸醫研究雜誌 2002; 63: 181–185。
34. Court MH, Freeman LM. 在商業貓糧中識別和濃縮大豆異黃酮。美國獸醫研究雜誌 2002; 63: 181–185。
35. Wedekind KJ, Blumer ME, Huntington CE, et al. The feline iodine requirement is lower than the 2006 NRC recommended allowance. J Anim Physiol Anim Nutr (Berl) 2010; 94: 527–539.
35. Wedekind KJ, Blumer ME, Huntington CE 等。貓的碘需求低於 2006 年 NRC 建議的允許量。J Anim Physiol Anim Nutr (Berl) 2010; 94: 527–539。
35. Wedekind KJ, Blumer ME, Huntington CE 等。貓的碘需求低於 2006 年 NRC 建議的允許量。J Anim Physiol Anim Nutr (Berl) 2010; 94: 527–539。
36. Edinboro CH, Scott-Moncrieff JC, Glickman LT. Feline hyperthyroidism: potential relationship with iodine supplement requirements of commercial cat foods. J Feline Med Surg 2010; 12: 672–679.
36. Edinboro CH, Scott-Moncrieff JC, Glickman LT. 貓咪甲狀腺功能亢進：與商業貓糧的碘補充需求之潛在關係。J Feline Med Surg 2010; 12: 672–679.
36. Edinboro CH, Scott-Moncrieff JC, Glickman LT. 貓咪甲狀腺功能亢進：與商業貓糧的碘補充需求之潛在關係。J Feline Med Surg 2010; 12: 672–679.
37. Edinboro CH, Pearce EN, Pino S, et al. Iodine concentration in commercial cat foods from three regions of the USA, 2008–2009. J Feline Med Surg 2013; 15; 717–724.
37. Edinboro CH, Pearce EN, Pino S, 等。2008–2009 年美國三個地區商業貓糧中的碘濃度。貓科醫學與外科雜誌 2013; 15; 717–724。
37. Edinboro CH, Pearce EN, Pino S, 等。2008–2009 年美國三個地區商業貓糧中的碘濃度。貓科醫學與外科雜誌 2013; 15; 717–724。
38. Kemppainen RJ, Birchfield JR. Measurement of total thyroxine concentration in serum from dogs and cats by use of various methods. Am J Vet Res 2006; 67: 259–265.
38. Kemppainen RJ, Birchfield JR. 使用各種方法測量犬和貓血清中的總甲狀腺素濃度。美國獸醫研究雜誌 2006; 67: 259–265。
38. Kemppainen RJ, Birchfield JR. 使用各種方法測量犬和貓血清中的總甲狀腺素濃度。美國獸醫研究雜誌 2006; 67: 259–265。
39. Peterson ME. More than just T4. Diagnostic testing for hyperthyroidism in cats. J Feline Med Surg 2013; 15: 765–777.
39. Peterson ME. 不僅僅是 T4。貓咪甲狀腺功能亢進的診斷測試。J Feline Med Surg 2013; 15: 765–777。
39. Peterson ME. 不僅僅是 T4。貓咪甲狀腺功能亢進的診斷測試。J Feline Med Surg 2013; 15: 765–777。
40. Norsworthy GD, Adams VJ, McElhaney MR, et al. Relationship between semi-quantitative thyroid palpation and total thyroxine concentration in cats with and without hyperthyroidism. J Feline Med Surg 2002; 4: 139–143.
40. Norsworthy GD, Adams VJ, McElhaney MR 等。貓咪甲狀腺半定量觸診與總甲狀腺素濃度之間的關係，無論是否有甲狀腺功能亢進。貓科醫學與外科雜誌 2002; 4: 139–143。
40. Norsworthy GD, Adams VJ, McElhaney MR 等。貓咪甲狀腺半定量觸診與總甲狀腺素濃度之間的關係，無論是否有甲狀腺功能亢進。貓科醫學與外科雜誌 2002; 4: 139–143。
41. Morrow LD, Adams VJ, Syme HM. Hypertension in hyperthyroid cats: prevalence, incidence, and predictors of its development. J Vet Intern Med 2009; 23: 699.
41. Morrow LD, Adams VJ, Syme HM. 甲狀腺功能亢進貓的高血壓：流行率、發生率及其發展的預測因子。J Vet Intern Med 2009; 23: 699.
41. Morrow LD, Adams VJ, Syme HM. 甲狀腺功能亢進貓的高血壓：流行率、發生率及其發展的預測因子。J Vet Intern Med 2009; 23: 699.
42. Higgs P, Murray JK, Hibbert A. Medical management and monitoring of the hyperthyroid cat: a survey of UK general practitioners. J Feline Med Surg 2014; 16: 788–795.
42. Higgs P, Murray JK, Hibbert A. 甲狀腺功能亢進貓的醫療管理與監測：英國全科醫生的調查。貓科醫學與外科雜誌 2014; 16: 788–795.
42. Higgs P, Murray JK, Hibbert A. 甲狀腺功能亢進貓的醫療管理與監測：英國全科醫生的調查。貓科醫學與外科雜誌 2014; 16: 788–795.
43. IRIS CKD Guidelines. Substaging by arterial blood pressure. http://www.iris-kidney.com/guidelines/ (2013, accessed November 2, 2015).
43. IRIS CKD 指南。根據動脈血壓進行分級。http://www.iris-kidney.com/guidelines/ (2013 年，於 2015 年 11 月 2 日訪問)。
43. IRIS CKD 指南。根據動脈血壓進行分級。http://www.iris-kidney.com/guidelines/ (2013 年，於 2015 年 11 月 2 日訪問)。
44. Scott-Moncrief JC. Feline hyperthyroidism. In: Feldman EC, Nelson RW, Reusch CE, et al. (eds). Canine and feline endocrinology and reproduction. 4th ed. St Louis, MO: Elsevier, 2015: 136–195.
44. Scott-Moncrief JC. 貓咪甲狀腺功能亢進症。收錄於：Feldman EC, Nelson RW, Reusch CE 等編輯。犬貓內分泌學與繁殖學。第 4 版。聖路易斯，密蘇里州：Elsevier，2015：136–195。
44. Scott-Moncrief JC. 貓咪甲狀腺功能亢進症。收錄於：Feldman EC, Nelson RW, Reusch CE 等編輯。犬貓內分泌學與繁殖學。第 4 版。聖路易斯，密蘇里州：Elsevier，2015：136–195。
45. WSAVA Nutritional Assessment Guidelines Task Force Members. WSAVA nutritional assessment guidelines. J Feline Med Surg 2011; 13: 516–525.
45. WSAVA 營養評估指導方針工作小組成員。WSAVA 營養評估指導方針。J Feline Med Surg 2011; 13: 516–525。
45. WSAVA 營養評估指導方針工作小組成員。WSAVA 營養評估指導方針。J Feline Med Surg 2011; 13: 516–525。
46. Aldridge C, Behrend E, Martin L, et al. Evaluation of throid-stimulating hormone, total thyroxine, and free thyroxine concentrations in hyperthyroid cats receiving methimazole treatment. J Vet Intern Med 2015; 29: 862–868.
46. Aldridge C, Behrend E, Martin L, et al. 評估接受美克咪唑治療的甲狀腺功能亢進貓的甲狀腺刺激激素、總甲狀腺素和游離甲狀腺素濃度。J Vet Intern Med 2015; 29: 862–868.
46. Aldridge C, Behrend E, Martin L, et al. 評估接受美克咪唑治療的甲狀腺功能亢進貓的甲狀腺刺激激素、總甲狀腺素和游離甲狀腺素濃度。J Vet Intern Med 2015; 29: 862–868.
47. Daminet S, Kooistra H, Fracassi F, et al. Best practice for pharmacological management of hyperthryoid cats with antithyroid drugs. J Small Anim Pract 2014; 55: 4–13.
47. Daminet S, Kooistra H, Fracassi F, et al. 使用抗甲狀腺藥物對甲狀腺功能亢進貓的藥物管理最佳實踐。小動物實踐雜誌 2014; 55: 4–13。
47. Daminet S, Kooistra H, Fracassi F, et al. 使用抗甲狀腺藥物對甲狀腺功能亢進貓的藥物管理最佳實踐。小動物實踐雜誌 2014; 55: 4–13。
48. Williams T, Elliott J, Syme H. Association of iatrogenic hypothyroidism with azotemia and reduced survival time in cats treated for hyperthyroidism. J Vet Intern Med 2010; 24: 1086–1092.
48. Williams T, Elliott J, Syme H. 醫源性甲狀腺功能低下症與貓咪治療甲狀腺功能亢進症後的氮血症及生存時間縮短的關聯。J Vet Intern Med 2010; 24: 1086–1092.
48. Williams T, Elliott J, Syme H. 醫源性甲狀腺功能低下症與貓咪治療甲狀腺功能亢進症後的氮血症及生存時間縮短的關聯。J Vet Intern Med 2010; 24: 1086–1092.
49. Williams T, Elliott J, Syme H. Effect on renal function of restoration of euthyroidism in hyperthryoid cats with iatrogenic hypothyroidism. J Vet Intern Med 2014; 28: 1251–1255.
49. Williams T, Elliott J, Syme H. 在有醫源性甲狀腺功能減退的甲狀腺功能亢進貓中恢復甲狀腺功能對腎功能的影響。J Vet Intern Med 2014; 28: 1251–1255.
49. Williams T, Elliott J, Syme H. 在有醫源性甲狀腺功能減退的甲狀腺功能亢進貓中恢復甲狀腺功能對腎功能的影響。J Vet Intern Med 2014; 28: 1251–1255.
50. DiBartola S, Brown S. The kidney and hypertension. In: Bongura J (ed). Kirk’s current veterinary therapy XIII. Philadephia: WB Saunders, 1999, p 137.
51. DiBartola S, Rutgers H, Zack P, et al. Clinicopathologic findings associated with chronic renal disease in cats: 74 cases (1973–1984). J Am Vet Med Assoc 1987; 190: 1196–1202.
52. van Hoek I, Vandermeulen E, Peremans K, et al. Thyroid stimulation with recombinant human thyrotropin in healthy cats, cats with non-thyroidal illness and in cats with low serum thyroxin and azotemia after treatment of hyperthyroidism. J Feline Med Surg 2010; 12: 117–121.
53. Weichselbaum RC, Feeney DA, Jessen CR. Relationship between selected echocardiographic variables before and after radioiodine treatment in 91 hyperthyroid cats. Vet Radiol Ultrasound 2005; 46: 506–513.
54. Sangster JK, Panciera DL, Abbott JA, et al. Cardiac biomarkers in hyperthyroid cats. J Vet Intern Med 2014; 28: 465–472.
55. Goldstein RE, Long C, Swift NC, et al. Percutaneous ethanol injection for treatment of unilateral hyperplastic thyroid nodules in cats. J Am Vet Med Assoc 2001; 218: 1298–1302.
56. Mallery KF, Pollard RE, Nelson RW, et al. Percutaneous ultrasound-guided radiofrequency heat ablation for treatment of hyperthyroidism in cats. J Am Vet Med Assoc 2003; 223: 1602–1607.
57. Wells AL, Long CD, Hornof WJ, et al. Use of percutaneous ethanol injection for treatment of bilateral hyperplastic thyroid nodules in cats. J Am Vet Med Assoc 2001; 218: 1293–1297.
58. Mooney CT, Peterson ME. Feline hyperthyroidism. In: Mooney CT, Peterson ME (eds). BSAVA manual of canine and feline endocrinology. 4th ed. Quedgeley, Gloucester, UK: BSAVA, 2012, pp 199–203.
59. Syme HM. Cardiovascular and renal manifestations of hyperthyroidism. Vet Clin North Am Small Anim Pract 2007; 37: 723–743.
60. Peterson ME, Kintzer PP, Hurvitz AI. Methimazole treatment of 262 cats with hyperthyroidism. J Vet Intern Med 1988; 2: 150–157.
61. Peterson ME. Hyperthyroidism in cats. In: Rand JS, Behrend E, Gunn-Moore D, et al. (eds). Clinical endocrinology of companion animals. Ames, Iowa: Wiley-Blackwell, 2013, pp 295–310.
62. Hui TY, Bruyette DS, Moore GE, et al. Effect of feeding an iodine-restricted diet in cats with spontaneous hyperthyroidism. J Vet Intern Med 2015; 29: 1063–1068.
63. Ward CR. Feline thyroid storm. Vet Clin North Am Small Anim Pract 2007; 37: 745–754.
64. Peterson ME. Radioiodine for feline hyperthyroidism. In: Bonagura JD, Twedt DC (eds). Kirk’s current veterinary therapy IV. St Louis, MO: Elsevier, 2008, 180–184.
65. Mooney CT. Hyperthyroidism. In: Ettinger SJ, Feldman EC (eds). Textbook of veterinary internal medicine. St Louis, MO: Elsevier, 2010, pp 1761–1779.
66. Peterson ME, Broome MR. Radioiodine for feline hyperthyroidism. In: Bonagura JD, Twedt DC. Kirk’s current veterinary therapy XV. Philadelphia: Saunders Elsevier, 2014, e112–e122.
67. Baral RM, Peterson ME: Hyperthyroidism. In: Little SE (ed). The cat: clinical medicine and management. St Louis, MO: Elsevier Saunders, 2012, pp 571–583.
68. Lunn KF, Page RL. Tumors of the endocrine system. In: Withrow SJ, Vail DM, Page RL (eds). Withrow and McEwen’s small animal clinical oncology. 5th ed, St Louis, MO: Elsevier, 2013, pp 504–513.
69. Theon AP, Van Vechten MK, Feldman E. Prospective randomized comparison of intravenous versus subcutaneous administration of radioiodine for treatment of hyperthyroidism in cats. Am J Vet Res 1994; 55: 1734–1738.
70. Meric SM, Hawkins EC, Washabau RJ, et al. Serum thyroxine concentrations after radioactive iodine therapy in cats with hyperthyroidism. J Am Vet Med Assoc 1986; 188: 1038–1040.
71. Mooney CT. Radioactive iodine therapy in feline hyperthyroidism [letter]. Vet Rec 1990; 127: 555.
72. Lucy J, Peterson ME, Randolph J, et al. Efficacy of low-dose (2 millicurie) versus standard-dose (4 millicurie) radioiodine (131I) treatment for cats with mild-to-moderate hyperthyroidism [abstract]. J Vet Intern Med 2015; 29: 1170.
73. Nykamp SG, Dykes NL, Zarfoss MK, et al. Association of the risk of development of hypothyroidism after iodine 131 treatment with the pretreatment pattern of sodium pertechnetate Tc 99m uptake in the thyroid gland in cats with hyperthyroidism: 165 cases (1990–2002). J Am Vet Med Assoc 2005; 226: 1671–1675.
74. Mooney CT. Feline hyperthyroidism: diagnostics and therapeutics. Vet Clin North Am Small Anim Pract 2001; 31: 963–983.
75. Trepanier LA. Pharmacologic management of feline hyperthyroidism. Vet Clin North Am Small Anim Pract 2007; 37: 775–788.
76. Veterinary Medicines Directorate. Product information database. Felimazole 2.5 mg Coated Tablets for Cats. http://www.vmd.defra.gov.uk/ProductInformationDatabase (2012, accessed July 31, 2015).
77. Frénais R, Rosenberg D, Burgaud S, et al. Clinical efficacy and safety of a once-daily formulation of carbimazole in cats with hyperthyroidism. J Small Anim Pract 2009; 50: 510–515.
78. Trepanier LA, Peterson ME. Pharmacokinetics of methimazole in normal cats and cats with hyperthyroidism. Res Vet Sci 1991; 50: 69–74.
79. Okuno A, Yano K, Inyaka F, et al. Pharmacokinetics of methimazole in children and adolescents with Graves’ disease. Studies on plasma and intrathyroidal concentrations. Acta Endocrinologica 1987; 115: 112–118.
80. Trepanier LA, Peterson ME, Aucoin DP. Pharmacokinetics of intravenous and oral methimazole following single- and multiple-dose administration in normal cats. J Vet Pharmacol Ther 1991; 14: 367–373.
81. Trepanier LA, Hoffman SB, Kroll M, et al. Efficacy and safety of once versus twice daily administration of methimazole in cats with hyperthyroidism. J Am Vet Med Assoc 2003; 222: 954–958.
82. Peterson ME, Broome MR, Rishniw M. Prevalence and degree of thyroid pathology in hyperthyroid cats increases with disease duration: a cross-sectional analysis of 2096 cats referred for radioiodine therapy. J Feline Med Surg 2016; 18: 92–103.
83. Kintzer PP. Considerations in the treatment of feline hyperthyroidism. Vet Clin North Am Small Anim Pract 1994; 24: 577–585.
84. Hill KE, Gieseg MA, Kingsbury D, et al. The efficacy and safety of a novel lipophilic formulation of methamizole for the once daily transdermal treatment of cats with hyperthyroidism. J Vet Intern Med 2011; 25: 1357–1365.
85. Padgett S. Feline thyroid surgery. Vet Clin North Am Small Anim Pract 2002; 32: 851–859.
86. Welches CD, Scavelli TD, Matthiesen DT, et al. Occurrence of problems after three techniques of bilateral thyroidectomy in cats. Vet Surg 1989; 18: 392–296.
87. Flanders JA, Harvey HJ. Feline thyroidectomy: a comparison of postoperative hypocalcemia associated with three different surgical techniques. Vet Surg 1987; 16: 362–366.
88. Swalec KM, Birchard SJ. Recurrence of hyperthyroidism after thyroidectomy in cats. J Am Anim Hosp Assoc 1980; 26: 433–437.
89. Naan EC, Kirpensteijn J, Kooistra HS, et al. Results of thyroidectomy in 101 cats with hyperthyroidism. Vet Surg 2006; 35: 287–293.
90. Kaptein EM, Hays MT, Ferguson DC. Thyroid hormone metabolism. A comparative evaluation. Vet Clin North Am Small Anim Pract 1994; 24: 431–466.
91. van der Kooij M, Becvárová I, Meyer HP, et al. Effects of an iodine-restricted food on client-owned cats with hyperthyroidism. J Feline Med Surg 2014; 16: 491–498.
92. Fritsch D, Allen T, Dodd C, et al. A restricted iodine food reduces circulating thyroxine concentrations in cats with hyperthyroidism. Intern J Appl Res Vet Med 2014; 12: 24–32.
93. Scott-Moncrieff JC, Heng HG, Weng HY, et al. Effect of a limited iodine diet on iodine uptake by thyroid glands in hyperthyroid cats. J Vet Intern Med 2015; 29: 1322–1326.
94. Boag AK, Neiger R, Slater L, et al. Changes in the glomerular filtration rate of 27 cats with hyperthyroidism after treatment with radioactive iodine. Vet Rec 2007; 161: 711–715.
95. Williams TL, Elliott J, Syme HM. Association of iatrogenic hypothyroidism with azotemia and reduced survival time in cats treated for hyperthyroidism. J Vet Intern Med 2010; 24: 1086–1092.
96. Wakeling J. Use of thyroid stimulating hormone (TSH) in cats. J Can Vet Assoc 2010; 51: 33–34.
97. Williams T, Peak K, Brodbelt D, et al. Survival and the development of azotemia after treatment of hyperthyroid cats. J Vet Intern Med 2010; 24: 863–869.
98. Panciera D, Lefebvre H. Effect of experimental hypothyroidism on glomerular filtration rate and plasma creatinine concentration in dogs. J Vet Intern Med 2009; 23: 1045–1050.
99. Milner RJ, Channell CD, Levy JK, et al. Survival times for cats with hyperthyroidism treated with iodine 131, methimazole, or both: 167 cases (1996–2003). J Am Vet Med Assoc 2006; 228: 559–563.
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Article first published online: May 3, 2016
Issue published: May 2016
PubMed: 27143042
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This article was published in Journal of Feline Medicine and Surgery.
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