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Modified Wen Dan Tang And Treating Hypothyroid Question

by fdzenitsky - November 19, 2021

Hi Steve,

What is the formula for modifying WDT v Phase II feline hyperthyroidism? My 2 sources differ. Has there been any formula updates to make this w/o adding in so many separate herbs?

When treating a new patient already on methimazole that now has T4 in normal range and is gaining weight, improving overall, BUT was probably Phase III before intervention, can you safely begin with the formula that fits the current picture as the med is weaned w/o much risk of going back to more advanced disease state? Is a second formula needed to address unmasked azotemia?

Thanks!
Franchesca

by naturevet

November 20, 2021

Hi Franchesca,

You can probably choose as your focus addressing any 'leaky gut' possibilities in the cat, through a diet change and the formula that seems appropriate as things stand now. Perhaps Wei Ling Tang, if he is asymptomatic?

If the tumor is quite large and palpable, it will not be curable with herbs and diet alone. If the tumor is tiny and non-palpable, it may be still resolvable.

If the tumor is large and the owner doesn't want to use the drug forever, I usually opt to surgically remove it, using techniques similar to those of Gary Norsworthy:

Norsworthy GD. Feline Thyroidectomy: A Simplified Technique that Preserves Parathyroid Function. Veterinary Medicine. 1995. 90;11:1145-1149.

Hopefully this helps. Consider also Yi Guan Jian as your GI/anti-thyroid formula if the tongue is still small and red

Steve

by fdzenitsky

November 26, 2021

Thanks Steve! Some clarifications...

I recently listened to your endocrine lectures on CIVT. For Phase III hyperthyroid - Yin Def. - you recommended ZBDHW, also mentioned TWBXD, but I missed YGJ. In Natural Path guide, you mention its use and say to 1st use ZBDHW to stabilize heart rate and BW. Should we consider that first, then move to YGJ?

For Phase II - Phlegm Fire cats, what is the formula for modifying Wen Dan Tang? Have there been any formula updates to make this w/o adding in so many separate herbs to the WDT?

Franchesca :)

by naturevet

November 27, 2021

Hi Franchesca

There haven't really been any changes to the Wen Dan Tang modification, so the recipe is as previously described. I know it's a pain, but there you have it. Potentially any appropriate IBD formula can help, however, but the Modified WDT is the one I have seen nodules of phase II cats shrink on.

For Phase III cats, I do find ZBDHW to be great for slowing the heart rate down and stopping the weight loss (or even causing them to gain a small amount of weight). Technically YGJ has even more anti-thyroid activity, though, and is an IBD formula as well, so it would seem to be of more utility long term. If a cat did improve greatly on ZBDHW, though, I'd be tempted to continue it

Hope that clarifies!

Steve

by fdzenitsky

December 14, 2021

It does Steve, thanks!
Most of these cats have CKD lurking or even signs of that with elevated P and low K even if Cr is WNL. So, when these formulas normalize thyroid function, can we expect renal function to plummet or do they somewhat support azotemia? What do you see in practice with renal function when treating for hyperthyroidism? Can a formula like Rehmannia Eight be used in tandem out of the gate or rolled in when azotemia is evident? And, do you make use of P-binders as needed?

Thanks again, I love endocrine, but it still challenges me!
Franchesca

by naturevet

December 21, 2021

Hi Franchesca!

For cats with compromised renal function, they are more in stage III of hyperthyroidism. At that point, I reach for Zhi Bai Di Huang Wan, Rehmannia Eight, or Yi Guan Jian

If you have a stage I cat showing the same signs, Wei Ling Tang can maintain renal perfusion in at least some of these cases. Or you can reach for Rehmannia 8

If it's a stage II cat, with full on Phlegm-Fire, then ZBDHW might help, although you risk further Dampness, so watch for that. Otherwise, San Ren Tang can help renal perfusion a little, while, not aggravating Dampness

I use phosphate binders if needed, but the best way to lower phosphorus is to increase renal perfusion, so I seldom find it necessary to use the binders, as the herbs and a normal protein diet are pretty good at maintaining renal perfusion.

Hopefully that answers your question

Steve

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