Sorry its long.
I'm at my wits end with my poor 13 yo Shih Tzu (weighs 13-14lbs). Although she's not sick, she's been Triple diagnosed: Cushings, Hypothyroidism, and Kidney Failure.
In 2004 she had a bloodwork as part of her physical.
Bloodwork #1 in 2004
Everything was ok, but the AlkPhos= 624. T4= 2.0. Lipids were a bit high(can't remember totals).
The vet suggested testing for Cushings and thyroid. I (in denial)opted to retest in 3 weeks.
Three weeks later, Bloodwork #2 in 2004
No thyroid done.
AlkPhos=604
Lipids still high.
Everything ok.

Because the Alkphos went down my vet thought she may have a partially obstructed duct....I was relieved(and HAPPY in denial. It is my fault, Not blaming him). Through the years,
SHE WAS NOT SYPTOMATIC AT ALL...just some "acne", and lately, growths.

She was fine over the years, walked (panting a bit, kind of lowgrade, nothing big), ate, happy. Had a couple of growths removed.

Over the last year, she seemed like she was getting a bit "older"-didn't smile as much, gained 1 lb...A couple of months ago had surgery for some growths on the eyelids. Did fine.
As it got warmer (in April 2009), she didn't want to walk as far as she used to. One warm April day she was sitting in the room and GOT HOT, started panting. The panting happened while the AC was on and I wore a sweater! I quickly put the 2(less walking and panting for no reason) together and took her in for bloodwork.

Bloodwork #1 May 8, 2009:
AlkPhos=694
Urea Nitrogen= 42 (nml 6-25)
Creat=1.4 (nml 0.5-1.6)
BUN/Creat =30 (nml 4-27)
Chol=534
Triglicerydes=1610
T4 = 1.0 (nml 1.0-4.0)

CBC=normal, Platelets high=467
US dipstick (at home)spgravity 1.030

FOLLOW-UP BLOODWORK:
Cushings & Thyroid
1) ACTH Stimulation Test:
Cortisol 10.7
1 hour 15 min after injection: 28.9

2)TSH, Free T4
TSH=.94 (nml 0.0-0.60)
FreeT4= 24 (nml 8-40)

****DIAGNOSIS*** Cushings and Hypothyroidism.

Here is the start of my problems:
1) On May 9, 2009 started on Trilostane 30 mg SID.
Waited a couple of days for the extra Thyroid tests (results above).
2) On May 16, 2009 placed on Soloxine .1 BID.

She has a little arthritic back leg problem ...Since 2007 has been taking Previcox 26.5 mg M. W. F (3 times a week only).
Synflex (Glucosamine SID).
Not very symptomatic of Cushings or Hypothyroid. Drank 8 oz WATER,plus or minus, depending on the weather (1 oz more on hot days, less on cold days). Ate well. Seemed a bit hungrier,but wanted good food ;)

Did fine a week into Trilostane. Belly pulled up. Drank 6-7 of water. Not much difference with or without Trilostane.
Started Soloxine (1 week later).....Coincidence???NOW I HAD A FULL BLOWN CUSHINGS dog. That day she started drinking 10 oz water plus..., ravenous. Fell walking on the 3rd day of Soloxine. Third day on Soloxine she stopped eating. I IMMEDIATELY stopped the Soloxine. She was like that 3 more days. Then she was back to normal, drinking 7 oz water, eating normal.

Bloodwork #2 June 8, 2009
Cortisol= 4.6
T4=.6

CBC
Platelets=478
Monos=1152
BASOS=0.6
otherwise nml
Alkphos-632

SC:
AlkPhos=632
GGTP=23
UREA Nitrogen=56
CREATININE=2.3 !!!!!!! KIDNEY FAILURE??????
Chol=423
Triglycerides= 626

UA dipstick (at home)spgr 1.030

Continue Trilostane 30 mg SID on AM (same dose). Eating well(gets hungrier and thirstier at night, probably less Trilostane in her system?)

June 6, 2009 Re started Soloxine .05 BID.

June 10th, I stopped the PREVICOX(last dose. ?kidney failure). She may be fine with just the Glucosamine. I'll see...so far she's using both legs to pee. Good sign.

THE PROBLEM? She is fine, other than going "hormonal" on me.
I'm questioning the Soloxine,AGAIN.
She was fine the first 3 days. She even ran/walked. It does look like she needs it.
Yesterday (4rth Solox day)she started getting hungrier and drinking a bit more. She feels HOT, Panting more.Her nose is dry . I have the AC running. It's warm, but not hot outside. Today she stumbled coming into the house. These are the same symptoms she had when I started her the first time on too much Soloxine. I put her back on Soloxine because the T4 went down to .6 from 1.0. She drank 7 oz of water yeaterday and drinking ok today-not too much so far.

Questions:
1)Could the .05 BID of Soloxine be too much for her IF she has kidney failure? I'm thinking of giving Soloxine .05 SID.
2)Could it be the Trilostane with Soloxine?

I'm trying to be patient. I had my other dog (loved to be 18 yo) on Soloxine for Hypothyroidism and never had a problem. My vet questioned why the Creatinine was elevated so quickly, within 30 days of starting Trilostane??? Could she have already been in kidney failure...and Trilostane pushed the values over the edge...

My vet says to recheck blood in 30 days. I want to check it in 2 weeks. I don't know if I want to keep her on Trilostane IF her kidney values come back worse...Although she doesn't have the typical kidney failure symptoms(drinking and peeing) I'm stressing...

Meghane,
have you had a complicated situation like that? Am I being impatient?

Has anyone here dealt with all 3(Cushings, Hypothyroid, and kidney failure), at the same time? My dog is not as sick as the bloodwork is showing...but I'm worried about the kidneys. My vet says she may be OK. Don't worry.

Thank you so much.

He was diagnosed with Cushings in his final 2 years but I was never convinced the tests were accurate since my dog never had 'true' cushings symptoms. The symptoms he did have, and died from, were more indicative of a brain tumor.

I wish you the best with your little gal.