Spontaneous adult-onset primary hypothyroidism in 17 cats

ObjectivesThe aim of this study was to describe the clinical, laboratory and thyroid imaging features of 17 adult cats with spontaneous hypothyroidism diagnosed over a 4-year period in four countries.MethodsThis multicenter case series included cats diagnosed with spontaneous hypothyroidism between 2021 and 2025. We collected data on cats' signalment, clinical signs, results of physical examination, routine laboratory and thyroid hormone testing, and thyroid imaging (scintigraphy, ultrasonography or CT). We also reviewed treatment data, including levothyroxine dosage, changes in serum thyroid hormone and creatinine concentrations, clinical progression and follow-up scintigraphy.ResultsCats were aged 2-14 years, with no breed predilection; 10 (58.8%) were male and seven (41.2%) female. Common clinical signs included lethargy, dermatologic signs (unkempt hair coat, increased shedding, dandruff, hair thinning), weight gain or obesity, and palpable goiter. The most common laboratory findings included azotemia (five cats), anemia (three cats) and worsening of pre-existing diabetes mellitus (two cats). A total of 13 (76.5%) cats had low serum thyroxine (T4), whereas all cats had high thyroid-stimulating hormone (TSH) concentrations. Thyroid imaging confirmed undetectable or atrophic thyroid tissue in 10 (58.8%) cats and bilateral thyroid enlargement in seven (41.2%). After levothyroxine treatment (median 133 µg/cat/day) in 15 cats, serum total T4 concentration increased and TSH fell. Treated cats became more alert and active, goiter resolved, azotemia resolved or improved, and two achieved remission of concurrent diabetes mellitus.Conclusions and relevanceThis study broadens current knowledge of spontaneous hypothyroidism in adult cats, a condition that remains underrecognized in clinical practice. Atrophic hypothyroidism appears more common than previously recognized, although goitrous hypothyroidism was identified in more than 40% of cats. Spontaneous hypothyroidism should be considered in cats with unexplained azotemia and in diabetic cats with worsening glycemic control. Levothyroxine supplementation reliably improved or resolved clinical signs in all treated cats.