Puppy First, Health First
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The big picture
Shih Tzus typically live 10–18 years.
Most Shih Tzus whose knees, hearts and eyes are checked get normal results. Many of the breed's health problems involve the eyes. Problems are usually easier to manage when they are caught early.
A few everyday habits do a lot of the work.
This page brings together what the research shows about Shih Tzu health.
It covers the conditions the breed is known to be prone to, screening and DNA results, what to watch for, treatment costs and a care plan for each life stage.
Worth knowing
Each entry below is a condition Shih Tzus are known to be prone to, with what you might notice and what helps.
This list is not exhaustive or official. Keep asking your veterinarian as your puppy grows.
The lids can roll inward (entropion) or fail to close all the way (exposure keratopathy), and the eyes can run dry (dry eye). Each can lead to a sore on the eye's surface (corneal ulcer).
Watch for squinting, a red eye or rubbing at the face.
Wipe the eye corners daily, keep face hair tied up and book a yearly eye exam with a dry-eye check. A vet may suggest eye drops or a small eyelid surgery.
The short face can narrow the airway, a problem called brachycephalic obstructive airway syndrome (BOAS).
Watch for noisy breathing at rest and for overheating in warm weather. Puppies often snort while teething, but a puppy that struggles to breathe needs a vet.
Keep your Shih Tzu lean and cool, and carry water on outings. Once your dog is grown, a breathing test can grade how freely it breathes.
In a liver shunt (portosystemic shunt), a blood vessel present from birth carries blood around the liver instead of through it.
A puppy that stays small, does not thrive next to its littermates or drinks a lot should see a vet.
Tell your vet early if your puppy seems small or slow to grow, so it can be checked.
In hip dysplasia, the hip joint forms poorly as a puppy grows.
It is found on X-rays, and most cases found in Shih Tzus are mild.
Keep your Shih Tzu at a lean weight, the everyday step that helps the hips.
Less common
A cloudy lens (cataract) also runs in the breed, and a yearly eye exam tracks any change.
DNA tests
A cheek-swab DNA test can check for several inherited problems, such as a thyroid problem present from birth and a clotting-factor shortage. A test on a lab's list for the breed means the test exists for Shih Tzus, not that the problem is common in them.
Each result comes back as clear, carrier or at risk, and a carrier is healthy. At risk means a higher chance, not a diagnosis, and an at-risk dog may never get sick, or may get sick late. A disc test reports one or two copies of a gene change, which raise the risk of back disc disease without meaning the dog has it. If your dog is at risk for the clotting-factor shortage, tell your vet before any surgery.
Checkups your dog will get
Care plan by life stage
Planning for Shih Tzu vet costs
These are typical published costs for treating what a Shih Tzu vet exam looks at and the conditions the breed is known to be prone to. Each range shows where it comes from and when, and your own vet's estimate will differ.
| Item | Typical cost | Per | Source | Year |
|---|---|---|---|---|
| Soft-tissue surgery workup with advanced imaging | $800–$1,200 | per workup | at one US veterinary teaching hospital (Illinois) | 2023 |
| Breathing (BOAS) surgery: nostrils and soft palate | $3,120–$5,500 | per procedure | at US veterinary teaching hospitals (Illinois, Tennessee) | 2023–2024 |
| Item | Typical cost | Per | Source | Year |
|---|---|---|---|---|
| Specialist's first exam (consultation fee only) | $198–$350 | per visit | at US veterinary teaching hospitals (Michigan, Missouri, Tennessee) | 2023–2026 |
| Eye tests before cataract surgery (ERG and eye ultrasound) | $500–$1,300 | per workup | at US veterinary teaching hospitals (Missouri, Tennessee) | 2025–2026 |
| Cataract surgery, one eye | $3,800–$5,500 | per eye | at one US veterinary teaching hospital (Missouri) | 2023–2025 |
| Cataract surgery, both eyes under one anesthetic | $5,600–$6,700 | at one US veterinary teaching hospital (Missouri) | 2025 |
| Item | Typical cost | Per | Source | Year |
|---|---|---|---|---|
| Liver shunt workup (before any surgery) | $1,622–$3,937 | per workup | at one US veterinary teaching hospital (Tennessee) | 2026 |
| Liver shunt surgery, shunt outside the liver (workup and surgery) | $5,408–$7,571 | per procedure | at one US veterinary teaching hospital (Tennessee) | 2026 |
| Liver shunt surgery, shunt inside the liver, open surgery (workup and surgery) | $6,685–$9,605 | per procedure | at one US veterinary teaching hospital (Tennessee) | 2026 |
| Liver shunt closure with coils through a vein (workup and procedure) | $10,600–$12,309 | per procedure | at one US veterinary teaching hospital (Tennessee) | 2026 |
Planning for pet insurance
When you are ready to compare plans, here is one option for Pawrade buyers.
Only with Pawrade, you receive a pet insurance policy with no waiting period included for immediate accident or illness coverage, 1 month, with every puppy.† You activate it by calling MetLife; instructions arrive with your travel details. Continuing MetLife coverage after the first month is strongly recommended.
View the MetLife 30-day offer →†NH, NY, RI, SC and TN residents excluded. Activated by calling MetLife; coverage begins immediately following policy activation. See the offer for full terms.
Whichever plan you look at, read the policy before you buy. Check the waiting periods, how it defines a pre-existing condition, and its deductible, reimbursement percentage and annual limit.
A waiting period is how long after you buy a pet insurance policy before a claim counts.
| Policy | Accidents | Illness | Joints |
|---|---|---|---|
| MetLife policy included with your Pawrade puppy† | None | None | None |
| MetLife, bought directly | None | 14 days | Not listed |
| Industry standard | 0–14 days | 14–30 days | 6–12 months |
| Nationwide | 14 days | 14 days | Not listed |
| Trupanion | 5 days | 30 days | 30 days |
| Embrace | 2 days | 14 days | 6 months |
| Figo | 1 day | 14 days | Not listed |
The breeder's licensed vet checks your puppy before it goes home. The vet follows PetPay's exam standards, and the results go in your puppy's Veterinary Health Report.
Focus
Breathing
How open the nostrils are · Coughing or congestion
03
Temperature, pulse and breathing rate
Temperature · Pulse · Breathing rate
04 Focus
Eyes
Discharge · Vision problems · Eyelash problems · Cherry eye
05
Ears and hearing
Debris or discharge · Ear mites · Signs of infection · Hearing
06 Focus
Mouth and bite
Teeth and jaw alignment · Bite (overbite or underbite)
07
Skin and coat
Fleas and ticks · Hair loss · Signs of infection
08
Kneecaps
Kneecaps that slip, and how much (grade)
09
Hips
Hip pain
10
Hernias
Belly-button (umbilical) hernia · Groin (inguinal) hernia
11
Soft spot on the skull
An open soft spot, and its size
12 Focus
Body condition and weight
Body condition score · Weight
13
Reproductive organs
Both testicles in place (males) · Extra skin folds around the vulva (females)
14
History of vomiting or diarrhea
Any history of vomiting or diarrhea (reported, not examined)
15
Stool test for parasites
Fecal flotation test, with any treatment given
16
Past surgery and notes
Any past surgery · The vet's explanation of anything abnormal
The vet checks how open the nostrils are, counts the breathing rate and listens for coughing or congestion.
A short muzzle can narrow the airway, so open nostrils are a good start for a Shih Tzu.
The vet checks for eyelashes or hairs that rub the eye and looks for discharge.
Eyelids that roll in (entropion) are something to watch for as your puppy grows. Big eyes and lids that may not close all the way leave the eye's surface exposed, so an early look matters in this breed.
The vet checks the bite, which is undershot or level in the breed standard, and looks inside the mouth.
The vet weighs the puppy, checks its body condition and looks for a puppy that is small or not thriving next to its littermates.
In a Shih Tzu, poor thriving can point to a liver shunt present from birth, so it gets a closer look. Drinking a lot can also be a sign worth raising with your vet.
The vet checks how open the nostrils are, counts the breathing rate and listens for coughing or congestion.
A short muzzle can narrow the airway, so open nostrils are a good start for a Shih Tzu.
The vet checks for eyelashes or hairs that rub the eye and looks for discharge.
Eyelids that roll in (entropion) are something to watch for as your puppy grows. Big eyes and lids that may not close all the way leave the eye's surface exposed, so an early look matters in this breed.
The vet checks the bite, which is undershot or level in the breed standard, and looks inside the mouth.
The vet weighs the puppy, checks its body condition and looks for a puppy that is small or not thriving next to its littermates.
In a Shih Tzu, poor thriving can point to a liver shunt present from birth, so it gets a closer look. Drinking a lot can also be a sign worth raising with your vet.
Puppies grow and change quickly, and their immune systems are still developing, so no exam can find everything. The Veterinary Health Report is a strong early look at your puppy and a written starting point that your own vet builds on.
Health guarantee
Every Pawrade puppy comes with a health guarantee administered by PetPay, independent of the seller. The terms are on the health guarantee page.
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Frequently asked questions
The conditions the breed is known to be prone to are mostly eye problems. They are eyelids that roll inward (entropion), sores on the eye (corneal ulcers), dry eye, lids that do not close fully (exposure keratopathy) and cataract. The list also includes breathing trouble from the short face (BOAS), a liver shunt from birth (portosystemic shunt) and hip dysplasia. Daily eye care, a cool home and a yearly eye exam keep you ahead of most of them.
Large, exposed eyes, lids that may not close fully, inward-rolling lids and hairs growing at the inner corner of the eye can all irritate the eye's surface. Keep face hair off the eyes, wipe the corners daily, and have your vet check for dry eye at least once a year.
Some do, because a short face can narrow the airway, a problem called brachycephalic obstructive airway syndrome (BOAS). Noisy breathing at rest is worth a vet check, although puppies often snort while teething. Adult dogs can have their breathing graded with a respiratory function test.
Shih Tzus can develop disc disease in the spine (intervertebral disc disease). A cheek-swab DNA test shows whether a dog carries a higher risk, which is not the same as having the disease. A lean weight and fewer jumps off the furniture help protect the back.
Cheek-swab DNA tests cover back disc disease risk, an inherited thyroid problem present from birth, a clotting-factor shortage (prekallikrein deficiency) and a spinal cord disease (degenerative myelopathy). A test on a lab's list for the breed means the test exists for Shih Tzus, not that the condition is common in them.
A carrier has one copy of a gene change and is healthy. An at-risk result means a higher chance, not a diagnosis, and an at-risk dog may never develop the condition, or develop it late.
Shih Tzus typically live 10–18 years.
Older Shih Tzus need a close watch on the eyes for cataract and dry eye, and your vet should listen for a heart murmur at each exam. Dental care continues, and it pays to watch weight and mobility.
Brush the teeth every day and book dental cleanings with your vet from time to time. When the adult teeth come in, at around 8–9 months, ask your vet to check for baby teeth that haven't fallen out.
Measure meals and count treats, because Shih Tzus put on weight easily. A lean weight is the everyday step that helps the hips, and it also helps protect the back.
