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Old 03-08-2011, 10:26 AM   #1 (permalink)
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Default Resthyro for Hyperthyroid

Hi to you all! I hope everyone and every kitty are doing good! I just registered a few days ago and am very happy to find this forum. All kitties are so cute! I am so glad that there are many cat lovers here. I am living on the street that all neighbors own cat except for one family, so it is nice to know many people love cats here!

The reason I am posting here today is that I have a question about hyperthyrooid. My baby, Spock, is 12 years old and has no symptom of hyperthyroid as far as I know and I observe. I took him to the vet for annual check-up which I was neglectant about 10 years because he is indoor cat living with his best friend cat, Ally, all his life. And I admit that I was wrong and feel stupid for not taking them for annual this long. I took them for annual becuase I want to rescue one stray cat who started coming to our yard. Then, the vet said Spock has heart mumur and elevated thyoid. The blood test showed that whatever value to determine hyperthyroid is 7.4 although the normal range is between 0.8 and 4.0. The vet told him to be on daily medication or radioactive iodine shot. According to my research about the medicine, it has some side effects, even like liver damage. I know it is necessary to treat this disease to avoid complication but I am thinking about bringing him to another vet to be checked again and maybe tested again for second opinion. I found also this natural herbal product "Resthyro" to treat this disease. I was wondring if anyone used it and if it helped to lower the level of the value on the test. If anyone can share your experience or thoughts about hyperthyroid, I really appreciate! I have been crying everyday about him and feel scared of losing him. Thank you so much for reading such a long post. Thank you!!!!
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Old 03-08-2011, 05:35 PM   #2 (permalink)
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I just registered a few days ago and am very happy to find this forum.
Welcome to the Cat Forum. We're glad you're here and are always glad to help answer questions where we can.

Quote:
Spock, is 12 years old and has no symptom of hyperthyroid as far as I know and I observe.
I'm sorry to hear of Spock's diagnosis, but it's actually a very good thing that he has been diagnosed, because untreated hyperT can be deadly. Fortunately, hyperT can be successfully managed or even cured in most cats, depending on the treatment you choose. The most common symptoms of hyperT are ravenous appetite coupled with weight loss. These cats may also be more vocal and hyperactive than usual, and may drink water excessively. As you already know, cats with uncontrolled hyperT may also develop heart murmurs, but these can sometimes resolve once the hyperT is brought under control. Occasionally, a cat can have hyperT without any of these symptoms, or with entirely different symptoms.

Quote:
The blood test showed that whatever value to determine hyperthyroid is 7.4 although the normal range is between 0.8 and 4.0.
This does indicate that he is hyperT, but it doesn't necessarily tell you anything about the severity of the disease or how long he may have had it. Let me offer you a little hyperT primer so that you'll understand more about it and your treatment options.

HyperT is a complicated disease because it puts the entire body into a state of hyperactivity. This includes the heart and kidneys (more about this later). It seems that many vets are not well versed in hyperT, its testing, or its treatment options. I am pleased to see that your vet has already recommended either daily medication or radioactive iodine treatment (I-131), as those are the preferred treatment options.

I-131 is the treatment of choice for hyperT cats with healthy kidneys because it is CURATIVE in almost all cats who undergo the procedure. It involves a single, subcutaneous injection followed by a period of quarantine at the administering hospital while the radioactive material dissipates to a safe level. This is a very costly treatment up front, though the cost is comparable to or less than the medication alternative over the long run, and again, it is the only CURE for hyperT.

HyperT can also be managed, but not cured, with medication – either methimazole or carbimazole. As you’ve already discovered, medication is not risk-free. Some cats experience unpleasant side effects that can range from mild to life-threatening, though many cats remain on medication for many years with no problems at all.

Although I have no direct experience with or knowledge of Resthyro, I doubt it is effective at either treating or managing hyperT. I recommend referring that question to the hyperT mailing list (linked below). I have gained most of my information and knowledge about hyperT from the mailing list, its members, their posts and message archives, and the research papers and other educational files stored in the "files" section of the list's Yahoo website. I strongly recommend you join that list. Even if you prefer not to post, you can learn a great deal by doing searches for specific information in their message archives and by reading the uploaded files. You may also, of course, ask whatever questions you may have of the list members by posting to the list. I'm sure there are members of the list who have researched and/or used Resthyro who can answer your questions about it. You can read about and join the list through this link:

feline-hyperT : A support list for people whose cats have been diagnosed as hyperthyroid (hypothyroid also welcome).

Let me back up a bit now and elaborate on hyperT and the meds used to control it. The Total T4 test does not test the actual function of the thyroid gland. It merely measures the amount of T4 thyroid hormone circulating through the bloodstream at the time of the test. It cannot tell the vet whether the T4 hormone level is the result of excess hormone accumulating in the bloodstream over time as a result of mild hyperactivity of the thyroid gland or whether it accumulated quickly as a result of more severe hyperactivity of the thyroid gland.

Some vets, however, seem to think that a very high T4 indicates the severity of the disease (which it does not - it ONLY indicates a very high level of circulating thyroid hormone in the blood)), and therefore prescribe too high a starting dose of methimazole. Methimazole itself does nothing to eliminate excess circulating hormone. Methimazole only helps to limit the amount of new hormone released by the thyroid. So all of that excess circulating hormone is either used by or eliminated from the body naturally and gradually after Methimazole therapy is started.

Here's the problem. If the starting dose of Methimazole is too high and shuts down the thyroid production too far, you won't know it until after the excess circulating hormone has been naturally utilized or released from the body, and that can take 1-3 weeks after starting the too-high dose. After that 1-3 week time frame is when a "crash" may happen ... if it's going to happen. If a crash happens, your cat will become hypOthyroid and may become extremely ill - nauseous, inappetant, weak. Usually this condition can be reversed by lowering the Methimazole dose, but occasionally the cat simply cannot recover and will fail.

A while ago, someone posted on this forum about their newly diagnosed hyperT cat. I warned him about the high starting dose of methimazole that his vet had put his cat on, and I begged him to start at a lower dose and work up to a higher dose, if necessary, to prevent his cat from "crashing". Unfortunately, he chose to ignore my warning and go with his vet's recommended dose. A few weeks later, his cat crashed so badly that he had him euthanized. It was a tragic and, in my belief, totally preventable loss of life. I don't want to see that happen to another cat.

Vets generally recommend a starting dose of 5-10 mg of Methimazole daily (generally split into two daily doses). This is the dosing recommendation they read in their standard veterinary pharmaceutical text. Unfortunately, many people, including myself, have found that even the lower end of this dosing recommendation is too high for our cats and has thrown them into hypothyroidism. Luckily, I was able to bring my cat back to euthyroid (normal thyroid levels) by lowering the dose. Others weren't so lucky with their cats.

On the hyperT mailing list, and in some veterinary research literature, you will find a much safer recommendation to start methimazole at a dose of 1.25 mg twice daily (1.25 mg once daily if the cat has known kidney disease), with retesting in 3 weeks. If euthyroid has not yet been achieved, a small dose increase of 1.25 mg daily is added and the cat is retested in another 3 weeks. This 3 week schedule of retest-med adjustment continues until euthyroid is reached.

This "start low and go slow" approach to dosing offers several critical advantages. First, it allows the body to slowly adjust to the decreased thyroid hormone. Second, it helps avoid severe crashes and hypothyroidism from occurring. Third, it protects the kidneys from the potentially devastating effects of a crash. There is NO disadvantage to starting on a low dose of Methimazole and working your way up, as necessary. It is the safest approach for your cat and one I hope you will discuss with your vet if your vet prescribes the standard starting dose of 5-10 mg daily.

Most cats can take methimazole with no or few side effects if dosed with the “start low and go slow” approach, though some may have a more difficult time with the med. Vomiting, inappetance, and facial itching are the most common side effects that some cats may experience. If these side effects occur, there are strategies such as always administering the med with a meal, using a transdermal form of methimazole or switching to carbimazole, which tends to have fewer digestive side effects.

Kidneys are a primary concern when starting thyroid med therapy because hyperT can mask renal failure. HyperT makes the kidneys work in overdrive, and blood tests cannot differentiate between healthy kidneys performing normally and sick kidneys being forced to work harder by the effects of uncontrolled hyperT. Both healthy kidneys and hyperactive ailing kidneys may have blood values within the normal range, so you can't know whether or not your cat's kidneys are truly healthy until AFTER you have normalized your cat's thyroid hormone levels. If, at that point, his bloodwork still shows healthy kidneys, then you can rest assured that they really are healthy.

This is where things get really complicated. IF your cat's kidneys are ailing, hyperT can actually help them function better to some degree. But that means you will have to balance the management of both conditions (hyperT and chronic renal failure) so that the hyperT can continue to support the kidneys without damaging other body systems.

Let's assume for the sake of this illustration that your cat DOES have masked CRF in addition to hyperT. Think of it as a teeter totter. You have CRF on one side and hyperT on the other. Since you didn't mention anything about your cat's kidney values being elevated, I'll assume that they're currently in "normal" range in his bloodwork. Since T4 is elevated, that puts the hyperT side of the teeter totter high in the air while the masked CRF side is solidly on the ground - certainly not the level balance we're striving for. Now let's put I-131 on the same side as the hyperT. This sends the hyperT side of the teeter falling to the ground as it CURES the hyperT; but without the support of the hyperT-induced hyperactivity, the previously masked CRF is now unmasked and goes sky high - still no balance here, just traded one set of illness symptoms for another. So how do we find that balance we're looking for between the two illnesses? Thyroid med, that's how. Forget the I-131 and use the med instead. The med now goes on the side with the hyperT, and by carefully adjusting the dose, we can balance that teeter so that CRF and hyperT both hopefully hold steady at a level that maintains the best possible degree of health for the cat.

If you decide to consider I-131 treatment for your cat, it is VERY important that you do a thyroid med trial first to get your cat's thyroid hormone level stabilized in normal range BEFORE you make a decision about I-131 treatment. That is the ONLY way you would be able to tell whether your cat's kidneys are healthy to determine if your cat would be a good candidate for I-131.

Try not to let yourself be too overwhelmed by this diagnosis. HyperT is a disease that can be cured or successfully managed in the vast majority of cats. You’re already taking a great first step in educating yourself about it. The more you know, the better a position you’ll be in to partner effectively with your vet and advocate for the best possible care for your cat. If I were in your place (and I have been … twice), I would start my cat on a low dose of methimazole or carbimazole immediately to start bringing his thyroid levels down gradually, then retest in 3 weeks and go from there.

Hang in there. This is one dragon you can slay.

Laurie
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Old 03-09-2011, 12:47 PM   #3 (permalink)
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Laurie:

I do not know how I can say "THANK YOU" for explaining to me all the things you wrote. I tried to find more information I could as much as possible, I was still having hard time and getting the same kind of findings. I was not aware of what the value means on the test and apparently misunderstood that Spock's condition is twice as bad as the normal condition. I have not had a chance to look at the link that you attached but I will definitely look into it and learn some more to understand better. The suggestion you gave me is going to be very helpful; starting the med dosage with the smallest or much smaller than the vet prescription. I want to help him to be under control of this disease but I do not want to cause any other problems, neither. I feel very fortunate that you read my posting and answered to it. I truly thank you for your help and time regarding this post. I hope you and your kitties are doing well. Again, thank you soooo much!!!!
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Old 03-09-2011, 04:04 PM   #4 (permalink)
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Originally Posted by spockally View Post
Laurie:

I do not know how I can say "THANK YOU" for explaining to me all the things you wrote.
You're welcome, but there's really no need to thank me. Sharing information is the purpose of forums like this one. I happen to have had two hyperT cats myself and have done a lot of research on the disease. If my cats must experience such difficulties, at least some good should come of what they've taught me along the way. I'm happy to share what I've learned with you.

Quote:
I was not aware of what the value means on the test and apparently misunderstood that Spock's condition is twice as bad as the normal condition.
That's a misunderstanding that a number of vets seem to have, as well. Actually, Spock's current T4 isn't all that high. My Tommy's T4 at diagnosis was 17.0. It took almost 2 1/2 months to bring her to euthyroid with the "start low and go slow" dosing regimen I described in my last response. Since she first achieved euthyroid in 6/09, I've had to increase her med dose twice to maintain euthyroid. HyperT is a progressive disease, so it's necessary to recheck TT4 every six months after achieving euthyroid to make sure the med dose is maintaining euthyroid properly or to adjust the dose if it's not.

If the hyperT cat's kidneys are healthy, T4 should ideally be maintained at the low end of the reference range. If the kidneys are functioning insufficiently, however, it's generally considered better to maintain T4 in the upper half of the reference range.

Quote:
The suggestion you gave me is going to be very helpful; starting the med dosage with the smallest or much smaller than the vet prescription.
What starting dose has your vet recommended? Some vets do recommend a low starting dose, which is great, but many are still stuck on the traditional, high starting dose.

Laurie
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Old 03-09-2011, 05:28 PM   #5 (permalink)
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Thank you again, Laurie. My cats, fortunately, had any serious sickness until now so I was panicky as you can tell but all the information and research you assured me to calm down and gave me some comfort. I do really appreciate that you shared all the knowledge and experience with me. I am sure you spent days and night trying to figure out what to do for your babies. I thank you for your kindness and thoughtfullness.

I am sorry but I have two more question. The thing I am really concerned about medicine (Methimazole) is the side effect. As you pointed out, if I start from very low dosage, I can minimize the side effect as well. Have you ever noticed any side effect on Tommy? I read vomiting, depression, even liver damage! as side effect. By treating Hyper-T, it is not great if Spock develop liver damage, I thought....
Another question is how you are giving Tommy medicine. My vet said that it comes in tablets or liquid (she did not give me the dosage). I have never given med to our cats (well, maybe long time ago, I gave liquid dewormer and I do remember they did not like it), so I wonder how people give med. I read some other threads about giving med to cats and examined some techniques that I should learn. I was wondering how you are administrating it to Tommy. I am thinking about putting the med in wet food, which Spock was not given for years..... I do appreciat eif you can share your experience again but I understand everyone is busy, so don't worry if you cannot

Thank you again and I hope Tommy's conditon will maintain stayble. We want our babies stay healthy and happy!
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Old 03-10-2011, 01:02 AM   #6 (permalink)
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Thank you again, Laurie. My cats, fortunately, had any serious sickness until now so I was panicky as you can tell but all the information and research you assured me to calm down and gave me some comfort.
I'm glad I could offer some comfort and help you calm down a bit. I do know what it's like to panic about an ailing animal companion, because I occasionally still panic if something critical happens to mine, esp. if it's something with which I have no experience. I do really appreciate that you shared all the knowledge and experience with me.

Quote:
I am sure you spent days and night trying to figure out what to do for your babies.
Indeed I did, but I've also made a regrettable number of mistakes over the decades, many of which my animals suffered for. I try never to make the same mistake twice, though, and rely on the animals to teach me much of what I need to know in order to take proper care of them.

Quote:
I am sorry but I have two more question.
Never apologize for asking questions. How else are you going to learn?

Quote:
The thing I am really concerned about medicine (Methimazole) is the side effect.
Methimazole is a very strong drug with potentially strong side effects, though as I said before, most cats can take it for extended periods with few or no negative side effects at all. This is one reason why I-131 is the treatment of choice for hyperT. It cures the disease and eliminates the need for long-term methimazole use. If I lived anywhere near a clinic that offers I-131, and if I could have borrowed enough money for the procedure, that's what I would have chosen for Tommy. But such is not the case, so I maintain Tommy on carbimazole.

If I-131 isn't an option for you logistically or financially, or if Spock turns out to have renal insufficiency and is not a good candidate for I-131, then methimazole or carbimazole are your only choices. You really can't let hyperT go untreated, because unmanaged hyperT is far more deadly than the meds are likely to be.

When Tommy was first diagnosed, I started her on low dose methimazole, but she had mild nausea on it, so I switched her to carbimazole. Carbimazole converts into methimazole in the cat's body AFTER it leaves the stomach, so it tends to not cause stomach upset the way methimazole sometimes does. Tommy has never had any noticeable side effects on carbimazole. My first (deceased) hyperT cat, Billy, also had mild nausea on methimazole but did well with no med-related nausea once I switched him to carbimazole.

Quote:
Another question is how you are giving Tommy medicine. My vet said that it comes in tablets or liquid
These meds can also be compounded into flavored soft chews and transdermal gels. I use liver flavored chews that I order from BCP Pharmacy in Houston, TX. Tommy LOVES her liver chews and snarfs them down as treats. When Billy was taking methimazole before I switched him to carbimazole, I gave him his pills in Pill Pockets. He happily ate them that way.

Transdermal gel is useful for cats who experience digestive upset with these drugs. The gel is applied to the inner ear flap where the med is absorbed through the skin, so it completely bypasses the digestive tract.

Quote:
Thank you again and I hope Tommy's conditon will maintain stayble. We want our babies stay healthy and happy!
You're welcome again, and thank you for the well wishes. I wish you and Spock the same.

Please don't hesitate to post again if you have any more questions.

Laurie
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Old 03-10-2011, 07:26 PM   #7 (permalink)
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Laurie,
Thank you so much again for all the information that you gave me! I feel like a personal vet for Spock on my side

Methimazole's side effect still worries me because Spock sometimes throws up. So, I wonder if I should ask my vet to change prescription to Carbimazole if it has less side effect. In either medicine, I really want to start with the lowest dosage as you advised me. My husband is really anti-medicine (or doctor?) person. He originally even said that we cannot afford the cost of medicine. I said ???? it is only about $20 per month and he explained that it won't be the only cost that he concerns. Once Spock is on medication, he has to be checked many times and other problems will show up, etc. Do you need to take Tommy every month for blood work? Well, within my budget, I want to treat him! I cannot leave it like this. My husband worries if the vest cost is going to drain our savings which I do not think and I think we can handle as long as we set the budget. There is a facility nearby, about 45 minutes away from where I live, doing I-131. In order to do that, as you mentioned, Spock has to be a good candidate. Also, I was told that he has to be on medication at first to regulate his system. In either way (if I decided to do I-131 or not), he needs medication. I hate to put him on daily medication but I need to so that he does not have other complications....
Speaking of I-131, so far I have not found any information about the side effect. All the things I found so far says "safe" and I am not sure if it is true. So, I need to do more research about it. "radioactive" scares me, especially about the fact that we cannot even touch until he is free from radiation after the shot. It sounds dangerous to me.... The cost is concern as well. My vet said that it is about $1000. If it totally cures, has no side effect, and is safe, I do not mind paying it for Spock.
Thank you so much again for giving me the link to order the medicine. I checked the website and it sounds like very good idea. I should ask my vet to send prescription to this company! It is just amazing how much you know!
I am sorry again about babbling whatever what is on my mind. Thank you again for your help and reading this. I wish I can be help for any when of if needed in near future! Have a great day!
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Old 03-10-2011, 11:17 PM   #8 (permalink)
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I feel like a personal vet for Spock on my side
I'm not a vet. I'm just an animal lover with five decades of animal caretaking under my belt. The more I learn about their maladies, the more I realize I still have to learn. My 4-leggeds are constantly educating me.

Quote:
Methimazole's side effect still worries me because Spock sometimes throws up.
Vomiting can be a symptom of uncontrolled hyperT, so it's possible that once he's regulated properly on the med, he won't throw up as much. Then again, all cats vomit from time to time, so you shouldn't worry too much about it unless it's happening frequently.

Quote:
So, I wonder if I should ask my vet to change prescription to Carbimazole if it has less side effect.
Carbimazole is more expensive than methimazole because it's only available from compounding pharmacies in this country (as far as I know). So you might want to start with a low dose of methimazole administered in Pill Pockets and see if Spock can take it without digestive upset. That's certainly your least expensive option. If it does make him nauseous or cause any other unpleasant side effects, you can always switch to carbimazole. That's what I did with both Billy and Tommy.

Quote:
In either medicine, I really want to start with the lowest dosage as you advised me.
That's a wise decision and the safest option for Spock, even though the retests will add to your expense.

Quote:
Do you need to take Tommy every month for blood work?
No. In the beginning, I took her for a retest every 3 weeks so that I could adjust her med dose until she achieved euthyroid (normal thyroid levels). After she achieved euthyroid, she only required retesting once every 6 months to make sure she remained euthyroid.

Billy was a different matter. After he achieved euthyroid, I had to have his blood retested every 3 months because he was also in renal failure and had hyperparathyroidism. Because of his multiple illnesses, I had to keep a closer and more frequent eye on his blood values.

Quote:
There is a facility nearby, about 45 minutes away from where I live, doing I-131.
You're lucky to have one so close.

Quote:
I was told that he has to be on medication at first to regulate his system. In either way (if I decided to do I-131 or not), he needs medication.
That's correct. As I explained to you earlier, you have to get his thyroid regulated on medication first so that you can accurately evaluate his kidney function. He will only be a good candidate for I-131 if his kidneys are healthy. If his kidneys are ailing, it would be best to maintain him on medication so that you can keep the hyperT and renal disease in better balance.

Quote:
Speaking of I-131, so far I have not found any information about the side effect.
In most cats, I-131 is very safe, has no negative side effects, and is curative. However, in a very small percentage of cats, hyperT will return after I-131, requiring another treatment with I-131 or treatment with meds. More than 95% of cats are cured with a single I-131 treatment.

The way I-131 works is that it targets and destroys only diseased thyroid tissue, leaving any healthy thyroid tissue undamaged so that it can function properly after the procedure. Occasionally, so much of the thyroid tissue is diseased that there isn't enough healthy thyroid left after I-131 to function adequately. If that happens, the cat becomes hypothyroid and requires thyroid supplementation for the rest of his life. This isn't a big concern, however, since thyroid supplementation doesn't cause side effects at proper dosage, and it's an inexpensive med.

Quote:
Thank you so much again for giving me the link to order the medicine. I checked the website and it sounds like very good idea. I should ask my vet to send prescription to this company!
Again, carbimazole is more expensive than methimazole, so you might want to give methimazole a try first to see how Spock handles it. If you do decide to use carbimazole, you can reduce cost by ordering a 6 mo supply to save on more frequent overnight shipping (unless you're likely to do I-131 after a couple of months). Also, you can ask your vet to order it at a strength of 10 mg/chew. The chews are pretty large, and they're easy to cut into smaller doses with an inexpensive pill cutter. I cut the chews into halves, quarters and eighths for Tommy.

Quote:
I wish I can be help for any when of if needed in near future!
That's what it's all about - passing on the knowledge we gain to other folks who can benefit from it. I'm sure you'll learn a lot from Spock that you can share with others in the future.

Laurie
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Old 03-11-2011, 05:13 PM   #9 (permalink)
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Laurie:
Thank you again. I finally get Methimazole today. It is liquid and the bottle says "5mg/ml" and the instruction says "give 0.25 ml every 12 hours." Since 0.25 ml is quarter of 1 ml, I need to give quarter of 5 mg, which is 1.25mg each time. I get to talk to the vet and asked if it is okay to start with only once a day to see how his system handles and he was happy to agree with it. I will start with this 1.25 mg per day from tonight. I hope Spock can handle this and the level will go down.

I did not know that carbimazole is more expensive. Thank you for telling me that. It is good to know there is alternative med if he cannot tolerate Methimazole. I will let you know how he handles Methimzole if you do not mind After I hear lots about this Hyper-T and treatment from you who actually have Tommy to take care of for his Hyper-T instead of articles over the internet, I feel much more comfortable giving med to Spock and more knowledgeble about Hyper-T. I just joined the Yahoo! website as well to gain more knowledge. Thank you again and have a good weekend!
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Old 03-11-2011, 08:10 PM   #10 (permalink)
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Originally Posted by spockally View Post
I finally get Methimazole today.
I am VERY pleased that your vet takes a conservative and safe approach to dosing. I know that methimazole makes you nervous, but it would probably be fine to start him on 1.25 mg twice daily. My only concern with once daily dosing is that a dose only lasts 12 hrs, so Spock will essentially be getting no medical treatment for the other 12 hrs of the day. If you don't want to start with 1.25 mg twice daily, it would be better to split the once daily 1.25 mg into two, 63 mg doses daily, instead (or as close to it as you can get).

Quote:
I did not know that carbimazole is more expensive.
I'm guessing that liquid methimazole is more expensive than methimazole pills, too, though it's probably still cheaper than carbimazole.

Quote:
I will let you know how he handles Methimzole if you do not mind
Mind??? I'll come find you if you don't keep me updated!

Quote:
Thank you again and have a good weekend!
You're welcome again. Oh, I think I forgot to tell you that even if Spock does experience mild side effects from methimazole, those side effects usually go away within the first three months of treatment. But starting with a low dose often avoids bad side effects altogether.

I hope you and Spock both have a great experience with methimazole and that his path to euthyroid is smooth and free of side effects.

Laurie
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