Hyperthyroidism

[ktel]

My cat -Tiger- had his annual vet visit a couple of days ago and his t4 level was high, 99 on a range of 10-60.

Last year the initial test was elevated at 66 but a subsequent test done a few weeks later came back in the normal range.

The vet doesn't recommend re testing this time as it is well out of the normal range.

We're now moving on to treatment options.

It would seem to me that the 2 main viable options are daily medication or radioactive iodine treatment.

I'm definitely inclined to go the medication route (probably transdermal gel) for now ,based on the hospitalization and associated stress with the iodine treatment.

Tiger doesn't really exhibit any of the symptoms of a hyperthyroid cat i.e. irritability,excessive hunger/thirst/urination or weight loss.

However the vet says that's probably because it's in the early stages.

I have done research on secondary problems that can develop from this condition and definitely want to make sure that I take the right course of action to avoid those.

I would appreciate feedback from people that have a hyperthyroid cat and their experiences with treatment and results etc.

I'm still in 2 minds as to whether I should have a second test done or just move forward with treatment.

As regards medication ,I've been told that an initial dose would be given daily for 6-8 weeks at which time another t4 test would be done to see if the dose needed to be adjusted .

Also because of possible kidney problems due to the medication I understand that blood tests/urinalysis should be carried out , I was told annually but I've also read that every 6 months might be advisable.

In terms of diet I feed him wellness wet and dry grain free , I don't know whether I would need to revisit this.

Thanks in advance

[hoofmaiden]

Honestly, if you can afford it by any means, I would consider the I-131 treatment. It is a CURE and it's not really that stressful. The I-131 centers are set up to provide a comfy environment and it's only for a few days.

Managing hyper-T cats on meds is hard. You have to keep testing and adjusting, and all you're doing is holding off the inevitable. With I-131 you are curing the problem and 99.9% of cats are completely normal afterwards.

[ktel]

Originally Posted by hoofmaiden

Honestly, if you can afford it by any means, I would consider the I-131 treatment. It is a CURE and it's not really that stressful. The I-131 centers are set up to provide a comfy environment and it's only for a few days.

Managing hyper-T cats on meds is hard. You have to keep testing and adjusting, and all you're doing is holding off the inevitable. With I-131 you are curing the problem and 99.9% of cats are completely normal afterwards.

Do you have personal experience with your cat and if so did you go immediately with the I-131 treatment or did you try the meds first ?

At the moment I'm considering going initially with the meds and the re evaluating based on his response.

I don't have un limited funds but in my decision making process that's further down the list than choosing the most effective treatment whilst minimizing stress.

[OSCARSMOM]

I think Doodlebug's cat went through the radiation recently. I remember reading a post about it. Hopefully she will chime in.

[doodlebug]

Maggie was diagnosed with hyperthyroid last December. Typically you should do meds for at least a few months for two reasons. First, to ensure they stabilize on the meds. Hyper-T is usually caused by a benign tumor on the thyroid, if the cat doesn't stabilize on the meds, it means that the problem is likely caused by something else (e.g. a cancerous tumor). Second reason is that hyper-t can mask kidney disease. Once the meds control the thyroid you need to have blood and urine tests done to ensure the kidneys are functioning properly. If they aren't, then you might not want to spend the money on the I131.

As I mentioned, hyper-t is usually caused by a benign tumor. If you choose meds, the tumor continues to grow and the medication dosage keeps needing to increase. Eventually the medication can no longer control the tumor. The meds also come with side effects. So if the cat is in otherwise good health, then choosing I131 will cure the problem, as opposed to the meds which will eventually fail and by that time the cat may not be able to undergo I131.

I chose to do the I131 for Maggie, despite her being 15 years old. Her bloodwork showed that she was in great health. I also knew that trying to get meds into her everyday, twice a day was not a challenge that I wanted to take on. I also didn't want the restrictions that twice a day, 12 hours apart meds would put on my life. Late or skipped doses are likely to make a hyper-t cat sick. And I was planning to get a dog in the spring and figured that the additional stress would just complicate things even more.

My first challenge was the vet that diagnosed her...he wanted to start her on 5mg twice a day. Everything I read said start at 1.25 twice a day. I ended up cutting the dose down myself and found another vet. I started with transdermal gel. Within a few days, she was avoiding me like crazy and every dose I had to come up with some new trick to let me get near her. Then I switched to treats, which she would only eat if I cut them into 4 pieces and rolled them in freeze dried chicken dust. But that worked OK for the long haul (which was 3 months). We upped her dose once and then she went into hypothyroid and we had to lower it. She stabilized at 2.5mg twice a day. Had I started her at 5mg twice a day like the first vet wanted to, it probably would have killed her.

Once she was stable and her blood results looked good, I scheduled the I131 treatment. It was done in Massachusetts at a RadioCat facility. I mention this because different states have different quarantine requirements, so you'll need to find out what it is where you live. Treatment was $1500, but that didn't include the blood tests and x-rays that needed to be done the week before the treatment. In total I think it came to about $2000.

She had to be fasted the night before. Meds were stopped two weeks prior to treatment. Dropped her off on a Monday, they did the treatment (it's just an injection) that afternoon and I picked her up on Thursday noonish. So she was there for 3 full days. She did fine, but seemed very happy to see me and go home. At home she had to use flushable litter (World's Best) for 2 weeks and I wasn't allowed to cuddle her or have her on my lap for more than 1/2 hour a day for two weeks. She doesn't cuddle with the other cats, so that wasn't an issue...but if she did it would have been the same restriction. Since she sleeps with me, right up against me, I had to segregate her at night in a spare bedroom, but she didn't give me any problem at all.

Her post treatment thyroid numbers are on the low end of normal. The rest of her blood test numbers are fantastic for a cat her age...her kidney numbers were the same as 3 years ago. She had one complication...about 3 months after treatment she started shedding like crazy, seriously dry brittle coat coming out by the handfuls. Googled around and found out that it's an uncommon side effect. Added some fish oil to her diet, brushed her twice a day and it took about 3 months to get back to normal.

She turned 16 a few weeks ago, she's happy, healthy and still spunky.

[ktel]

Hi Doodlebug

Thanks very much for the information

I want to make sure that I am as informed as possible before moving ahead.

I have a lot of questions that I am going to address with the vet today but am also looking to connect with other people in the same situation.

The more I read and think about this the more inclined I am to look into the I131 option.

I want to make sure that I make the right decision based on the best outcome whilst minimizing his stress.

I don’t like the idea of the hospitalization with the I131 but with the medication option there would appear to be numerous side effects and he would still have to go through regular visits and blood tests.


Tiger doesn't really exhibit any of the symptoms of a hyperthyroid cat,

His behavior’s good, he's eating normally, I haven't noticed any excessive urination, no diarrhea, no vomiting etc.

This morning he did seem to drink quite a lot but typically he tends to drink once in the morning and once in the evening when he has his food, which doesn't seem excessive.

He’s pretty active and vocal but he's always been that way.

He's at a healthy weight-11.7lbs- and this has been stable over the last 3 years. Prior to that he used to be a pound to a pound and a half heavier.

However despite no clinical signs the vet says that's probably because it's in the early stages.

I'm still in 2 minds as to whether I should have a second test done to confirm the diagnosis or just move forward with treatment. I’m not sure if the T4 test he had done was total or free so I should probably ask about that.


The vet said his blood panel showed that all his organs are functioning normally however I was wondering if an EKG would be recommended to test heart function.


As regards medication, I've been told that an initial dose would be given daily for 6-8 weeks at which time another t4 test would be done to see if the dose needed to be adjusted.

Everything I have read indicates the re testing should be done after 3 weeks, my vet follows the 6-8 week protocol.

I was wondering if this could be a problem not testing earlier?

I am trying to decide if I should try the transdermal gel or the pills. I can see him getting annoyed with the gel application so perhaps the pills in pillpockets might be better

Did your cat have any side effects or digestive problems with either the gel or pills?

I spoke to the vet’s assistant regarding dosage and she said 0.5mg is to be given twice daily.

This seems to be a lot lower than the 1.25-2.25mg that I’ve been reading about although I understand it’s better to start low and move up slowly to prevent the risk of hypothyroidism.

[doodlebug]

Originally Posted by ktel

I want to make sure that I make the right decision based on the best outcome whilst minimizing his stress.

I don’t like the idea of the hospitalization with the I131 but with the medication option there would appear to be numerous side effects and he would still have to go through regular visits and blood tests.

My thoughts were that with the regular vet visits and blood tests, twice a day meds and me constantly hovering (why is she so hungry today, does she look like she lost weight etc.) would be way more stressful than a few days spent at the vets. It's not 3 days of constant poking and prodding, they receive an injection and then are pretty much left to hang out...just daily care and petting/play if they're interested.

Originally Posted by ktel

However despite no clinical signs the vet says that's probably because it's in the early stages.

I'm still in 2 minds as to whether I should have a second test done to confirm the diagnosis or just move forward with treatment. I’m not sure if the T4 test he had done was total or free so I should probably ask about that.

When he had the second test last year, what was the number? If it came back on the high side of normal I think that's pretty indicative along with this year's test that there's a problem. Hyper-t is one of those things that slowing creeps up over time. A cat without thyroid disease usually has values on the low side of normal. The test you had was probably a Total T4. Doing a Free T4 on a cat with a high Total 4 doesn't provide any additional info. It's typically only used on cats with hyper-t symptoms and a Total T4 within normal limits. Free t4 will catch 6-7% more cases than Total.

Originally Posted by ktel

The vet said his blood panel showed that all his organs are functioning normally however I was wondering if an EKG would be recommended to test heart function.

There's no way for your vet to know that his organs are fine at this point. Hyper-T causes organ function to speed up and can mask failing kidneys. You need to get the numbers down to normal and do another blood test.

Originally Posted by ktel

As regards medication, I've been told that an initial dose would be given daily for 6-8 weeks at which time another t4 test would be done to see if the dose needed to be adjusted.

Everything I have read indicates the re testing should be done after 3 weeks, my vet follows the 6-8 week protocol.

I was wondering if this could be a problem not testing earlier?

6-8 weeks is way too long imo. Maggie went into hypo-T in under 3 weeks. I noticed a significant change in her behavior at about 2-2.5 weeks.

Originally Posted by ktel

I am trying to decide if I should try the transdermal gel or the pills. I can see him getting annoyed with the gel application so perhaps the pills in pillpockets might be better

Did your cat have any side effects or digestive problems with either the gel or pills?

I think you'll just have to experiment and see how it goes. I found that the extra $$ for the treats were well worth it.

Originally Posted by ktel

I spoke to the vet’s assistant regarding dosage and she said 0.5mg is to be given twice daily.

This seems to be a lot lower than the 1.25-2.25mg that I’ve been reading about although I understand it’s better to start low and move up slowly to prevent the risk of hypothyroidism.

Starting slow is the way to go, but .5mg per day seems really low...but being really conservative is better than overloading so if that's what they want to do, I'd be fine with it.

[ktel]

yes it seems low, however that information was given to me by the receptionist so I'll double check with the vet when I speak to her on Monday

[doodlebug]

45 is still pretty up there. You can do a retest, but I suspect you're seeing progression of the disease.

I've never really had any luck with pill pockets, they always seem to find the pills and spit them out. A compounding pharmacy can mix the medication into a treat "potion" that is poured into molds and refrigerated. They're similar to the soft and chewy type treats (Zuke's, Perfect Bites etc.). It's mixed at whatever dose you need. One treat in the morning, one at night. Most cats will eat them right up. Maggie is a bit fussy, so I rolled them in freeze dried chicken dust and she was happy.

[ktel]

Originally Posted by doodlebug

45 is still pretty up there. You can do a retest, but I suspect you're seeing progression of the disease.

it was 45 based on arrange of 10-60 so was considered normal


I've never really had any luck with pill pockets, they always seem to find the pills and spit them out. A compounding pharmacy can mix the medication into a treat "potion" that is poured into molds and refrigerated. They're similar to the soft and chewy type treats (Zuke's, Perfect Bites etc.). It's mixed at whatever dose you need. One treat in the morning, one at night. Most cats will eat them right up. Maggie is a bit fussy, so I rolled them in freeze dried chicken dust and she was happy.

Excuse my ignorance but when so say a compounding pharmacy, is that something that is arranged with the vet?