Hyperthyroid cat, need experiences

[dogmelissa]

My approximately 12 year old cat, Rusty, was recently diagnosed as hyperthyroid. She also had/has some liver involvement or affected liver, with elevated liver enzymes.

Here are her lab values:
Amylase 1907 (ref range 100 - 1200) U/L
T4 150 (ref range 10 - 51)

She had 2 seizures (that I know of) before she was diagnosed. One was less than 10 seconds, the other maybe 30 seconds. We started treatment with 0.5mL of liquid methimazole (5 mg/mL) twice a day, on Friday January 20. I started a food transition on Wednesday evening, and Thursday night she vomitted quite a few times. She also vomitted (just a little fluid) Friday. She did not vomit up any of the medication.
This morning she had another seizure, worse than the others. It lasted close to a minute. The vet is closed today but I will be calling first thing tomorrow. I have not taken her in for a repeat analysis yet as they said she needed 2 full weeks of the medication before doing so.

Today I am looking for experiences. Does this dosage sound right? (I don't know her exact weight but I can get it from the vet tomorrow) Is the vomiting and seizure today related to the thyroid? Is there a commercial food that seems better for these kitties? (She shares her food with Aubrie who does not have thyroid problems)

Any and all experiences are welcome.
Thank you in advance,
Melissa

[chico2]

Melissa,my Rocky had HT was on meds for a couple of years,past from cancer on his Para-Thyroid.

My Chico at 14yrs now also has HT and he is on Felimazole 2,5mg twice /day..he weighs about 15 lb's.
He has never had any seizures and neither did Rocky,but they both vomit liquid,Chico only small amounts ever now and then.
The pills I give Chico are sugar-coated which is a great thing,he does not mind them.
There is also a special food out to lower the thyroid-level,but I chose not to go that route,because they have to eat this food exclusively,nothing else.
There also is another option and I am sure Growler will tell you about that.

My Chico is doing good,gaining weight,but the vet said his level is too low,so he will be rechecked again,since this blood-test was in the morning almost right after he'd gotten his pill,next time he'll go in the afternoon.
I am hoping Growler can tell you more,maybe the seizures are unrelated to HT???

[sugarcatmom]

Originally Posted by dogmelissa

I started a food transition on Wednesday evening,

Let me guess, would that be prescription Y/D?

Originally Posted by dogmelissa

Is there a commercial food that seems better for these kitties?

YES!!! Please read this link to find out what hyperthyroid cats should be eating (basically, high protein, low carb): http://endocrinevet.blogspot.com/201...roid-cats.html
Try to stay away from foods containing fish, as they tend to be higher in iodine.

[Love4himies]

Nice to see you back, dogmelissa, just sorry it's under these circumstances . I don't have any advice for you, but you are in good hands with chico and SCM.

[sugarcatmom]

Originally Posted by dogmelissa

Is the vomiting and seizure today related to the thyroid?

Just found an interesting article discussing what is referred to as a "thyroid storm". Apparently seizures can be one of the symptoms: https://s3.amazonaws.com/assets.prod...elineFocus.pdf


Did Rusty have his heart and blood pressure checked recently? That might also provide an important clue.

[dogmelissa]

Originally Posted by sugarcatmom

Let me guess, would that be prescription Y/D?

YES!!! Please read this link to find out what hyperthyroid cats should be eating (basically, high protein, low carb): http://endocrinevet.blogspot.com/201...roid-cats.html
Try to stay away from foods containing fish, as they tend to be higher in iodine.

Nope! Aubrie & Rusty share food, and Aubrie has been having digestive issues (diarrhea). I had them on Acana Wild Prarie (chicken, potatoes, fish) to Blue Buffalo Sensitive Stomach (chicken and brown rice with "life source" bits of cold formed probiotics). But Rusty started vomitting shortly after starting this food - coincidence or not - so I was considering returning it.

I don't think I want to go vet-food route as I don't know how I could separate her food from Aubrie and prevent her eating other's food.

I had a bad experience with a high protein food with Taz so I'm a bit scared to try another with the girls. I don't really know what to do!

Melissa

[dogmelissa]

The other option being the radioactive iodine? I read an article yesterday that said it doubled the average life vs oral medication, from 2 years to 4. Now I'm honestly wondering if Rusty is even going to have 2 years, and what her quality of life will be - and ours. It's hard enough to go on a vacation when Taz needed meds, now Aubrie is also on meds and Rusty needs meds twice a day. I'm not suggesting we're going to put her down, but I'm not sure what we can afford. The vet guessed that the radioactive iodine was $1500 and would require a 2 week stay in the vet hospital. Rusty hates being kenneled, it's very stressful on her. But I'm not sure how many blood tests I can afford either. They're easier to budget for, rather than a big fat payment.

The vet checked her heart, I'm not sure about bp. Her heart rate was really high and she had a small murmer. She said the seizures were probably related, because her values were so high. She's 3 times over the "normal" range, so I'm a bit surprised the dosage started so low.

Anyways, I called and am taking her in this afternoon again. I will report once I get her results back (tomorrow).

Thanks,
Melissa

[sugarcatmom]

Originally Posted by dogmelissa

The vet checked her heart, I'm not sure about bp. Her heart rate was really high and she had a small murmer.

Oops, didn't mean to call Rusty a "he". My appologies to her!

High heart rate (tachycardia) can certainly be an issue with hyperT (and may be part of the "thyroid storm" talked about in my second link). Ask the vet about Atenolol. It's easy to administer (it's tasteless so can be pulverized and mixed into wet food or a treat).

Good luck at the vet! (and glad to hear Y/D isn't in the picture - the ingredients are brutally bad).

[growler~GateKeeper]

Since this was already on the board I thought I would just post the link for you to read, this is my experience with Radioactive Iodine Therapy

[chico2]

dogmelissa,who told you they'd live 2 yrs on meds and 4 with the Iodine treatment??
My Rocky lived longer on meds,unfortunately he grew a tumor on his para-thyroid and had to be sent to the Bridge

I certainly hope Chico will live longer than 2yrs,but you never know,the thyroid has to be stable before the Iodine treatment.
I could be wrong,but I thought the treatment is more like $3.000???

[dogmelissa]

I read it in an article written by a vet: http://www.2ndchance.info/hyperthyroid.htm (scroll down to 'procedures that help') " Studies published in 2006 found that cats that were treated with radioactive iodine lived , on average, twice as long (2 vs 4 years) as cats treated with methimazole. (ref)" It is an average, so some cats will live longer, some shorter. I asked the vet yesterday about life expectancy and she said that if it's controlled, it really doesn't affect their life span and most die from kidney failure at the likely time they would have anyways. I have 2 very different experiences with kidney failure and no desire to repeat either one but not much choice. I'd like to believe that Rusty will still live a long time, but no way of knowing.

Got results today of rusty's T4 and now she is borderline hypothyroid: level was 9 - ref range 10 to 51. So she said to reduce Rusty to once daily medication. When it gets near the end of the bottle (will probably be about 3 months now) then she should go back for another check.

Re: vomiting: because it was happening really more before she got her med than after, the vet wasn't sure why. Said any side effects from the meds should go away after a few weeks and in the meantime, she sent me home with some Sucralfate (sulcrate) suspension. I'm supposed to give it to her half an hour after her med, 2 mL of chalky liquid. Last night's attempt got maybe 1 mL into her, the rest dripped or was shaken out of her mouth. But she didn't vomit (that I know of) last night, so that's good. Not sure if I will continue with this med.

We also talked about the seizures and the only thing she could come up with was a possibility of trying anti-epileptic medication. She was going to give me something to put in her rectum to stop a seizure but I think we both forgot. For now, we are just going to watch and see, and if she has another then add in the anti-epileptics. It's a pill, but can be compounded. Rusty is very difficult to pill, but actually comes when called for her tuna-flavoured methimazole liquid! She was kinda miffed when she didn't get it this morning, LOL! I am hoping we don't need it, but I think I'd rather pay extra for it to be compounded than give her a pill.

All I know about the cost of the iodine is what the vet told me and she wasn't even sure as it's a different clinic that does it. The link I posted above mentions costs as being "a little lower in Canada" than their $800 to $1400 range, but who knows? I guess I could phone to ask. The vet didn't mention needing to be stable for it, she said Rusty would be a good candidate for it before we even started treatment with the methimazole.

I'm not really sure where we go from here. I guess we'll stick with the methimazole for awhile at least to see how she does. Hope no more seizures. And see how both girls do with the Blue food - or maybe try the higher protein Blue food.

Thanks for everything!
Melissa

[sugarcatmom]

Originally Posted by dogmelissa

Got results today of rusty's T4 and now she is borderline hypothyroid: level was 9 - ref range 10 to 51.

Did they check her BUN/Creatinine levels while they were at it? That might provide some insight into her current renal function.

Originally Posted by dogmelissa

So she said to reduce Rusty to once daily medication.

Studies show cats generally do better with twice/day dosing on methimazole: http://vetmed.tamu.edu/common/docs/p...ethimazole.pdf

After 2 weeks of treatment, the percentage of euthyroid cats in the group receiving methimazole once a day (54%) was significantly lower (P = 0.04) than in the group receiving methimazole twice a day (87%). After 4 weeks of treatment, euthyroid cats in the group receiving methimazole once a day (71%) was still lower than in the group receiving methimazole twice a day (92%);

Originally Posted by dogmelissa

I guess we'll stick with the methimazole for awhile at least to see how she does. Hope no more seizures.

[chico2]

DM,My vet,Dr Dieter Kohlmaier,writes in www.petsmagazine.ca and it so happens in the January/February issue he writes about feline Hyperthyroidism.
With my Rocky,by the time my old vet tested him,his thyroid-gland was already half an inch.Shortly after I changed vet to Dieter and he is wonderful.

SCM,what should I look for in foods,right now they eat,Wellness,Go-Natural and Natural Balance canned on the cans it says 10%protein,how do I find out if the iodine content is high?

[growler~GateKeeper]

When the article mentions "2 vs 4 years" I think that was just a poorly thought out example of what "twice as long" life span means. They didn't actually mean a cat that undergoes RaId will only live 4 years where a cat that is on meds will only live 2 years. What was meant in their opinion is a cat treated w/RaId will live twice as long as a cat treated with meds.

A cat that has under gone RaId therapy no longer has medical issues stemming from higher than normal thyroid hormone levels whereas a cat treated with meds still is dealing with the potential for tachycardia, hypertension etc from HyperT (of course a cat treated with RaId could still have those due to other issues), when the dose needs constant adjusting or a dose gets missed/the cat starts spitting pills out etc. Stress of vet visits can also play a factor in the health/life span of a cat.

Originally Posted by chico2

the thyroid has to be stable before the Iodine treatment.
I could be wrong,but I thought the treatment is more like $3.000???

Originally Posted by dogmelissa

All I know about the cost of the iodine is what the vet told me and she wasn't even sure as it's a different clinic that does it. The link I posted above mentions costs as being "a little lower in Canada" than their $800 to $1400 range, but who knows? I guess I could phone to ask. The vet didn't mention needing to be stable for it, she said Rusty would be a good candidate for it before we even started treatment with the methimazole.

Yes the thyroid levels need to be at a consistant level for a couple of tests, doesn't have to be normal range though for treatment to start. Untreated HyperT can sometimes result in large fluctuations of T4 results from one test to the next. In most cases this will mean being on meds for a few weeks to stabilize the numbers first, once stabilized you would be able to see if there were any hidden kidney issues before starting RaId treatment.

When my cat was treated her T4 was just above normal, stable for 2 consecutive tests and I opted to go for RaId and not try the meds first.

In 2005 in BC I paid $1300. Price will vary depending on clinic/location/availability.

It has to be a separate clinic or at least a part that is kept completely separate from the regular clinic because they are dealing with bio-hazardous materials. There are only certain people with proper clearance allowed in to the clinic, you are not allowed to visit your cat while there - which is why sending them w/a worn shirt is a good idea, any toys/blanket etc they arrive with do not come home since it would've been affected by the Radioactive Iodine. The mandatory stay in-clinic for a week with some more severe cases staying longer is due to the cats shedding radioactive material in there urine, saliva etc for about two weeks after treatment, once they come home you must wear protective gloves to do litterbox duty, the cat doesn't sleep in close contact with you for the first week they are home.

[chico2]

Melinda,my Chicos T4 was down to 2 at his latest bloodtest,which is too low,but the vet thinks,because it was taken in the morning to soon after he'd taken his pill,he tested low.
In March he will be tested for everything,the more extensive Thyroid test and after those results,we might consider the Raid Therapy,don't really know yet..
If my vet thinks he'll be doing ok on meds,we might stick with the pills...we'll see.

[dogmelissa]

Attempt #2 at this since the first one disappeared on me.

Let's see.
Most recent test was just for T4, but it was full panel in January. I have photos if anyone wants me to post them.

The article *did* mean the average time for survival was 2 years for methimazole & 4 for iodine: " When cats with preexisting renal disease were excluded, median survival time for cats treated with methimazole alone (2.0 years; interquartile range [IQR], 1 to 3.9 years) was significantly shorter than median survival time for cats treated with 131I alone (4.0 years; IQR, 3.0 to 4.8 years) or methimazole followed by 131I (5.3 years; IQR, 2.2 to 6.5 years)." Based on this, the *longest* we can expect Rusty to live with just methimazole is almost 4 years, but it was a relatively small study and there are always exceptions. It doesn't really matter, but given the differences if started on methimazole vs going directly to iodine - which tells me they don't *have* to be stable for iodine - maybe that information will help someone else make a decision regarding treatment.

Maybe things have changed since 2005, but everything I've read says that cats don't go home until they are not radioactive - again, not really an issue for me, since I highly doubt we're going that route.

So now we have a new issue. The new Med (forgot the name) to help with the vomiting seemed to work for 3 or 4 days. Then Thursday night just as I was crawling into bed - about 15 min after giving it to her - she threw up, big time. Full stomach contents: new meds, undigested food. Heaved without much more coming up about 6 more times. Thought she was OK, repeated both meds last night. Maybe half an hour after I went to bed, with Rusty laying beside me, same thing! (I pushed her off the bed in time) All day today she has seemed like she's not feeling well, been quite lethargic and seems listless. I haven't watched closely and I don't know if she has been eating or drinking. I already decided not to give her the second Med tonight, but I did give her the methimazole. But now I'm worried, and her vet is closed tomorrow. How long can a cat go without eating before their liver gets messed up? Any idea what's going on here?? Should I take her to emerg tomorrow?

Thanks,
Melissa

[dogmelissa]

I think Rusty is dying. She has the same look in her eyes that Sierra did. She just looks miserable and like she's given up. I can't decide if I should take her to emerg to have her blood checked today or try to get in the regular vet tomorrow morning before the courier arrives. I guess I will see how today goes.

So much for that "2 year" minimum. Poor girl.

Melissa

[chico2]

Melissa,one thing I was told when my Rocky was vomiting and probably his meds came up too, was not to give him another pill.
Rocky drank a lot of water and often times it would come back up.
I never gave him anything other than his thyroidmeds.
Oh yes,I gave him some Slippery Elm,for diarreha(sp?).
Please don't think Rusty is dying:-(
Most HT cats eat a lot,are always hungry,but if you are certain she's not eating,hence lethargic,I would take her to the vet tomorrow morning.
I am not an expert like Growler and Sugar Cat Mom,I can only tell you about my experience with Rocky,he did not die from HT,but had a huge groth attached to his para-thyroid.
She is most likely dehydrated,we know ourselves how we feel after vomiting,you feel week and listless.
I am not sure how long a kitty can go without food or water,so I cannot answer you there..but I hope she's eating again and to you,it's heartbreaking to have to watch your kitty being sick...but I am sending lots of good vibes for her to get better

[growler~GateKeeper]

I would have her into the emergency vet it sounds like she might be having issues with the pancreas as well

[dogmelissa]

We took Rusty to be euthanized tonight. The look in her eyes was exactly like Sierra's when Sierra was dying. In just 4 short days, Rusty had lost nearly a pound (we didn't know how much until tonight), was dehydrated and had clearly just given up. Her eyes were sunken in and she wouldn't open them all the way; when she did it looked as if she was saying "I'm done".

They took her in the back to put a catheter in her leg and when they brought her back my DH asked the vet if he thought we were making the right decision. The vet said that he thought so: she was very thin, dehydrated and didn't seem to have any "fight" left in her. He said we could try aggressive IV fluids but it wouldn't be a good quality of life and would probably just postpone the inevitable.

She went very peacefully, just laid her head down on my arm and drifted away. I held her for a few minutes, stroked her beautiful face and kissed her wonderful polydactyl feet.

I know she is on her way to the Rainbow Bridge and she will be reunited with Sierra there.

Rusty was an amazing cat, and she deserved to go in peace. I couldn't bear to watch her suffer anymore and I know that we made the right decision. But it's still horribly hard and I'm an emotional wreck right now.

Thank you for all your kind words and help - again and as usual.
Hugs to all the furry, feathered, finned and other friends in all of your lives.

Melissa

[hazelrunpack]

It's such a heart-wrenching decision to make. I'm so glad you could be with her as she passed. It was the best gift of all, to send her on surrounded by your love. I hope happy memories soon ease that hole in your heart.

Rusty

[chico2]

Awww Melissa,I am so very sorry

[growler~GateKeeper]

I'm so sorry Melissa