Constipated cat and medical roller coaster

[CatEng]

Some background: one of my cats has had ongoing constipation for about a year. Prior to that he was vomiting on a regular basis, we just thought he was a pig stuffing himself too much, until we recently realised he's most likely allergic to chicken and tuna. Based on his regular vet's advice, we tried high fiber, wet food only, miralax, laxatone, etc. and it was an endless cycle of him being fine for a few days, then clogged up bad enough to need an ER visit for manual feces removal, and cycle starts over again. Turnss out fibers make everything worse and he does better on miralax with low residue. At some point his regular vet felt an abdominal mass, we went for an ultrasound expecting he had cancer, they saw inflammation and thickening of the small intestines, told us "allergy, IBD or lymphoma we don't know" and to go see internal medicine. Basically convinced myself my cat has lymphoma and will die. Finally see internal medicine, he basically tells us the ultrasound is inconclusive for anything really except to show no visible obstructions, believe that obstructions lower down the intestinal tracts are also unlikely, does blood tests to rule out hypothyroid, electrolyte anomalies, etc and tells us to just keep going with wet food and miralax. Blood tests come in, the only abnormal value is very, very high T4. Vet doesn't understand what is going on because he has absolutely no signs of being that hyperthyroid.

TL;DR: Cat with allergies and chronic constipation had elevated T4 on blood tests but has no symptoms, trying to understand what's going on.

We feed him mostly frozen raw food, and some dry kitten kibble. Both contain fish. And we've been supplementing him with oral B12 lately. Has anyone heard of these two things (fish based diet and/or B12) causing falsely elevated T4? The food manufacturer does specify they don't use gland tissues in their products so it's less likely the extra T4 is dietary, but I suppose one never knows.

Looking for any anecdotes of someone who went through something similar to help investigate the possible cause (also he's scheduled for a follow up of course).

 

[rubysmama]

Blood tests come in, the only abnormal value is very, very high T4. Vet doesn't understand what is going on because he has absolutely no signs of being that hyperthyroid.

My cat Ruby was recently diagnosed with hyperthyroidism, with an extremely high T4. She did not show any of the common symptoms for hyperthyroidism, such as being hungry all the time and drinking lots of water.

Ruby was the opposite, and was super picky with food, and though she was losing weight, I attributed it to not eating enough. Eventually she started to drink more water, and that's when I realized something was off, and got her bloodwork checked. So a high T4 can occur without the typical symptoms.

Ruby has also had symptoms of IBD over the years, but she tended to have vomiting and loose stools, not constipation.

I hope your cat will show some improvement once he is treated for the hyperthyroidism.

 

[IzzysfureverMom]

Mine girls senior blood work just came back with thyroid and kidney values in the high normal range. Retest in 3 months. She also had some issues with constipation but a little Miralax solved that. She is not on any high phophorus foods. Her weight is still good, urination the same and eating the same,but I am weighing her every week and will call her vet if I see that or any other changes.If they lose a lot of weight it can be tough it get it back.

 

[Alldara]

Hyperthyroidism can be a pretty quiet disease. Lily's was very progressed before she had symptoms. She was throwing up bile and bits of fur a lot. We tried changing the food etc for suspected allergies. She got more vocal and clingy but she was already those things. (Assumed separation anxiety because I was just back at work and it wasnt THAT much more than usual)

Then we finally got Hyperthyroidism blood work and that's what it all was!

 

[IzzysfureverMom]

Hyperthyroidism can be a pretty quiet disease. Lily's was very progressed before she had symptoms. She was throwing up bile and bits of fur a lot. We tried changing the food etc for suspected allergies. She got more vocal and clingy but she was already those things. (Assumed separation anxiety because I was just back at work and it wasnt THAT much more than usual)

Then we finally got Hyperthyroidism blood work and that's what it all was!

Honestly I am very concerned with hyperthyroidism with Izzy.She had started crying all night. Everything else was the same. I had a cat with hyperthyroidism years ago and that was the only change I had..... and then he started losing weight. Her weight and everything else is fine as of now. However, if anything else changes she is going into the vets before retesting. Hyperthyroidism can turn bad fast. Like your girl Izzy has always been very ' needy'.

 

[CatEng]

Thanks everyone for the replies, and sorry I didn't post back earlier, it has been quite a rollercoaster with his health issues lately.

He has been way more vocal than usual, but I attributed it to him having an upset tummy due to all the miralax he's giving (and the moratorium on dry food which he strongly disagrees with).

He is eating a ton without as much weight gain as I would expect with that amount of food... The vet said he might have to do a scintigraphy first, do they have to put the cat under sedation for that? I'm thinking if he needs treatment for hyperthyroidism we should just go with the I-131 and not bother with pills since pilling is a difficult endeavor.

 

[IzzysfureverMom]

Hyperthyroid cats can be very vocal especially at night. My cat many years ago that was the only sign he had. The I -131 is pretty much the gold standard,so if vet feels he is a candidate for that procedure and you can do it that is good. I am in the same spot as you as Izzy is the most difficult cat to pill. If she does get diagnosed with hyperthyroidism at her recheck, I have been told she may not be a candidate because she as asthma.They try to have as little contact as possible with them and she needs asthma treatments. There is also a gel compound now of the pill medication that you put in their ear. I have no experience with that but maybe someone else here does.

 

[fionasmom]

Thyroid Scintigraphy (Thyroid Scan) | Animal Endocrine Clinic
I have never had this treatment for any of my cats, but this is not because of any reservations that I would have about it. This article suggests that sedation is not needed, but that might vary from vet to vet.

Scintigraphy is an important step in this entire procedure.

 

[CatEng]

So to add to the drama of IBD cat, he decided to vomit several times this morning, sparking a lot of anxiety about whether he's now allergic to his food (that he was doing well on), or that his thyroid is really worse than we thought, etc... only to find in the last puddle of vomit a bunch of plant leaves. Turns out he raided the greenhouse during the night. Thankfully none of the plants are toxic, but still...

 

[BellaBlue82]

When we adopted Julian last year, he was very skinny. He was a year and a half and only weighed 7 lbs, with an extremely underweight body composition hidden mostly by his fur. The poor guy would eat and eat, but then I noticed it would be days for him to have a BM. I had our vet check him out, and he had a. Bit of an elevated T4 along with some other elevated labs. I thought he might have thyroid disease.

After discussing in depth with our vet, she mentioned how constipation can sometimes cause elevated labs including some thyroid levels. She suggested we do some additional thyroid tests to rule out thyroid disease. This was helpful for us, as we found the other tests were in normal range plus the T4 was back in normal range the second time around.

We figured he may have a form of IBD, and began giving him small doses of Miralax. Sadly, that worsened his issue (the Miralax flared his poor colon.) We found slippery elm bark does the job for his constipation now, and after just two or three small doses he's able to pass stool without straining or colon irritation. Of course we also changed his food, and try to keep him hydrated, but this guy hates to drink water lol so we have to get creative. I make him food water (mix water in his wet food.)

I hope this gives a bit of a different perspective. I think if you're concerned about thyroid disease and want to be sure, ask to see if there are some additional labs they can run (antibodies, TSH, etc.) At least then it will solidify for you what is really going on before you move forward with anything else.

Good luck, I hope kitty starts feeling better soon!