16 year old female cat not eating and we are told it’s hyperthyroidism?

[neely]

I just pulled up the instructions and this is what it says: "Give 0.25 tablet by mouth every 12 hours unless otherwise directed by a veterinarian as treatment for hyperthyroidism.

I'm a little perplexed by this dosage since the starting dose of Methimazole is usually 1.25 mg twice a day. Do you live in the U.S. or another country? Is the medicine your vet prescribed Methimazole/Felimazole or something else? Obviously you trust your vet but you may want to ask them about the dosage. Best of luck!

Please refer to this article about Monitoring Methimazole Treatment in Cats and scroll down to Monitoring T4 Levels in Cats:
Monitoring a Cat on Methimazole Treatment for Hyperthyroidism

 

[Lisannez]

I just reread it and they are 5mg tablets but the instructions are to cut that table into .25 pieces, which we are doing and is not easy. I guess they did not have that dosage in pill forms. Hopefully when we see the regular vet they will have it. We were at an emergency vet on the weekend. Yes I am in the US.

 

[FeebysOwner]

I just reread it and they are 5mg tablets but the instructions are to cut that table into .25 pieces, which we are doing and is not easy. I guess they did not have that dosage in pill forms. Hopefully when we see the regular vet they will have it. We were at an emergency vet on the weekend. Yes I am in the US.

Those tablets are methimazole and cutting them into quarters equates to 1.25mg per dose. That is the lowest mg tablet available, unless you pay to have one compounded to the dose you want.

There is a cat specific one called felimazole, but the smallest mg pill is 2.5mg. It isn't too bad to cut into halves, but quarters are hard to do with it as well. Sometimes, when dosages change, they need to be done in .625mg increments, which means methimazole would have to be cut into eighths or felimazole into quarters. I currently have to cut Feeby's felimazole into quarters to give the proper dose to her (she gets 1.875mg in AM & 1.25mg in PM).

 

[Lisannez]

Those tablets are methimazole and cutting them into quarters equates to 1.25mg per dose. That is the lowest mg tablet available, unless you pay to have one compounded to the dose you want.

There is a cat specific one called felimazole, but the smallest mg pill is 2.5mg. It isn't too bad to cut into halves, but quarters are hard with it as well. Sometimes, when dosages change they need to be done in 0625mg increments, which means methimazole would have to be cut into eighths or felimazole into quarters. I currently have to cut Feeby's felimazole into quarters to give the proper dose to her (she gets 1.875mg in AM & 1.25mg in PM).

Thank you so much for this info.

 

[gitabooks]

Some of the hyperthyroid cats I've worked with have been on liquid methimazole and others have been on the ear cream (transdermal). Those are probably easier to control the dose with? I've never worked with a pill. A few of the cats I work with have had the radioactive iodine treatment with great success though!

We started Genny on the lowest dose and even then her kidney disease got so bad (apparently the high blood pressure compensates for it) that she didn't want to eat and looked in pain all the time (showing the signs of loafing, squinting, etc). We had to stop the medication and reassess her quality of life. She's 16 and refuses medication by mouth so treating her with pain meds just wouldn't work. We're still considering our options right now.

Some pain "ethograms" for cats:

New feline pain scale interprets pain from cats’ facial expressions

There are a number of pain scoring scales specifically developed for measuring pain in cats, but only two were validated for clinical use—until now...

www.aaha.org

https://www.semanticscholar.org/paper/Evaluation-of-facial-expression-in-acute-pain-in-Holden-Calvo/8f4e680291d5473ce59ac800393b54e106b08cbf

 

[Lisannez]

Thank you so much for the information and I am sorry to hear about your kitty.

 

[FeebysOwner]

We started Genny on the lowest dose and even then her kidney disease got so bad (apparently the high blood pressure compensates for it) that she didn't want to eat and looked in pain all the time (showing the signs of loafing, squinting, etc). We had to stop the medication and reassess her quality of life. She's 16 and refuses medication by mouth so treating her with pain meds just wouldn't work. We're still considering our options right now.

The reason kidney disease appears to get worse when treating for hyperthyroidism is because of the reduced blood flow to the kidneys when controlling the overproduction of iodine by the thyroid. It doesn't change the fact that the kidney disease will progress anyway. Hyperthyroidism simply masks kidney disease. And not controlling the thyroid can lead to high blood pressure which will ultimately cause additional heart problems.

When a cat has both hyperthyroidism and kidney disease, there is a balancing act in terms of how much you reduce the thyroid level to - most CKD cats should maintain a level between 2-3 μg/dL to enable a little more blood flow to the kidneys, and still reasonably control the thyroid. Many cats are also on high blood pressure meds as well to reduce risks of heart damage - and, both hyperthyroidism and CKD can lead to high blood pressure.

In so far as pain meds, you could try using Buprenorphine. The quantity is so small, usually in the ballpark of 0.1ml, that it is easy to administer via an oral syringe. It is meant to be absorbed into the mucous membranes of the mouth (cheek, typically) to be the most effective, and that is very doable because there really is not enough of it to swallow. All you have to do is get the tip of the syringe in your cat's mouth and depress the plunger. My cat does not like oral syringe meds and has in the past spit them back out or regurgitated them, which is impossible to do with the small amount of Bupe. She still doesn't appreciate the Bupe syringe either, but the process is so quick that she's learned how fast it is over and done and tolerates it pretty well.

Btw, for the past 3 years I have crushed the thyroid med dose after splitting the pills (felimazole) into a bite of her food or a lickable treat - and while she can detect some other meds - she doesn't seem to notice this one at all. She is also on BP meds and so far, I also have been able to crush those into lickable treats without issue. Ondansetron (anti-nausea med) is a whole other story, and I am still working on that one.

 

[Lisannez]

Thanks for this. The vet did explain that about kidney disease but not anywhere close to how you just did!

 

[Lisannez]

Thanks for this. The vet did explain that about kidney disease but not anywhere close to how you just did!

Your response is much better.

 

[gitabooks]

One of the kitties I care for (I'm a pet-sitter) recently passed at the age of 20. He had hyperthyroidism and kidney disease but did well for years on pain meds, fluids, methimizole, and blood pressure meds (amplodipine). He was such a sweet kitty.
Hydracare and plenty of wet food helped keep him hydrated too. I think he was on two different pain medications but it was only my job to give him the liquid one (gabapentin if I remember right, it was pre-drawn into a syringe for me).

The vet did tell me that the high thyroid hormone can cover up kidney disease by increasing blood flow through the kidneys. So finding the perfect balance of thyroid meds is necessary. We spent a lot of money recently on another cat with diabetes (and a dog who had surgery) though so I'm trying to hold off on another vet visit for Genny for now.

Giving fluids can help by flushing the body of toxins the kidneys can't clear as well.

 

[Lisannez]

That's so much. That's really positive to hear. I am taking notes on all of these things, to discuss with our vet and to try. Even though she has stopped eating, she is still voluntarily drinking. She walks to her water bowl and drinks several times a day.