5 year old with - Border Hyperthyroidism

catpack

TCS Veteran
Thread starter
Kitten
Joined
Aug 13, 2013
Messages
3,271
Purraise
646
Location
Southeastern USA
Background:

Max is 5.5 and has had periods of weighloss (up to 2 lbs), nausea and appetite issues (won't eat and then ravenous) off and on since he was about 18 months old. He has had full blood panels (CBC/Chen, glucose, and T4/free T4) during each episode. Everything was within normal limits. He's also had a few instances (3) of low-grand pancreatitis/triditis.

I've done full abdominal ultrasounds and done the blood test that checks for malabsorption, EPI, pancreatitis (thus pancreatitis diagnosis). All in all, nothing significant found.

He's having another "flare up" and is down about 3/4 a pound from where he was 2 months ago. He had some initial vomiting (empty stomach...never food) that was likely from stomach acid build up, but hasn't vomited in several days.

Took him in for blood work and his T4 was at 2.4.. This is still considered "normal", but he is slowly inching up to that gray zone. He acts hungry most of the time and will break into treat bags and will typically eat well *if I hand feed him*. But, I'm starting to notice that he wants to eat, but after a few bites he stops, almost abruptly, so I am thinking he is nauseated.

I will be doing a Pro BNP that will also include the SDMA test, so will be able to see if kidneys are an issue.

For those with experience, do Max's symptoms seem to correspond with how your cat presented with HyperT?

Any suggestions?

I have Pepcid to start him on and have Cerenia if he needs it. Is there something else to try? I am also going to try him on a home-cooked meal (using EZ Complete) and see how he likes that. He is currently loving plain baked chicken, though he only gets it as a snack.
 

stephenq

TCS Member
Veteran
Joined
Jun 19, 2003
Messages
5,672
Purraise
944
Location
East Coast, USA
Background:

Max is 5.5 and has had periods of weighloss (up to 2 lbs), nausea and appetite issues (won't eat and then ravenous) off and on since he was about 18 months old. He has had full blood panels (CBC/Chen, glucose, and T4/free T4) during each episode. Everything was within normal limits. He's also had a few instances (3) of low-grand pancreatitis/triditis.

I've done full abdominal ultrasounds and done the blood test that checks for malabsorption, EPI, pancreatitis (thus pancreatitis diagnosis). All in all, nothing significant found.

He's having another "flare up" and is down about 3/4 a pound from where he was 2 months ago. He had some initial vomiting (empty stomach...never food) that was likely from stomach acid build up, but hasn't vomited in several days.

Took him in for blood work and his T4 was at 2.4.. This is still considered "normal", but he is slowly inching up to that gray zone. He acts hungry most of the time and will break into treat bags and will typically eat well *if I hand feed him*. But, I'm starting to notice that he wants to eat, but after a few bites he stops, almost abruptly, so I am thinking he is nauseated.

I will be doing a Pro BNP that will also include the SDMA test, so will be able to see if kidneys are an issue.

For those with experience, do Max's symptoms seem to correspond with how your cat presented with HyperT?

Any suggestions?

I have Pepcid to start him on and have Cerenia if he needs it. Is there something else to try? I am also going to try him on a home-cooked meal (using EZ Complete) and see how he likes that. He is currently loving plain baked chicken, though he only gets it as a snack.
Pancreatitis can cause nausea and loss of appetite, Sub q fluids with cerenia in the bolus to prevent stinging could have a big positive impact, possibly along with Zofran injections (different type of anti nausea drug, but must be given sub q every six hours, but not needed with fluids.  When my cat simon, who had IBD, and pancreatitis and possibly triditis would have a flare up we would knock it back down with the cocktail - fluids, cerenia, sometmes zofran, then he'd be ok and would take cerenia orally daily.

From where i'm sitting, these symptoms seem mostly connected to the pancreatitis, with additional symptoms coming from low grade Hyper T - with an interesting conflict of illnesses - the onset of Hyper T is making him hungry, the itis's are killing his appetite, a potentially bad combo.  If your vet agrees, i would treat in a big way for the "itis's" and maybe concurrently with a "starter dose" of Tapazole, or alternatively a food that can control Hyper T, Hills, YD.
 
  • Thread Starter Thread Starter
  • #3

catpack

TCS Veteran
Thread starter
Kitten
Joined
Aug 13, 2013
Messages
3,271
Purraise
646
Location
Southeastern USA
stephenq stephenq , I was thinking this may be a multifaceted issue too. Hadn't thought about Zofran for him. Will talk to our vet about this. Thank you!
 

stephenq

TCS Member
Veteran
Joined
Jun 19, 2003
Messages
5,672
Purraise
944
Location
East Coast, USA
Background:

Max is 5.5 and has had periods of weighloss (up to 2 lbs), nausea and appetite issues (won't eat and then ravenous) off and on since he was about 18 months old. He has had full blood panels (CBC/Chen, glucose, and T4/free T4) during each episode. Everything was within normal limits. He's also had a few instances (3) of low-grand pancreatitis/triditis.

I've done full abdominal ultrasounds and done the blood test that checks for malabsorption, EPI, pancreatitis (thus pancreatitis diagnosis). All in all, nothing significant found.

He's having another "flare up" and is down about 3/4 a pound from where he was 2 months ago. He had some initial vomiting (empty stomach...never food) that was likely from stomach acid build up, but hasn't vomited in several days.

Took him in for blood work and his T4 was at 2.4.. This is still considered "normal", but he is slowly inching up to that gray zone. He acts hungry most of the time and will break into treat bags and will typically eat well *if I hand feed him*. But, I'm starting to notice that he wants to eat, but after a few bites he stops, almost abruptly, so I am thinking he is nauseated.

I will be doing a Pro BNP that will also include the SDMA test, so will be able to see if kidneys are an issue.

For those with experience, do Max's symptoms seem to correspond with how your cat presented with HyperT?

Any suggestions?

I have Pepcid to start him on and have Cerenia if he needs it. Is there something else to try? I am also going to try him on a home-cooked meal (using EZ Complete) and see how he likes that. He is currently loving plain baked chicken, though he only gets it as a snack.
Pancreatitis can cause nausea and loss of appetite, Sub q fluids with cerenia in the bolus to prevent stinging could have a big positive impact, possibly along with Zofran injections (different type of anti nausea drug, but must be given sub q every six hours, but not needed with fluids.  When my cat simon, who had IBD, and pancreatitis and possibly triditis would have a flare up we would knock it back down with the cocktail - fluids, cerenia, sometmes zofran, then he'd be ok and would take cerenia orally daily.

From where i'm sitting, these symptoms seem mostly connected to the pancreatitis, with additional symptoms coming from low grade Hyper T - with an interesting conflict of illnesses - the onset of Hyper T is making him hungry, the itis's are killing his appetite, a potentially bad combo.  If your vet agrees, i would treat in a big way for the "itis's" and maybe concurrently with a "starter dose" of Tapazole, or alternatively a food that can control Hyper T, Hills, YD.
@stephenq, I was thinking this may be a multifaceted issue too. Hadn't thought about Zofran for him. Will talk to our vet about this. Thank you!
OK let me know how it goes!
 

missmimz

TCS Member
Top Cat
Joined
Jan 11, 2015
Messages
2,301
Purraise
365
What was his T4 the first time he had blood work? Did you ask your vet about running a free T4? Absolutely don't start treatment for hyper-t without running a free T4 to confirm hyper-t. 2.4 isn't grey zone for a young cat, but if his free T4 is high that's going to tell us much more. He's young, so it would be uncommon, but the meds for hyper-t are nothing to mess around with and ideally if he is hyper-t he'd be a good candidate for i-131. 
 
Last edited:
  • Thread Starter Thread Starter
  • #7

catpack

TCS Veteran
Thread starter
Kitten
Joined
Aug 13, 2013
Messages
3,271
Purraise
646
Location
Southeastern USA
M missmimz I'm getting copies of all of his previous labs tomorrow (I've changed vet clinics since his last episode 2 yrs ago). We have been monitoring his glucose and T4 since he was about 14 months old. Just need to get all his records in one place so that we can chart/compare numbers.

Using medication to treat HyperT isn't on our list right now. We haven't done a free T4 yet.

My vet has recommended I get a consult with the dental specialist (though I'm not very confident that his teeth are the issue), so we are doing that tomorrow. I'd certainly take a dental over a chronic condition!

The odd thing with Max is that his symptoms appear cyclical. He's typically had "flare ups" between late Oct to Dec and again late Spring. However, we've made it more than a year this time without needing medical attention (closer to 18 months). I took him to the dental specialist 2+ years ago and they didn't find anything. (Thought he might have an issue with TMJ at the time). They also did not recommend a cleaning.
 

missmimz

TCS Member
Top Cat
Joined
Jan 11, 2015
Messages
2,301
Purraise
365
@missmimz I'm getting copies of all of his previous labs tomorrow (I've changed vet clinics since his last episode 2 yrs ago). We have been monitoring his glucose and T4 since he was about 14 months old. Just need to get all his records in one place so that we can chart/compare numbers.

Using medication to treat HyperT isn't on our list right now. We haven't done a free T4 yet.

My vet has recommended I get a consult with the dental specialist (though I'm not very confident that his teeth are the issue), so we are doing that tomorrow. I'd certainly take a dental over a chronic condition!

The odd thing with Max is that his symptoms appear cyclical. He's typically had "flare ups" between late Oct to Dec and again late Spring. However, we've made it more than a year this time without needing medical attention (closer to 18 months). I took him to the dental specialist 2+ years ago and they didn't find anything. (Thought he might have an issue with TMJ at the time). They also did not recommend a cleaning.
Have you looked at adding slippery elm/probiotics to his diet (if you aren't already). SE is really good for vomiting/nausea. Although my cat, when his T4 was grey zone, was having a lot of vomiting and nausea. Once his T4 hit 5 it was a daily struggle to get him to eat. He was cured with i-131 and the symptoms mostly vanished. He's 14, tho. 

If labs show a steady increase in your cats T4, a free T4 would be a good idea. Here's what Dr. Peterson says about confirming hyper-t.

http://www.animalendocrine.info/2011/07/confirming-diagnosis-of-hyperthyroidism_23.html
 
Top