Help: Symptomless Hyperthyroid What To Do?

[Jojo&Tutu]

At the advise of her regular internal medicine vet my kitty has an appointment with a radiology vet. At her regular internal Med vet her thyroid level was 4.6 a little elevated and so was her blood pressure 64. The elevated blood pressure can be up a little from stress at the appointment. Her kidney was in stage 2 failure but she is on amlodipine blood pressure meds and her kidney values also went normal at her last appointment. Her kidney values being normal could be from blood pressure meds or it could also be being masked by hyperthyroid. The thing is when I got the paperwork to fill out for the rad vet it did not make sense. She doesn't have any other symptoms of hyperthyroid. Her appetite is good, her weight is up, her coat is beautiful,she is a bit more vocal but that is about it. No tremors no weakness no panting. She seems better than she has ever been. Her regular internal Med vet said her thyroid was a little enlarged but I am concerned about doing a thyroid uptake test which uses radioactive iodine unnecessarily. The appointment is late in the day and she would have to stay overnight. Anyone have any advise?

 

[duckpond]

No advice. Just wanted to wish her, and you the best. Hope everything is ok, which ever way you go.

 

[Antonio65]

Some hyperthyroid cats show no symptoms of the disease.
My cat didn't show any, yet she was HT, all the tests confirmed.
It is called apathetic hyperthyroidism, and it occurs in 8-9% of cases. Because of the lack of clear symptoms it might go unnoticed.
The preliminary tests do not involve I-131 or other radioactive materials.
A blood test with T4 and fT4 should do. A good vet can feel an enlarged thyroid even with bare hands.

The radio-iodine is required when the diagnosis says it is necessary, it's one off shot, then your cat is fine for years.
My cat was treated early August, she's much better now and all levels are within range.

 

[pushylady]

My cat was diagnosed just with bloodwork, but he also showed symptoms so there was no doubt. I'm a little unsure of why your vet wants to do this other test when your cat is only slightly elevated.

 

[sweetblackpaws]

I agree with pushylady. It seems extreme for only slight elevation.

 

[Antonio65]

My cat was diagnosed just with bloodwork, but he also showed symptoms so there was no doubt. I'm a little unsure of why your vet wants to do this other test when your cat is only slightly elevated.

I agree with pushylady. It seems extreme for only slight elevation.

If it's hyperthyroidism, isn't it good to catch it early, when the dosage of methimazole can be lower and hence with fewer and lighter side effects?

 

[Jojo&Tutu]

I think because my vet felt the thyroid was enlarged a little and the t4 went up in the last two months and she wants to catch it early so the I 131 dose is low and my cat is currently stable with overall blood values now, has been unstable with pancreatitis for two or three years prior. It is a good time to treat if she actually needs it since she is finally pretty atable. The radiology vet will test first with a radioactive uptake imaging dose and will not treat with the dose required that is to cure the problem if there is no adenoma present. He has thirty years experience so he might be able to tell from feeling the thyroid if it should be tested. Prayers needed. Kitty bled from her bowel just from a recent deworming shot - she had tapeworm from a flee - and had a shot to deworm which shouldn't have been a problem but...so her bowel is fragile and I am worried. She is all I have and my one and only - I worry that she will be able to tolerate it and will be ok and I worry she will get depressed and anxious without me. More than two weeks gone.

 

[Antonio65]

The uptake scan does not use I-131 as far as I know, it uses a different slightly radioactive compound called "pertechnetate" , a short-lived isotope technetium.
The scan has the name of scintigraphy, and it is used to assess the size of the tumor of the thyroid gland and to see if there are other metastasis in the cat's chest.
The size of the tumor revealed with the scintigraphy is useful to give the proportionate dosage of I-131.
Too little and it will be useless, too much and the cat could become HYPO thyroid.
Usually the I-131 is performed right after the scan.

 

[Jojo&Tutu]

The uptake scan does not use I-131 as far as I know, it uses a different slightly radioactive compound called "pertechnetate" , a short-lived isotope technetium.
The scan has the name of scintigraphy, and it is used to assess the size of the tumor of the thyroid gland and to see if there are other metastasis in the cat's chest.
The size of the tumor revealed with the scintigraphy is useful to give the proportionate dosage of I-131.
Too little and it will be useless, too much and the cat could become HYPO thyroid.
Usually the I-131 is performed right after the scan.

Yes that is right though I don't know the name of the radioisotope used. Poor baby I was petting her and she moved her head to the spot of her thyroid to show me it is bothering her. Smart Siamese,poor baby she knows there is something not right.

 

[Antonio65]

Yes that is right though I don't know the name of the radioisotope used. Poor baby I was petting her and she moved her head to the spot of her thyroid to show me it is bothering her. Smart Siamese,poor baby she knows there is something not right.

Follow the instructions from your vet, everything will be fine

 

[Jojo&Tutu]

Follow the instructions from your vet, everything will be fine

I felt and could not feel enlarged thyroid. Might be a salivary or lymph gland enlarging and receding. I will have rad vet feel and maybe retest t4 before doing anything. It is stressing me out.

 

[Antonio65]

Have both T4 and fT4 tested.

 

[Jojo&Tutu]

Thank you. Do you know if they test tsh on cats?

 

[Antonio65]

Thank you. Do you know if they test tsh on cats?

They could, even if not all labs do that, and anyway it is Canine TSH, it can only be used as a guide, not for diagnosis.
Talk to your vet about this, I had to argue with my vets for a long time before they agreed to have TSH tested too.

 

[Jojo&Tutu]

They could, even if not all labs do that, and anyway it is Canine TSH, it can only be used as a guide, not for diagnosis.
Talk to your vet about this, I had to argue with my vets for a long time before they agreed to have TSH tested too.

Well here is the latest:
My kitty had a scan for thyroid tumor and there is a small encapsulated one, an adenoma, meaning it is benign. Medication can control the hyper reactive thyroid these can cause but the tumor can grow and metasticize. So usually the vets recommend I 131 radioactive iodine uptake to get rid of bad cells and keep good ones. However I have a parotid gland adenoma myself and a radiation injury from long ago and do not really want to be exposed to my kitty who can emit nuclear radiation for some time after I 131 treatment. Kitty would have to be gone for two weeks to a month. She would also be exposed in her own overall system to some degree which might eventually affect her: I am not convinced otherwise even though they say it is ok. Since her tumor is small and encapsulated and only on one side she could manage without one side of her thyroid and parathyroid. The radiation vet recommended surgery as a better option for me and my kitty. I am currently hunting for an experienced surgeon. My internal medicine vet has a few but I may have found two with stronger backgrounds and am meeting with one soon. I want them to have done many of these on cats at some point in their career and have gone to a good vet school. There are nerves for the trachea there so they need to be using proper magnifiers and detail equipment or special techniques. The I 131 is still an option and I will talk to my internal medicine vet about it. Her internal medicine vet is off on family er right now will be back soon. I feel overall better about this situation and kitty is currently back home in my arms again and we will take care of this soon. The radiation vet said that after I 131 treatment or surgery her kidney values will go up. The elevated blood pressure from hyperthyroid causes more blood flow through the kidneys helping to get rid of more toxins and after surgery or I 131 either way the heart will slow back down and kidney values will rise. Good for the heart but no so for kidneys. Her kidney values are not too bad from the past before hyperthyroid which is ok. The hyperthyroid made them better - made them lower normal -they were stage one or two kidney failure before the hyperthyroid so he recommended flushing the kidneys by subcutaneous fluids every other day for twenty days till the thyroid remaining kicks up in doing its job again at a normal level. Then she will be back to stage one or two again, not too bad. I will talk to my internal medicine vet to make sure this all will work before doing anything. I feel some relief but a long way off from whew it being over.

 

[Antonio65]

I don't know about the surgery, but in case of I-131 treatment the thyroid gets back to its normal function in more than 20 days, at least 4 months.
So, I don't know if surgery has a quicker good outcome on the good part of thyroid. If not, you'd need to give your cat subQ's for longer than 20 days. You will have to keep her kidneys under control for at least 3 months post treatment, but this goes along with the regular thyroid checks that you will have to run after the therapy.
My cat had the therapy August 2017, she had a first check 30 days later, a second check at 90 days and a third one at 180 days.

The surgery is the second best choice of therapy after I-131, but has a greater percentage of risk. Damage to the trachea and nerves around it is possible.
When the vet exposed the choices to me, they would have liked to go with the surgery but I had read all about it and knew it was way too risky for me, and I insisted on the I-131.

I understand you have issues that will prevent you from being next to your cat for a while, but I still think that it is absolutely the best treatment for a cat.
She will stay away from home for a while, but it won't long, in 4 weeks she'll back with you, and 4 weeks go by faster than you think.
As for the radiations that would affect the cat's body system too, that might be true, but as far as I know, no cat has ever suffered from these consequences.

I live in a country where nearly no vets know much about I-131, and there's no facility here that does this treatment. I should have continued with methimazole or choose the surgery.
But I am stubborn and only look for the best for my cats and travelled abroad, to another country, to have it done, and I say it's been money well spent, and I would recommend it to everybody!

 

[Jojo&Tutu]

You might be right but my cat already had a liver adenoma and had 1/3 of her liver removed and I have a parotid gland adenoma. Adenomas are tumors that are benign but will convert to cancer. There is a risk of causing adenomas to convert to cancer or converting one unknown in her to cancer from the exposure of I 131. Small risk but present. There is a risk with surgery also of trachea nerve damage but it is very very small according to the first surgeon I talked to who had done many of these surgeries. There is also anesthesia risks for older cats but she handled it well just a year and half ago with her liver surgery. I will review everything with her internal medicine vet when she is back to her office from her own family emergency before I decide what to do. Her kidney function is pretty good and she will be closely monitored by her internal medicine vet following whatever procedure is chosen for the need for subcutaneous fluids. The radiology vet's assessment of twenty days might be based on her present kidney function and how he believes she would respond. He is very very experienced with I 131, uses only a necessary dose and does recommend surgery for cats he believes can tolerate it based on the owner's needs for example if a owner has cancer or is pregnant and if the cat could tolerate an I 131 exposure or not.

 

[Etarre]

[QUOTE=" I may have found two with stronger backgrounds and am meeting with one soon. I want them to have done many of these on cats at some point in their career and have gone to a good vet school. [/QUOTE]

It's so important to trust your vet, and I think you're doing the right thing for you and your cat to do this background research!

 

[Jojo&Tutu]

UGH!!!! My internal medicine veterinarian is out on family emergency for the next month. I am worried about her- don't know if she is ill. I think she might be ill. Whatever it is I think it is serious. She rarely misses work and is only in twice a week sharing her practice with other internal medicine vets. My kitty needs her advice. I was thinking surgery is best as per the radiology doctor recommendations after imaging her and only seeing one likely benign adenoma tumor in one thyroid nothing else but I read on Cornell University's website that 80 % of cats have cells outside the tumor that are bad and need treatment. That's why they mostly do I 131 radioactive uptake treatment for cats. The radiology vet said there was a minuscule chance anything would ever occur on her other thyroid. I don't know if the 80% occurrence outside the tumor is in adenomas found on bilateral or unilateral scans. (1 tumor in 1 thyroid or more than one tumor on both thyroids of the cat - cats have twobthyroids). I will have to meet with another less knowledgeable internal medicine veterinarians and request she contact Cornell and/or Colorado State for current research on unilateral thyroid adenomas in cats. I miss Cindy my internal medicine vet of 14 years and I pray she is ok.