Hyperthyroid early CKD cat (Mumu's new thread)

WMM201

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I wanted to start a new thread to document my cat Mumu (8 or 9 years old, we're not sure since she was an abandoned kitty) and her recent hyperthyroidism. I got great information from many threads from molly92 molly92 and Antonio65 Antonio65 , and was posting to M MamaKat9 's thread about her cat Smoke (best wishes for Smoke!) and didn't want to take over Smoke's thread!

Mumu was started on 2.5 mg twice daily of methimazole ear gel this week after getting a T4 blood test result of 5.5. I've gotten the vet to let her go down to 1.25 mg instead, because comments here and on the feline hyperthyroidism group suggest that it was a safer way to go. I will hopefully get that medication in a couple of days. We are going to recheck her bloodwork in a few weeks after this adjustment. Mumu has early CKD (stage 2), and her recent kidney blood work has looked really good, within normal range. If her kidney levels continue to look good after her thyroid is under control with the medication, and she is a good candidate for I-131 therapy, I'll arrange it for her so we don't have to worry about further organ damage from the H-T. This is just where I'll update and chronicle her progress! :)
 

neely

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Our cat, Carleton, was diagnosed with Hyperthyroidism last month. This is still new to me but I've been reading as much as I can and will be learning along with you. We've had many cats over the years but this is the first one with H-T. We go to a feline only cat clinic and I had a long talk with the vet. She discussed the different options with me and for now I also decided on the transdermal gel form of Methimazole. Carleton had his bloodwork this week and his level dropped from 4.3 to 2.4. He's on 1.25 mg twice a day. I'm very happy that his results are in the normal range now but eventually will proceed with the radioactive iodine therapy. Fortunately we have an excellent facility not too far away to take him to where they do scintigraphy. We have a long history with them from our dog's autoimmune illness so I fully trust their care and expertise. Good luck to Mumu and you. :hearthrob: I will check your updates and wish you the best. 🤗
 
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WMM201

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neely neely I hope that Mumu will have the same success with the transdermal methimazole as Carleton! I would love to be updated with Carleton's condition. Wishing you and Carleton the best!
 
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WMM201

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Hello everyone, I thought I would provide an update on Mumu's hyperthyroidism and CKD after her first blood work recheck. Mumu her H-T treatment with methimazole transdermal gel on March 24. She has been on 1.25mg per dose, twice daily, and yesterday on April 13 went to have her first follow up bloodwork. Her T4 went from 5.5 to 2.9, and she has gained a little weight! The vet is going to keep her on the 1.25mg methimazole dosage, and I'm glad I asked for that adjustment from the initial 2.5mg dosage. However, Mumu's kidney bloodwork moved a little in a worse direction. Her SDMA went from 13 (high end of normal reference range) to 19, which is above reference. Her creatinine barely increased, from 1.7 to 1.8 (0.9 to 2.3 is the reference range), but her BUN went from 27 to 36 (16 to 37 is the normal reference range). I think treating the H-T did unmask the true progression of her CDK, but at least it's not hugely worse. Her bloodwork test notes say that the kidney numbers indicate "likely impaired GFR and kidney function."

I've got a consult with her vet scheduled next week to ask about treatment strategies going forward. I would like to get Mumu the I-131 treatment if her vet and the referral center where they actually do the I-131 consider her a good candidate, but I think there is some uncertainty about possibly causing hypOthyroidism and causing kidney damage. From what I understand, getting the right iodine dosage with scintigraphy, close monitoring, and supplementing with thyroxine can reduce the chances of that happening. M MamaKat9 , Antonio65 Antonio65 , molly92 molly92 , neely neely , and FeebysOwner FeebysOwner , I would love to hear your thoughts! Mumu is so sad about getting medications (including other ones for arthritis and allergies) that I'd love to be able to give her at least one real cure if I can.
 

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Hi. The change in Mumu's H-T is great! I would still do another recheck or two before considering the dosage to be stable for her. After 5 months Feeby's H-T creeped back up from 2.9 to 3.8, so we have increased one of her two daily doses from 1.25 mg to 1.875 mg. I was also told that creatinine is a better indicator for kidney issues than BUN - which can be impacted by stress, proximity between food intake and testing, among other not-necessarily-kidney related variables. And, some vets don't like to rely on the SDMA, but I know many members' vets do think it is a reliable tool.

From all that I have read so far, the key to getting the right dosage of I-131 is the scintigraphy. The other members can confirm this - and, can tell you whether or not any medications like thyroxine are even necessary if the dosage is correct. As I understand it, they generally are not needed.

Med administration suggestions:
1.) 'juice' from canned tuna and chicken, and then give him a piece of the meat as a treat afterward
2.) baby food meats (Gerber Stage 2 or Beechnut)
3.) lickable treats, such as Applaws, Wholehearted, Tiki Cat Stix, Inaba Churu, Vitakraft - just to name a few
4.) Tiki Cat Mousse (which is complete meal, not a treat)
All of the above have worked with Feeby and are much less stressful (for the both of us) than syringing or pill poppers!!
 
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WMM201

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That's great advice, FeebysOwner FeebysOwner . I definitely want to do at least 60 more days of the methimazole, because I think this recheck is on the early side and I want to see if her kidney numbers also fluctuate. I have a feeling that the H-T was making the creatinine and BUN readings look better than they were, while the SDMA was still indicating more progression in her CKD relative to the other numbers. But I need to go over this with my vet to see how often we should recheck Mumu's kidneys. I don't want that to get much worse for her.

Unfortunately, Mumu is super stubborn. I can't get her tricked with crushed or hidden pills anymore, she sniffs it right out, even from this enticing menu you listed (tried almost all of them, lol)! All her meds have been compounded into liquids and transdermal gels because she won't open her mouth for pills, or spits them out even after I keep her mouth closed. Even those Onsior quick melt tablets don't melt quick enough! She's a tough customer only when it comes to meds.
 

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Thanks for asking me for my opinion.
The aim of having the scintigraphy done is to avoid the risk of getting a cat hypo.
The scintigraphy is the gold test to assess the precise size of the thyroid mass and hence to adjust the I-131 injection precisely.
Without the scintigraphy the risk of giving the cat the wrong dosage is much higher.
So, if the vets consider Mumu a good candidate, as I'm sure she is, the chances the treatment is successful are very very high, close to 100%.
 
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neely

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Her T4 went from 5.5 to 2.9, and she has gained a little weight!
That's music to my ears. 🎵 Good luck on your consult with the vet next week about treatment strategies. I'm going to wait until Carleton's next bloodwork appointment and then make a decision when to proceed with the I-131 treatment. That will give me some time to save up for it too.

I can't get her tricked with crushed or hidden pills anymore, she sniffs it right out, even from this enticing menu you listed (tried almost all of them, lol)! All her meds have been compounded into liquids and transdermal gels because she won't open her mouth for pills, or spits them out even after I keep her mouth closed.
Don't feel bad, I can't get Carleton to take a pill either. Whenever he needs meds I always request a liquid and the Methimazole is a transdermal gel like Mumu's. :thumbsup:
 
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WMM201

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That's music to my ears. 🎵 Good luck on your consult with the vet next week about treatment strategies. I'm going to wait until Carleton's next bloodwork appointment and then make a decision when to proceed with the I-131 treatment. That will give me some time to save up for it too.

Good luck with Carleton's next checkup! Yes, that I-131 treatment is really pricey especially with all the pretreatment tests and the follow-ups added, but our kitties are worth it! :silver:

Don't feel bad, I can't get Carleton to take a pill either. Whenever he needs meds I always request a liquid and the Methimazole is a transdermal gel like Mumu's. :thumbsup:
 
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WMM201

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Good luck with Carleton's next checkup, neely neely ! Yes, that I-131 treatment is really pricey especially with all the pretreatment tests and the follow-ups added, but our kitties are worth it! :silver:
 

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Good luck with Mumu (and Carleton too :)) Smoke is now 2 months out from his I131 treatment. His bloodwork is good so far and he is gaining some weight and growing his hair back!!! I know that hypothyroidism is a concern, but the drugs for hypothyroid treatment cause less damage to the organs than the methimazole does. Obviously ANY medications can cause issues for cats since they are so sensitive and prone to kidney and liver issues. I hope you manage to moderate Mumu's kidney issues too!!! Smoke is a PILL about taking pills too. That was one contributing factor that led me to do the treatment for him. As of this moment, I still think I made the best decision for him. Although I have to admit I was uptight at first because the 2 weeks after the treatment were a little difficult with quarantining him from the rest of my cats and being unable to give him comfort and cuddles. (I bought a Geiger counter to monitor him throughout the 2 weeks and to monitor the litter since that was radio active too)
 
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WMM201

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M MamaKat9 that is wonderful about Smoke! I am so happy for you and him that his numbers are good. I am optimistic for Mumu, and I can't help but laugh when I picture the Geiger meter being waved over your kitty Smoke! That would be tough, since Mumu is a love bug, but I think I will get a dedicated radioactive Litter Genie for Mumu once we get to the I-131 therapy time, so we can keep that in the garage.
 
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WMM201

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I spoke with my vet today, and she seems very hesitant to recommend the I-131 treatment for Mumu because of the elevated kidney numbers. She wasn't sure if the clinic that she refers her to would take her, because of the SDMA being elevated at 19 and her creatinine at 1.8, but said she'd call them and ask. She said she would give me their contact information after they respond to her, so I could also ask them my questions directly. From what I've been reading here and at the other feline hyperthyroid groups, Mumu's kidney numbers don't seem all that bad for I-131 treatment. My vet also said that if Mumu's next bloodwork shows further elevated levels in kidneys, she might lower the methimazole to keep Mumu's thyroid less controlled for the sake of her kidneys. From my research and reading the AAFP guidelines for hyperthyroidism, this might be a more conservative and outdated approach. I'd rather not keep Mumu "a little" hyperthyroid for her CKD, because there's other systems that the hyperthyroid is affecting. Mumu's next recheck is at 3 months, for a full senior profile and urinalysis, but my vet said that if Mumu is considered a candidate for I-131 treatment, we could certainly move that up. I'm thinking of calling around other treatment centers with Mumu's blood test results to see what they think. I'd love any advice anyone has!
 

neely

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From my research and reading the AAFP guidelines for hyperthyroidism, this might be a more conservative and outdated approach. I'm thinking of calling around other treatment centers with Mumu's blood test results to see what they think. I'd love any advice anyone has!
If it were me I'd want to look into other treatment centers in order to be well informed and make the right decision for Mumu. I noticed you live in Michigan - have you considered contacting Michigan State University since their veterinary school treats Hyperthyroidism with the Radioactive Iodine I-131 treatment? Hyperthyroidism and Iodine (I131)
 
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WMM201

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If it were me I'd want to look into other treatment centers in order to be well informed and make the right decision for Mumu. I noticed you live in Michigan - have you considered contacting Michigan State University since their veterinary school treats Hyperthyroidism with the Radioactive Iodine I-131 treatment? Hyperthyroidism and Iodine (I131)
You're totally right, neely neely ! I am certainly going to look for second or third opinions about the I-131. I did think of MSU for their treatment center. molly92 molly92 had her cat treated there, and wasn't too happy with her experience, but if it's MSU or nothing, I'm definitely taking MSU. I've written an email to the Ohio State vet school medical center also, because they said that they will perform scintigraphy to determine the iodine dosage if needed, and that's definitely something I'd like Mumu to get based on the recommendations I've seen here at The Cat Site and in the other groups.
 

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I spoke with my vet today, and she seems very hesitant to recommend the I-131 treatment for Mumu because of the elevated kidney numbers. She wasn't sure if the clinic that she refers her to would take her, because of the SDMA being elevated at 19 and her creatinine at 1.8, but said she'd call them and ask. She said she would give me their contact information after they respond to her, so I could also ask them my questions directly. From what I've been reading here and at the other feline hyperthyroid groups, Mumu's kidney numbers don't seem all that bad for I-131 treatment. My vet also said that if Mumu's next bloodwork shows further elevated levels in kidneys, she might lower the methimazole to keep Mumu's thyroid less controlled for the sake of her kidneys. From my research and reading the AAFP guidelines for hyperthyroidism, this might be a more conservative and outdated approach. I'd rather not keep Mumu "a little" hyperthyroid for her CKD, because there's other systems that the hyperthyroid is affecting. Mumu's next recheck is at 3 months, for a full senior profile and urinalysis, but my vet said that if Mumu is considered a candidate for I-131 treatment, we could certainly move that up. I'm thinking of calling around other treatment centers with Mumu's blood test results to see what they think. I'd love any advice anyone has!
Have you researched into what to do with lowering the kidney levels (regardless if you do or don't move ahead with I-131)? I know Phosphorous control in food is one action owners can take. Are there medications or other therapies available?

Thank you for helping me on my threads. :) I fear my Leia is in a similar boat to Mumu where H-T either caused and/or is masking an underlying Kidney disease. Very unfortunate as Leia is only 5.5 years old. It's all new to me. I'm glad to see Mumu and Leia fighting this together here and on the other Groups.io communities.
 
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WMM201

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Have you researched into what to do with lowering the kidney levels (regardless if you do or don't move ahead with I-131)? I know Phosphorous control in food is one action owners can take. Are there medications or other therapies available?

Thank you for helping me on my threads. :) I fear my Leia is in a similar boat to Mumu where H-T either caused and/or is masking an underlying Kidney disease. Very unfortunate as Leia is only 5.5 years old. It's all new to me. I'm glad to see Mumu and Leia fighting this together here and on the other Groups.io communities.
I was just thinking that Leia is almost like Mumu's twin kitty; Mumu is also a 8.2 lb cat, who had gone down to 7.6 lbs when she was diagnosed with hyperthyroidism, and is now back at 8 lbs after the 4 weeks of methimzole (at 1.25 mg twice daily)! Mumu is such a picky eater, and it's hard to find a good wet food with low phosphorus that she likes. :ohwell: An internal medicine vet had also recommended turkey as her main protein when she had her bout of maybe pancreatitis, and that's when I was feeding her the American Journey food. I'm looking forward to Mumu's next blood test to see what her phosphorus level is, and maybe I can talk to the vet about phosphorus control based on that result.

Good luck with Leia's journey! Let's hope both Leia and Mumu will get the treatments they need for many more years!
 

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There are phosphorus binders. I've seriously thought about them with Feeby since I really haven't successfully found any of the lower phosphorus food locally.
 
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WMM201

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There are phosphorus binders. I've seriously thought about them with Feeby since I really haven't successfully found any of the lower phosphorus food locally.
That's something I have in the back of my mind, too, for when Mumu's CKD progresses further.
 
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WMM201

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Hello group! Not much to update, except that I noticed this morning that one of Mumu's ears, where she is getting the methimazole transdermal gel, has become quite red. The other ear looks normal. I haven't been cleaning her ears between doses, because when I asked the pharmacy, they said it wasn't necessary. I know that Mumu tries to run away when it's time for the ear gel, but she holds still and doesn't cry when I actually apply it. The ear gel is in a lipoderm base right now. Should I start cleaning her ears between doses, or ask for another base?
 
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