Hyperthyroidism Experience?

[KJIA]

Hello! My 17 year old ragdoll was just diagnosed with hyperthyroidism and I was curious to hear others experiences with either the medication (pill or transdermal ear gel) or I-131 radioactive iodine therapy.

We have opted to start with Felimazole medication, a pill administered twice a day, 12 hours apart. Our vet suggested we start with the medication because 1) my cat can be a little stressed at the clinic and the vet was concerned the hospital stay for I-131 therapy would be hard on her, and 2) my cat had a little increased protein in her urine tests. Although all her bloodwork indicated kidney function was normal, hyperthyroidism apparently may mask kidney disease, so we have to go back for testing in about one month to check thyroid levels (and adjust medication dose if needed) and also recheck kidney markers and urinalysis. Hopefully, the increased protein will have resolved with the thyroid treatment and all kidney markers are still normal. Fingers crossed!

Although I am pretty good at administering the pill, we aren't quite perfect each time and occasionally have a bit of a battle. While most times it shouldn't be an issue to administer the meds and stick to the 12 hour apart schedule, it does have me a bit worried. I already worry about her the few rare times I have to travel and ask a friend to check in on her, and having her on medication is a whole next level of worry and trust. There may be a few times I need to work early or late hours, or I feel pressure from my family to join them on trips and vacations. It can be hard to explain to people that I'm really hesitant to leave her, especially when it may affect her health. She isn't "just a cat" to me. I've since learned that there is an option for a transdermal gel medication instead of a pill that may be worthwhile looking into and help alleviate some of these concerns. However, twice a day medication is getting old, fast (and we've only been on it ten days!). Given that the medication would be life long, the option of a one time cure with I-131 therapy seems like it may be a good idea to consider. However, the aftercare of the radioactive treatment, when kitty and her litter waste are still somewhat radioactive, has me a little concerned.

For those that have opted for the medication treatment...

• Did you have experiences with the pill and transdermal gel? The transdermal gel is appealing, but what pros/cons did you find?
• How soon after beginning treatment did you begin to see an improvement in symptoms? We are ten days into treatment, and much of her symptoms still seem the same. I understand it may take some optimization of medication dose.

For those of you that have opted for the I-131 radioactive therapy...

• How did your cat handle the separation and hospital stay? My vet seems to think my cat is stressed at the vet clinic, but to me it is more unhappy stress then anxiety stress. She is not panting or panicking. She just tends to squish herself in a corner and can get a grumbly when handled. Honestly, she used to be all purrs at the vet clinic until she had to have her anal glands expressed once and ever since then, well, lets just say I understand her caution and grumbles. I would think the hospital stay where she is mostly just monitored and not overly handled, she would do okay. Prefer to be home, of course, but do okay.
• How old was your cat when they had the therapy? My kitty is 17 years old, and some people have cautioned me on choosing an expensive treatment for an elderly cat that may not have many years left. I know we can't see the future, but I think I would feel that it was worth it whatever the outcome, and given she has no other significant health issues I hope she has many years yet to enjoy.
• How did you isolate your cat after I-131 therapy if you live in a small apartment? I understand that after kitty comes home, she needs to be isolated for two weeks and the litter waste needs to be stored for two months. I live in a small one bedroom apartment. I can imagine a scenario where she could isolate in my bedroom, and I could sleep in the living room on the sofa. I do have a small concrete porch as well that I could try to store a bin of the used litter and other waste until it is safe to dispose of.
• Any challenges you found during the I-131 aftercare? I guess I am not sure on how the radioactive contamination works. If she is isolated to my bedroom, are my blankets now contaminated? How do I clean them? What do I do with uneaten food or water? How do I clean the dishes? Are the plates and silverware safe for me to use after running through the dishwasher, or do I purchase her own set of dishes and discard them after isolation? Is the dishwasher now contaminated? I'm sure I'm overthinking this...

I will be reaching out to our specialty hospital with all these questions, but just interested to hear others experiences and tips! Thank you all for your input!

 

[ProMeower]

Also have a 17 year old cat who just got diagnosed with kidney disease and hyperthyroidism. The kidneys were our main concern and the thyroid was not as bad based on blood work, but then we found that she has an enlarged heart so we started treating.

The first week we had methimazole pills that we had to cut in half. We tricked her into eating them by wrapping them in a kind of cream cheese but she wised up fast. We switched to the transdermal as fast as we could, and will need to do the blood testing within the month to see how she's doing.

About the gel administration: USE GLOVES. We try hard to give it 12 hours apart, switch ears every time, and clean the other ear with wet tissue before dosing (so it's ready for next time and not wet). This does mean one of us has to be home to care for her and can't really travel. Still, if you ask a friend to stop by when you're busy, they can much more easily give transdermal medicine than a pill.

Can't comment on how soon you may see improvement because a lot of my cat's issues are from kidneys and not thyroid. We're thinking about the radioactive treatment also but it's not certain they'll do it on a cat with bad kidney values. In terms of storing waste, we use a litter genie currently and the bags do a good job sealing odor in, so maybe that can be part of your storage solution.

Best of luck with your kitty - if you do the radioactive treatment before we can, I will have the same questions you do so I would love to hear about it.

 

[pearl99]

• Did you have experiences with the pill and transdermal gel? The transdermal gel is appealing, but what pros/cons did you find?
• How soon after beginning treatment did you begin to see an improvement in symptoms? We are ten days into treatment, and much of her symptoms still seem the same. I understand it may take some optimization of medication dose.

I used a liquid oral first, then a pill. The oral liquid was pricey, and I wanted to try the pill. I stayed with the pill.
At the first the dose was 1/4 tablet- felimazole- twice daily. Gracie was hard to pill, I was successful putting the pill dose in a well of 1/8-1/4 teaspoon of Gerber 2nd Sitter chicken or turkey baby food. She LOVED baby food. I put a drop of water on the pill and let it sit for about 2-3 minutes in the baby food to dissolve it. She gobbled it up. I didn't do transdermal, this system worked perfectly. Kidney disease was found and her blood tests 3 weeks after starting the felimazole, Stage 3, so renal diet was added.
I don't remember exactly how long after starting the felimazole the symptoms improved, but the vomiting and decreased appetite were better by the 3 weeks.
I didn't do the I-131, she was 13 years when diagnosed, and this past January she passed over The Bridge after 3 years of treatment, she was 16. She also developed arthritis and hypertension. She needed Mirataz for appetite stimulation too, that was transdermal and worked well for her appetite.
Your kitty's blood tests will show if a higher dose is needed, after about 2.5 years Gracie needed a higher dose of felimazole.

I hope your kitty gets to feeling better!

 

[pearl99]

I already worry about her the few rare times I have to travel and ask a friend to check in on her, and having her on medication is a whole next level of worry and trust. There may be a few times I need to work early or late hours, or I feel pressure from my family to join them on trips and vacations. It can be hard to explain to people that I'm really hesitant to leave her, especially when it may affect her health. She isn't "just a cat" to me. I've since learned that there is an option for a transdermal gel medication instead of a pill that may be worthwhile looking into and help alleviate some of these concerns.

Oh, and my vet said if I went on a trip it would be OK to temporarily give the felimazole once daily. I didn't go on vacation during this time more than a week at a time, and Gracie did fine on the temporary once daily felimazole.
I hear you about twice daily medication getting old . I opted to not do the I-131, though if in the future I have another cat with hyperthyroidism I would do it if it was appropriate for the kitty!

 

[KJIA]

Thanks everyone for the suggestions! The felimazole we have says not to cut or crush the pill, but I never thought to try wrapping it in a bit of cream cheese so I may just have to give that a try. She does like cheese - although she's never had cream cheese. Hopefully she thinks it is a tasty treat. I think I will also ask about the transdermal medication and give that a try, while researching the I-131 therapy.

 

[jencat]

I had a 17 year old with kidney disease and secondary hyperthyroidism. Our vet felt that because of his age and the CKD, feeding him Y/D was the best option. It did keep his thyroid numbers in check up until he eventually passed away renal failure.

 

[ProMeower]

Thanks everyone for the suggestions! The felimazole we have says not to cut or crush the pill, but I never thought to try wrapping it in a bit of cream cheese so I may just have to give that a try. She does like cheese - although she's never had cream cheese. Hopefully she thinks it is a tasty treat. I think I will also ask about the transdermal medication and give that a try, while researching the I-131 therapy.

They do say that! But all the research papers I looked at recommend the starting dose as 2.5 mg 2x/day, and that's exactly what the vet prescribed, too, and instructed us to use a pill cutter. The gel is good for one other thing: your vet can really dial in the dose without being limited to increments of 2.5.

 

[pearl99]

The felimazole we have says not to cut or crush the pill,

Gracie was on 0.625mg twice daily at first, so not the enteric coated pill that can't be crushed or split. Then 1.25mg in the morning and 0.625 in the evening. So I was doing a quarter pill and a half pill.

 

[Mac and Cats]

This won't answer your questions, but I wanted to share in case it helps. In my experience, pilling does get easier and becomes less of a chore over time once everybody gets the hang of it. I believe a really high quality treat after you pill is key. I have a 13 year old and a 15 year old with hyperthyroidism. Both take methimazole orally, plus various other pills for their various other health issues. My female cat (13) was not easy to pill at first. She is quite a sassy lady to begin with. We finally got into a routine and I do not have to hold her down or wrap her like a burrito any longer. I made a video for a friend as he recently had to start his cat on methimazole as well. Here is the link if this helps. I wrap the pills in part of a pill pocket so it doesn't get stuck in their throat and then I give them a liquid treat after I administer the pill for two reasons: 1) to make sure the pill goes all the way down as it can cause esophagus problems if pills constantly get stuck in their throat and disolve in their throat and 2) so that they associate pilling with a treat. I NEVER mix medicine into these treats as she would immediately stop eating it and never eat it again if I did this. This has happened before with other treats and to this day she still refuses those treats. She still occasionally spits the pill out and then gets a little feisty when I have to put it back in her mouth, but for the most part, she is good. She now greets me when she knows its pill time and it's all thanks to her treat at the end. I use these, these or these for the liquid treat (I put them in a little dish). Our 15 year old cat is an angel to pill and he rarely fights me. I set an alarm on my phone to alert me it is pill time. Hope this helps some even though it doesn't answer your questions!

 

[sidneykitty]

My first cat, Sidney, got felimazole pills. Normally, she was very good at taking them twice a day. I placed the pill on a small teaspoon and dabbed a little plain or vanilla yogurt on/around it. Then I offered the spoon and 9 times out of 10, she licked it up and ate the pill and all.

I also did pill pockets for her. The felimazole pills are so nice and small, they were easy to fit. Sometimes this worked, sometimes not. She just happened to be a very easy kitty to put it in pill pockets or yogurt and I almost never had trouble with it. I imagine cream or cottage cheese would also hide it well depending on what your cat likes.

I fostered a hyperthyroid cat just a few months ago. He was initially on the transdermal. I alternated ears and such, but he did not do well on it and his thryroid levels never came down. He is one of those kitties who transdermal just did not work/absorb for. I've heard of others with this experience, too.

We switched him to the pills twice daily. At first, I tried putting it in a pill pocket and hiding it in treats like I did for my other cat, but this didn't work for him. Amazingly, he coped much better with just being pilled the normal way. You really get used to it and get better at doing it over time. I always made sure to syringe a bit of water after to make sure the pill went down his throat and didn't get stuck. I usually gave a treat after, too. He coped with being pilled just fine!

Amazingly, I'm told by his adoptive family that he now knows when its pill time and he comes running when the bottle shakes. The plus was he also HATED having the stuff put on his ears but coped fine with being pilled. I think he is a very special case because of all the cats I've pilled or given meds, he is the only one who didn't mind it. After 2 weeks of being on the felimazole, we rechecked his thyroid levels and they had come way down to normal levels, so they obviously worked well for him.

That's my experience. Long story short, it may take a bit of experimentation to determine what works for you and your kitty! Best wishes <3

 

[neely]

When our cat was diagnosed with Hyperthyroidism we decided to use Methimazole 1.25 mg twice a day in the transdermal gel form because it can have fewer adverse effects than the pill. Some cats exhibit gastrointestinal side effects with the pill. I found it very easy to administer the gel in his ear(s) especially since he's difficult to pill. He stayed on the transdermal gel for approximately nine months then our vet recommended the I-131 radioactive iodine treatment. He went through the appropriate tests and was considered a good candidate because he had no organ involvement. He was between 11-12 years old when he had the I-131. We had the same initial concerns as you so if you decide to go this route I would strongly recommend going to a facility that does Scintigraphy prior to the I-131 injection.

Regarding your questions about the I-131 radioactive treatment - we were worried about him being confined at the veterinary specialty clinic for five days but he actually handled it quite well and the staff couldn't have been more caring or attentive. They called regularly with updates and told us to call as often as we like. The isolation afterwards worked out too because we had no other pets in the house at that time so we did not have to isolate him to one room. We just had to be sure to keep approximately a three and-a-half foot distance from him. However, we did not leave him in our bedroom which I admit seemed like forever but looking back the two weeks passed by quickly. The specialty clinic gave us special litter to use that we could flush down the toilet and it would not affect the plumbing so we did not have to dispose of our regular litter outside away from the house.

You're not overthinking any of this at all. It's a lot to digest but if you have a knowledgable vet that you trust talk it over with them and go from there. For us the I-131 was the best thing we ever did but our guy was younger than your cat so once again discuss your concerns with your vet. Best of luck and please feel free to ask any more questions.

 

[ProMeower]

She now greets me when she knows its pill time and it's all thanks to her treat at the end. I use these, these or these for the liquid treat (I put them in a little dish). Our 15 year old cat is an angel to pill and he rarely fights me.

Do you know if these treats are okay for a kidney cat? My cat disdains all treats after medicine, even her favorite (cheese). Also holds her mouth shut. Also drools liquid meds out rather than swallow. Also blocks her throat with her tongue and spits pills back.

 

[Mac and Cats]

Do you know if these treats are okay for a kidney cat? My cat disdains all treats after medicine, even her favorite (cheese). Also holds her mouth shut. Also drools liquid meds out rather than swallow. Also blocks her throat with her tongue and spits pills back.

I'm sorry, I don't. They probably aren't great for CKD, but it is such a small amount that I give them, I feel like it's probably ok. Both their levels were in "normal" range about two months ago when they had their T4 and kidney levels tested.

 

[silent meowlook]

I use Methimazole 1.25mg twice a day. My cat was very hard to pill at first. Just have to take a deep breath, stay calm and give the pill. Approach from the back of the cat and try to catch them off guard. Don't make a big deal about it. Don't take the cat up onto a table to give the pill. Just do it quick and be done with it. I did start using pill pockets and they work most of the time.

I don't worry myself about breaking the Methimazole or the cat version of the drug, The concerns are for human contact, not that it alters the effectiveness of the medication. Mostly the concern is reproductive health. You can always use gloves, but the risk isn't absorbing it into your skin, it is that you won't wash your hands and will accidently ingest some of it.

The transdermal gel is not as accurate as the pill but can still be used if pilling your cat is causing a great deal of stress.

I personally didn't do the I-131 because my cat would not of done well in the hospital, and I am to much of a control freak about my animals to have her out of my care.

 

[Mac and Cats]

Do you know if these treats are okay for a kidney cat? My cat disdains all treats after medicine, even her favorite (cheese). Also holds her mouth shut. Also drools liquid meds out rather than swallow. Also blocks her throat with her tongue and spits pills back.

I just learned something from my neighbor last night who works at a vet. She told me that a cat's mouth/throat can only hold a certian amount of liquid (I texted her to ask her the amount), but she said that usually the recommended dosage of liquid drugs is more than a cat's mouth/throat can hold and she said she always opts for pills if given the choice for her own cats. I also opt for pills as with liquid, I never know how much they spit out/drool out and at least with pills I know if they got it all or none. I would also say that the liquid treats are probably better for them than cheese.

 

[FeebysOwner]

Every situation - and cat - is different. Feeby currently takes 1.85mg Felamizole crushed into a bite of her food in the AM, and then again crushed into a lickable treat for her PM dose. There are other less well received meds, but for this one, this is what works for me, so far (going on 2 years, with dose adjustments). It is all an experiment until you find what works for your cat.

 

[Twylasmom]

I also use 1.25 mg in pill form twice a day. My cat is on several different pill based meds. I use size 4 or 5 gel caps and can put multiple meds in a single capsule so she only needs to get 2 pills a day instead of four or five! She is an easy cat to pill. I sit on the floor on my knees, with the cat between. I gently open her mouth and drop the gel cap towards the the back of her tongue. After she gets a little purée treat or baby food as a reward and to ensure the pill goes down easily. She also gets a dose from her asthma inhaler after the evening dose. She will go and sit in our pilling spot when it is time for medicine!

I realize that I am fortunate that she is such a good pill taker, but setting up a routine, having a reward system and giving positive reinforcement can make things easier. It took several months to train her on the inhaler and she is less cooperative about her one transdermal medication. Be confident and calm when giving the medication, if you can,

 

[catmando2]

My cat was diagnosed with HT about a year ago. My first choice of treatment was I-131 as that's a one and done thing and likely cure.

However the vet said my cat wasn't a good candidate because of what looked like heart failure so tried the gel. That didn't work as my cat acted like I was trying to poison him when I got close to his ear and ran away almost every time. I then went to the pill (sneaking them in pill pockets) which for the most part worked until the vet decided to up the dosage and then my cat had side effects.

Eventually, I had a an echocardiogram (why didn't the vet suggest this in the first place) done that revealed my cat's heart is normal. The "signs" of heart failure were just false symptoms from the HT.

Luckily (to escape the pill side effects), I was able to bring him in for I-131 treatment (in one pill dosage at cat hospital). Fast forward to about 8 months later and my cat now gained all the lost weight back and is back to his playful self. I do need to bring him in for another thyroid panel in October which will be one year since treatment to see (hopefully) that his thyroid levels are all okay.

In a heartbeat, if you have a choice, my suggestion is to do the I-131 treatment.

 

[IndyJones]

My cat was diagnosed with HT about a year ago. My first choice of treatment was I-131 as that's a one and done thing and likely cure.

However the vet said my cat wasn't a good candidate because of what looked like heart failure so tried the gel. That didn't work as my cat acted like I was trying to poison him when I got close to his ear and ran away almost every time. I then went to the pill (sneaking them in pill pockets) which for the most part worked until the vet decided to up the dosage and then my cat had side effects.

Eventually, I had a an echocardiogram (why didn't the vet suggest this in the first place) done that revealed my cat's heart is normal. The "signs" of heart failure were just false symptoms from the HT.

Luckily (to escape the pill side effects), I was able to bring him in for I-131 treatment (in one pill dosage at cat hospital). Fast forward to about 8 months later and my cat now gained all the lost weight back and is back to his playful self. I do need to bring him in for another thyroid panel in October which will be one year since treatment to see (hopefully) that his thyroid levels are all okay.

In a heartbeat, if you have a choice, my suggestion is to do the I-131 treatment.

Out of curiosity, what side effects of felimezole did your cat experience? I'm currently dealing with a hyperthyroid/chf cat myself my cat though is confirmed a bad candidate for the chemo.

 

[FeebysOwner]

Out of curiosity, what side effects of felimezole did your cat experience?

I am not saying that some cats may not have side effects, but most who do it is because the dosage is too high. Lethargy/ sluggishness are probably most common, but others can experience nausea, lack of appetite, and some may even get loose stools. Even with starting at a low dose, it can take some time for a cat's body to adjust to the meds, so if you are seeing some side effects they should dissipate over time.

I see from your previous post that your cat is getting 1.25mg twice a day - which is a good starting dose. The dose may need to be raised depending on what your cat's thyroid level is when it is rechecked, which should be about 3 weeks after starting the meds.

Depending on what happens with the thyroid level re-check, you can ask your vet about the side effects if they are still worrisome, that would be especially true if your vet wants to raise the dose because your cat's thyroid level hasn't come down enough. Some folks have better success with less side effects by using the transdermal version that you rub into your cat's ear. So, that is another thing to ask about.

Also, sometimes when a cat's thyroid level is returned to a more normal state, some of the heart issues may improve too. Another thing to discuss with your vet.