Hyperthyroidism in Feeby - Questions

[FeebysOwner]

I don't want to paly the vet here, but most vets advise to give 2.5 mg twice a day, which is way too much. All forums and groups on HT cats advise users to start with 1.25 mg twice a day.

Finally, just picked up Feeby's H-T script. It is generic form of Methimazole at 5 mg per pill. The instructions state one pill twice a day. I have a call in to clarify this is really the vet's intent. I had read at least one article that said initially the dose is 2.5mg twice and day, and then I see what Antonio65 said (above) which is even less. Where, might I ask, is the documentation/forums/groups on HT cats that I can reference?

Also, what dosages were other members' cats started on?

 

[daftcat75]

Finally, just picked up Feeby's H-T script. It is generic form of Methimazole at 5 mg per pill. The instructions state one pill twice a day. I have a call in to clarify this is really the vet's intent. I had read at least one article that said initially the dose is 2.5mg twice and day, and then I see what Antonio65 said (above) which is even less. Where, might I ask, is the documentation/forums/groups on HT cats that I can reference?

Also, what dosages were other members' cats started on?

I thought I read here too that 5 mg once a day is not as effective as 2.5 mg twice a day. I don't know how easy it is to pill Feeby. But since compliance is absolutely required here and also since I read the recommendations on this thread, I would ask the vet to call in your prescription to Wedgewood for a transdermal gel pen. You'll need to set up a profile for Feeby first.

Methimazole Twist-a-Dose Transdermal Gel

 

[FeebysOwner]

I thought I read here too that 5 mg once a day is not as effective as 2.5 mg twice a day. I don't know how easy it is to pill Feeby. But since compliance is absolutely required here and also since I read the recommendations on this thread, I would ask the vet to call in your prescription to Wedgewood for a transdermal gel pen. You'll need to set up a profile for Feeby first. Methimazole Twist-a-Dose Transdermal Gel

The instructions say 5.0 mg TWICE a day. Not once. Right now that is my main concern.

 

[verna davies]

Guinness started on 5mg once a day, 5mg being the lowest dose tablet available to me.

 

[verna davies]

Graceful-Lily 's thread was called
Radioactive Therapy For Hyperthyroidism
Sorry, I can't seem to attach direct link.

 

[FeebysOwner]

Guinness started on 5mg once a day, 5mg being the lowest dose tablet available to me.

The particular brand that Guinness was on - Vidalta - is a UK brand, not offered in the US as I understand it. It is a sustained carbimazole formulation which is why it cannot be cut or crushed, and is administered once a day, as you said. I presume this is why the dosage might not match what is recommended/given in the US.

Edit: I found the thread you noted above!

 

[FeebysOwner]

Vet called me back. Lots of info to process from our discussion - but, bottom line, he said he was fine with me lowering the dose to 2.5mg twice a day. It will help to reduce the chances of side effects, and can easily be raised after her follow up tests in about 3 weeks. He did however say that a cat's weight does have some bearing on the dosage, so that is why he chose to go with 5.0mg twice a day rather than the lower amount because she weighs around 13 pounds. I am exhausted.

 

[FeebysOwner]

Round #1 - 2.5 mg (such a tiny amount of pill), put in a tiny amount of Tiki Cat Mousse - and gone. Thank god. I promise I am NOT going to report on every dose...

 

[Antonio65]

Finally, just picked up Feeby's H-T script. It is generic form of Methimazole at 5 mg per pill. The instructions state one pill twice a day. I have a call in to clarify this is really the vet's intent. I had read at least one article that said initially the dose is 2.5mg twice and day, and then I see what Antonio65 said (above) which is even less. Where, might I ask, is the documentation/forums/groups on HT cats that I can reference?

Also, what dosages were other members' cats started on?

As I had said, 5 mg TWICE a day is way too much and it's possible it gives a cat side effects that can't be reversed.
My vet had me start with 1.25 mg TWICE a day, then lowered to 1 mg a day on one of the following check up visit. The lowest dosage I had to give my cat was just 0.625 mg TWICE a day shortly before she was treated with I-131.
The level of methimazole might have something to do with the cat's weight, but it must be assessed periodically on the T4 and fT4 levels. My cat would have a blood check every 5-6 weeks, and the dose of methimzole was adjusted accordingly.

Anyway your vet agreed to lower the dosage to a half of the original dosage, which is fine.

The group that gave me a ton of help is this
feline-hyperthyroid groups.io Group
When I first joined, it was a Yahoo! Group, but it seems it is now from a different provider. Once you join and tell other your cat's story, you will receive lots of help and support, suggestions, whatever you need.
I will never thank them enough, without them I wouldn't have been able to have my Pallina treated the way she was.

In my country there are no facilities for I-131 due to a lack of legislation in this matter, so people know nothing about it, and even vets know very little or nothing, because nobody would travel abroad to do what I did, so vets don't even bother.
I did know that there were facilities in all the countries around me, but they all need a referral vet to introduce the pet to the clinic, and my vets didn't know enough to follow me in this adventure.
If it wasn't for that Group, I would have never found the facility that would accept my cat without a referral vet. And it had much lower fees than the others. Moreover, they also had the in-house scintigraphy available, which I strongly recommend.

EDIT:
I forgot to say tat if you decide to join that group, it is very likely that your account isn't activated right away, it might have to wait for the approval from the admins. I just wanted to tell you, so you don't think something is wrong with the sign up.

 

[FeebysOwner]

After having some time to digest additional pieces of the conversation with the vet, I am a bit irritated - in that he initially labeled Feeby's case as mild. Then, yesterday, he noted that her T4 reading was 'off the charts' (>100 pmol/L with a reference range of 10 - 50). I was shocked - I mean I knew what the reading was, but assumed it could be much higher since he said 'mild'. And, I wasn't going to get into an argument with him about how "off the charts" and "mild" seem incongruous. But, it likely has to do with his assessment to start with 5 mg twice a day, even though he was quick to agree to lower it to 2.5 mg. And, maybe the 'mild' relates to the idea that he seems to think the H-T is a relatively recent condition in Feeby. I don't know...

Antonio65 - thanks for the extra information! May I ask, if you remember, what Pallina weighed when she first started on the H-T meds? Just curious, given my vet did say that weight plays at least a partial role in the dosing.

 

[fionasmom]

Fiona was a pudgy little girl when she was dxed, at least 13 lbs and she was on 2.5 twice a day.

 

[FeebysOwner]

Fiona was a pudgy little girl when she was dxed, at least 13 lbs and she was on 2.5 twice a day.

Thanks! Good to know! Kind of helps, at least, feeling better about the 2.5 mg I pushed the vet to reduce her script to.

 

[FeebysOwner]

I forgot to say tat if you decide to join that group, it is very likely that your account isn't activated right away, it might have to wait for the approval from the admins. I just wanted to tell you, so you don't think something is wrong with the sign up.

I joined; account activated pretty quickly. Posted a thread about Feeby, have had some responses. And, they are very alarming. One poster even suggested that too high of a dosage of Methimazole can cause kidney issues. That does not sound very informed to me, based on what I have read so far. Treating H-T with meds can reveal a kidney issue, it can't cause one.

Another suggested my vet is trying to kill my cat! How did you decipher the information you received on this site?

 

[Antonio65]

After having some time to digest additional pieces of the conversation with the vet, I am a bit irritated - in that he initially labeled Feeby's case as mild. Then, yesterday, he noted that her T4 reading was 'off the charts' (>100 pmol/L with a reference range of 10 - 50). I was shocked - I mean I knew what the reading was, but assumed it could be much higher since he said 'mild'. And, I wasn't going to get into an argument with him about how "off the charts" and "mild" seem incongruous. But, it likely has to do with his assessment to start with 5 mg twice a day, even though he was quick to agree to lower it to 2.5 mg. And, maybe the 'mild' relates to the idea that he seems to think the H-T is a relatively recent condition in Feeby. I don't know...

I seem to remember that my vet told me to only look at the T4 level rather than at bot T4 and fT4.
What I had learned through that group was that another level had to be checked, but probably only after the I-131 treatment to see if it had been effective, the TSH, which most labs only have reference ranges of for dogs.
In my case the lab only could compare it to what dogs' is, and the vet told me it has to be higher than 0.39.

Antonio65 - thanks for the extra information! May I ask, if you remember, what Pallina weighed when she first started on the H-T meds? Just curious, given my vet did say that weight plays at least a partial role in the dosing.

Pallina had always been a rather overweight kitty. When she was young and healthy, she was about 5.6 kg (a little more than 12 lbs). Over here in Italy, such a weight is above the average for a cat. Normally, an Italian cat is around 3.5 - 4.5 kg. Furthermore, Pallina was a small sized cat, hence she would look quite roundish. Keep in mind that in Italian, Pallina means "little ball", so it might seem that we chose an apt name for her.
I can't remember the precise weight when she started the methimazole treatment, I can guess something around 3.5 - 3.7 kg, definitely below 4 kg, but the clinic report on the day she was admitted for the I-131 August 2017 says she was 2.9 kg, that is half of what her weight was when she was healthy.

 

[Antonio65]

I joined; account activated pretty quickly. Posted a thread about Feeby, have had some responses. And, they are very alarming. One poster even suggested that too high of a dosage of Methimazole can cause kidney issues. That does not sound very informed to me, based on what I have read so far. Treating H-T with meds can reveal a kidney issue, it can't cause one.

I checked your thread on the group and you got replies from two of the most informed and helpful members of the group, Linda and Ro.
Of course there are many members in the group, and some of them might be not very up-to-date, but let me assure you that Linda is one of the best ones there.
When I needed them, Linda and a few others were of great help, and suggested me all the steps I had to take for my Pallina. I passed their info on to my vet who accepted what I told him, agreed with the suggestions, and eventually would listen to me (the group's suggestions).
I was particularly lucky when I was looking for a facility, and one of the members, who seldom logs in, saw my post and sent me the address of the clinic in Belgium where I went to.
Like I told you in another post of mine, I did know of many facilities in Europe, and I was already looking at two of them in the south of England. Thanks God I crossed my path with that member who helped me a lot and addressed me to a wonderful facility.
Not to mention the personal and social experience I had with the staff at the clinic and many other people I had the luck to meet with during my week up there and enhanced my overall stay experience in a foreign country. But this is a different story and does not help you right now

Another suggested my vet is trying to kill my cat! How did you decipher the information you received on this site?

In my case I didn't have to decipher the information. I took it all for granted and, as the outcome proved, it was all correct. The member who suggested that your vet is trying to kill my cat, was a bit rude, but I think they would just want to make you aware about the possibility that a higher dose might be harmful.
In my opinion too, it is better to start on with a low dose and then adjust it to a higher dose if the check up test tells you it wasn't enough, rather than seeing that the high dose gave the cat a bad side effect and having to deal with them too.

 

[Antonio65]

FeebysOwner ,
you just received another reply on your thread. Sounds like an experience which is worth to keep in mind.

 

[FeebysOwner]

FeebysOwner , you just received another reply on your thread. Sounds like an experience which is worth to keep in mind.

I saw that response. I replied by asking if there were any indications of a kidney issue with the 2nd cat (brother), given the symptoms/side effects of this med can mimic other health issues, even in some cases kidney disease. We'll see if they answer.

Did you ever find any information/data on how early side effects might start to appear? Most everything I read said it would take a couple of weeks, but I am wondering if it can happen sooner than that.

I do appreciate all of your input.

 

[Antonio65]

Did you ever find any information/data on how early side effects might start to appear? Most everything I read said it would take a couple of weeks, but I am wondering if it can happen sooner than that.

Well, no, I didn't, but I presume that the first negative side effects might appear about the same time the med could give its good effects, that is not less than 3 weeks. This was my vet said about good effects, and it's the reason why a cat is retested at least 4 weeks after the beginning/change of therapy.
On a second thought, though, the lethargy or lack of appetite might appear sooner. By bad effects I also think of renal, liver and GI damages, which might appear after a longer time.

I do appreciate all of your input.

Thanks, I'm speechless. But I only have one single experience, luckily, though I did thorough researches, which had me to know more about HT than my vets themselves...

You have two new replies

 

[Antonio65]

FeebysOwner ,

They gave you a definition of Apathetic HT, which is what my Pallina had. It seems this condition is less rare than what I was told.

 

[FeebysOwner]

FeebysOwner , They gave you a definition of Apathetic HT, which is what my Pallina had. It seems this condition is less rare than what I was told.

If her lack of appetite is any indication, I suspect Feeby has this form of H-T. Her lethargy could be simply because of her age, but... And, I don't even know how to assess depression, but her vocalization may be a sign. She is by no mean in any state of 'hyperactivity' - short of bouts of restlessness, a more typical sign of H-T.

Now I am on the search for med side effects that might be different with A H-T, if there is such a thing. If not, then short of her vomiting, having diarrhea, and/or becoming excessively itchy, I don't have much to go on in terms of recognizing med side effects.