Hyperthyroidism in Feeby - Questions

neely

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FeebysOwner FeebysOwner I'm refreshing your thread because Carleton was diagnosed with Hyperthyroidism the end of this week. He has a moderate case of Pancreatitis which I was familiar with but the H-T took me by complete surprise. 😲 BTW, this was his first Senior Physical exam. I'm picking up a script for the Methimazole transdermal gel tomorrow. i take Carleton to a feline only specialty practice and the vet did discuss Radioactive Iodine Therapy with me. But it was a lot to process since I wasn't expecting this news. It was my decision to start with the transdermal gel first and then go from there depending on his bloodwork results in 3-4 wks. I'll be checking this thread on a regular basis now and look forward to other members' posts as well - Antonio65 Antonio65 , fionasmom fionasmom , ClaireandPanda ClaireandPanda
 

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FeebysOwner FeebysOwner I'm refreshing your thread because Carleton was diagnosed with Hyperthyroidism the end of this week. He has a moderate case of Pancreatitis which I was familiar with but the H-T took me by complete surprise. 😲 BTW, this was his first Senior Physical exam. I'm picking up a script for the Methimazole transdermal gel tomorrow. i take Carleton to a feline only specialty practice and the vet did discuss Radioactive Iodine Therapy with me. But it was a lot to process since I wasn't expecting this news. It was my decision to start with the transdermal gel first and then go from there depending on his bloodwork results in 3-4 wks. I'll be checking this thread on a regular basis now and look forward to other members' posts as well - Antonio65 Antonio65 , fionasmom fionasmom , ClaireandPanda ClaireandPanda
I'm sorry to read that Carleton was diagnosed with HT on top of the pancreatitis. Sounds like what happened with my Pallina. She had an IBD, pancreatitis and HT too.
I think that starting with the methimazole first is a good idea, to stabilize Carleton's condition, while preparing the path to the I-131 therapy.
I think your vet might need some data from the first weeks of methimazole treatment before understanding if your kitty is a good candidate to the radioactive therapy. I guess a couple of months of gel would do. I wouldn't treat him for a longer time, though. My opinion is that the methimazole exposes our kitties to a few side effects that in some cases are irreversible!
As I always advise, pick a facility where they can do the scintigraphy as well, it is a very good tool to adjust the radioactive iodine therapy to the necessary level, rather than giving a random dose and see what happens.
 

neely

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As I always advise, pick a facility where they can do the scintigraphy as well, it is a very good tool to adjust the radioactive iodine therapy to the necessary level, rather than giving a random dose and see what happens.
Thank you for your concern and, yes, I agree that scintigraphy is extremely beneficial. :agree: I do have one question, did they do this procedure for Pallina with or without sedation? I'm sure I will have more questions along the way but for now I'm still reading and learning about his diagnosis as well as trying to get him over the hump from the Pancreatitis. Thanks again for your help, I sincerely appreciate it.
 
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FeebysOwner FeebysOwner I'm refreshing your thread because Carleton was diagnosed with Hyperthyroidism the end of this week. He has a moderate case of Pancreatitis which I was familiar with but the H-T took me by complete surprise. 😲 BTW, this was his first Senior Physical exam. I'm picking up a script for the Methimazole transdermal gel tomorrow. i take Carleton to a feline only specialty practice and the vet did discuss Radioactive Iodine Therapy with me. But it was a lot to process since I wasn't expecting this news. It was my decision to start with the transdermal gel first and then go from there depending on his bloodwork results in 3-4 wks. I'll be checking this thread on a regular basis now and look forward to other members' posts as well - Antonio65 Antonio65 , fionasmom fionasmom , ClaireandPanda ClaireandPanda
Sorry to hear about Carleton! It is most certainly a shock - other than weight loss, Feeby didn't have other signs. Although, oddly enough she was bordering on numbers that could have suggested pancreatitis as well. Not sure I have read anywhere about there being a connection, but now I am wondering.

She has been on the pill form of methimazole since mid-October and is due this month for a geriatric exam as well as a 3 month H-T check up following the ones she had in Nov & Dec. I still don't know what I will do about radioactive iodine therapy - I guess that is somewhat dependent on how her geriatric check up goes, as she is still having on-n-off 'selective' eating and after 3 months of stable weight, she is losing again.

I take it you have accessed, or will access, this site for additional information? Animal Endocrine Clinic | Where science and compassion cure.
 

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Thank you for your concern and, yes, I agree that scintigraphy is extremely beneficial. :agree: I do have one question, did they do this procedure for Pallina with or without sedation? I'm sure I will have more questions along the way but for now I'm still reading and learning about his diagnosis as well as trying to get him over the hump from the Pancreatitis. Thanks again for your help, I sincerely appreciate it.
I'm sure that the scintigraphy for Pallina was done with the sedation, mainly because it is necessary that the pet stands perfectly still, it's like an x-ray, or a CT scan, it's an image and it has to be as clear as possible.
What I presume is that for Pallina they sedated her, they did the scintigraphy while she was under, and right after that, following the assessment of the thyroid mass size, they injected the necessary amount of radioactive iodine, all in a row.

The timeline was as following:
-Saturday after lunch we (I and Pallina) left home, northbound, to Belgium, but we stopped halfway, as planned, at a hotel in France.
-Sunday, we left the hotel in France and drove north, up to Belgium, where we had our room booked in advance at a fancy hotel. We prepared for the following day.
-Monday at noon, medical visit with all the doctors involved. An IM doctor noticed a heart murmur and wanted to run an ultrasound (extra, not included in the estimation, but it was only €45 more). This ultrasound also revealed some fluids in Pallina's chest. This was going to put the entire procedure in question. The scintigraphy and I-131 injection should have been done on this Monday, but the results of these tests put everything on hold.
-Tuesday, they ran further tests and decided it was safe to go on, so they did the scintigraphy and injection around noon this day. So, everything was a day later than the initial schedule.
-Wednesday and Thursday, days when Pallina was in isolation at the facility. I couls only have updates on the phone.
-Friday, Pallina was discharged at 9:30 am, with all the papers and the things to do (and not to do) at home.

Then, a long drive (12 hours) back home, since we were in another country, 680 miles away.

If you have further question, I'm here for you.
 

neely

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I take it you have accessed, or will access, this site for additional information? Animal Endocrine Clinic | Where science and compassion cure.
Yes, already checked it out. Hopefully we can commiserate on whether to proceed with the radioactive iodine therapy, exams, bloodwork, etc. Fortunately our vet is on staff at one of the two facilities here that offers this type of therapy so should we decide to go that route she would be overseeing Carleton's treatment. I already had a sleepless night and I'm sure there will probably be others but it's so nice to have both your support and Antonio65 Antonio65 as well as other TCS members while going through this health issue. :touched:
 

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Don't panic about the thyroid. You have time to begin treatment with the gel and then make decisions from there. Fiona was on Felimazole for about 3 years as I recall and was dxed as an older cat. She took this orally in BFF food every day. She would not allow me to pill her, but the fact that it was crushed in food never seemed to make any difference to her treatment. At the time, no one discussed the radioactive treatment with me, which is the main reason I did not do it. Given I did not investigate it, I cannot say if Fiona would have been a candidate or not, but I assume that she might have been. If I had another cat with the condition, I would look into it.

Fiona had no obvious signs and it was caught on a routine blood panel. She was a fat little girl, in fact, when she was dxed....she had always been a good eater so appetite did not jump out and she was not drinking or urinating excessively.
 

neely

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Don't panic about the thyroid. You have time to begin treatment with the gel and then make decisions from there.
Thanks, I think I needed to hear that since I'm not an alarmist but like to research first in order to make what I feel is a well-informed decision. I don't want to rush into anything but also don't want to wait until any further damage is done. Next I will be looking into the two facilities that offer radioactive iodine therapy here so that I am prepared if and when the time comes.

In the meantime, I picked up the Methimazole transdermal gel this afternoon. The compound pharmacist had a consultation with me and I was pleasantly surprised that they put individual finger tips in with the prescription so I won't have to search for gloves. I was worried about the short supply due to Covid.
 
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Update on Feeby after 5 months on Methimazole at 1.25mg twice a day. Her T4 is 3.8 - up from a reading of 2.9 in December (normal range .08 - 4.0). The vet said it is a bit higher than he would like, but he doesn't want to increase her the dose at this point. I have mixed emotions about this, but I said OK. Other numbers:
  • Creatinine 1.8, down from 1.9 (normal range 0.6 - 2.4)
  • BUN 42, up from 38 (normal range 14 - 36)
The vet said he is less concerned with the BUN increase as he generally focuses more on the Creatinine level. I have to look more into this for my own education, but in part due to the following:

The Renal Tech Index status is Positive, which simply means that Feeby "will develop chronic kidney disease within the next 24 months with greater than 95% accuracy". The vet didn't mention this at all when he called me with her tests results, and I had not yet gotten my copy. Given that this index is based on several test result factors - all of which are within normal range besides the BUN, I take it to mean that this BUN reading alone is high enough to warrant the Positive Renal Tech Index status. So, I am not sure why Creatinine seems to be more important from my vet's perspective.

Any thoughts from any of you who were exposed to kidney issues after your cat was placed on H-T meds?
 

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This is not going to solve the question for either of us, but this is what happened with Jamie about a month ago at his last blood test to measure the BUN and creatinine. We have been doing this for quite some time, beginning with an ultrasound of the kidneys when he was about 2...he is going on 4 now. His last reading was BUN of 41 down from 42 and his creatinine was normal at 2.2. Then the vet brought up the Renal Tech Index status which she said that they are automatically including now on those tests but had not been doing this prediction earlier. I did not check to see if that is true or not. It said the same thing for Jamie...that within 24 months he will have kidney failure....now my vet did use the words kidney failure so I am not sure if they make a distinction between that and chronic kidney disease or if it even mean anything much different. Since nothing has added up on Jamie, we are proceeding with an echocardiogram next. My vet has remained more concerned about BUN than creatinine.

Jamie's thyroid is fine and they have ruled out hypothyroidism as a cause. Fiona was on Felimazole for several years but had no thyroid issues.
 
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fionasmom fionasmom - I do believe the Renal Tech Index is a more recently instituted prediction tool - my vet mentioned that to me just awhile back, and the first notation about it that I saw on the Antech lab results I get was last August. Did your test results actually use the words 'kidney failure' as opposed to 'kidney disease'? Mine specifically stated the latter. If so, that might tie to why in your case BUN is more crucial than Creatinine.

Tanya's website (felinecrf.org) has some 'interesting' information related to kidney function issues pertaining to BUN, Creatinine, etc. - and what can play a role when one or the other (or, both) are elevated.

There is another website referenced on Feeby's test results - iris-kidney.com (IRIS - International Renal Interest Society), but tbh, from what I have read so far, it made my brain hurt! They do include diagnosis, staging, & treatment, but I am still working on how to process all of that.
 

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I do have a copy of the IRIS information but it was very hard for me to apply. Yes, it made my brain hurt, too!

When I see Jamie's vet, I will ask her specifically about the RTI and if it said "failure". When she read it to me over the phone, I was taking notes and she did say "failure" so that might have to do with the BUN. His readings have been higher in the past, if this report followed those as well. So far, he has been an outlier. We do a test or ultrasound that we think will be conclusive about something and it shows nothing out of the normal.

I have been studying Tanya's website and next week have a list of food I am going to seek out and buy in person to see if he can change his diet from his beloved Fussie Cat Salmon or Applaws Ocean Fish.
 
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And, just so you know (from Tanya's site):
"You may also be frightened because your vet says your cat's kidneys have failed. Fortunately, this may also not be as bad as it sounds.

There are a number of different expressions used to describe chronic kidney disease. It used to be widely known as chronic renal failure (CRF), and for many years this website was known as Tanya's Comprehensive Guide to Feline Chronic Renal Failure.

I decided to change the name in 2011 and use the expression Chronic Kidney Disease (CKD) instead. This was for two reasons. Firstly, it is the term most commonly used in the academic literature. Secondly, I think it more accurately reflects the nature of the disease, and focuses on the important word, "chronic" rather than on that awful word, "failure", which tends to scare people, making them feel the end is nigh.

Chronic means that CKD is an ongoing disease. This is good news, because it means that in many cases it can be managed. For this reason, some vets prefer to use the word "insufficiency" for early stage cases instead.

Whatever expression your vet uses, try to focus on the chronic aspect of CKD."
 

neely

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Update on Feeby after 5 months on Methimazole at 1.25mg twice a day. Her T4 is 3.8 - up from a reading of 2.9 in December (normal range .08 - 4.0).
I'm sorry to hear that Feeby's T4 has increased from December. :hugs: I brought Carleton in for bloodwork yesterday after being on the transdermal form of Methimazole for one month. He is also on 1.25 mg twice p/day. His level dropped from 4.3 at the end of February when he was diagnosed to 2.4 now. This is all still new to me but I was very relieved that his number went down so I decided to keep him on the transdermal gel for now. She told me everything else in his bloodwork was normal so this would make him a good candidate for the I-131 treatment. My plan is to eventually have him get the I-131 but I need to save up for it first since the specialty center where I plan to bring him is very costly. We used them for our dog and although he did not have H-T they gave us 13 more years with him. I have the utmost respect for their knowledge and expertise.

Out of curiosity, are you going to have Feeby stay on the 1.25 mg dose twice a day or call and ask why he didn't increase it?
 
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His level dropped from 4.3 at the end of February when he was diagnosed to 2.4 now. This is all still new to me but I was very relieved that his number went down so I decided to keep him on the transdermal gel for now.
That is a good drop! Feeby went from 4.5 originally to 2.6 after a month on the meds. Then after 2 months, she went to 2.9 and now (5 months later) back up to 3.8. Hopefully, Carelton doesn't do the same! The thing I didn't ask the vet, but suspect it to be true is that as the tumor(s) grow(s) in size, the dosage does have to be increased. For Feeby's H-T to raise might mean her tumor size has increased.
Out of curiosity, are you going to have Feeby stay on the 1.25 mg dose twice a day or call and ask why he didn't increase it?
Even though we talked a long time on the phone, I don't think he or I were thinking 'out of the box' initially. He said, for the meds immediately available to him, it would mean doubling her dose, and he thought that was too drastic at this point. However, toward the end of the conversation he mentioned Wedgewood Pharmacy for different compounds (and, maybe dosages?). I told him I would look into that aspect. So, perhaps if I find out this pharmacy can compound in "in-between" doses, that might be an option.
 
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After a few days of driving myself nuts over the changes in Feeby's T4, BUN, and the Rental Tech Index being Positive, I've decided to forgo looking into anything other than possibly increasing her H-T dosage by a bit, for now.

I found a pill cutter that will enable me to cut her 2.5 mg pill into equal quarters. The H-T forum web site made a suggestion to increase one of her two daily doses to 1.875 mg and leave the other dose at 1.25 mg. Since, I can accomplish that now with the pill splitter and if the vet thinks it is a good idea, I will make the change. It's a middle ground between status quo and doubling her dose - which the vet didn't want to do.

I did look into the SDMA test based on some comments made on this site, and will talk to the vet about this test. While the articles I read do state that Creatinine is the primary marker used by vets regarding kidney function, they also state that Creatinine doesn't usually elevate much until kidney function has been reduced by nearly 75%. The SDMA will show losses in kidney function that exceed 40%. So, it would seem reasonable to think having this test done would be a prudent step.

EDIT: The vet just called me and said go with the adjusted dose as noted above. He said he isn't an advocate of running the SDMA given her age, and basically speaking other than putting her on a kidney diet there aren't a lot of other changes that can be made. He pointed out that she is a picky eater so there is no way to ensure she would even eat it - anymore than she will eat her old urinary tract food, which she rejected months ago.

He also noted the just about ALL cats by the age of 16 will test Positive on the Renal Tech Index, so he didn't find that aspect alarming either.
 
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I did look into the SDMA test based on some comments made on this site, and will talk to the vet about this test. While the articles I read do state that Creatinine is the primary marker used by vets regarding kidney function, they also state that Creatinine doesn't usually elevate much until kidney function has been reduced by nearly 75%. The SDMA will show losses in kidney function that exceed 40%. So, it would seem reasonable to think having this test done would be a prudent step.
My sweet Lola had CKD since the age of 6, but with the proper food and therapies, and love, I was able to keep her Creatinine and BUN level border line for years, till her death (4 years ago today).
Till when, at the age of 16, she was hospitalized for a heavy surgery, and the clinic wanted to run all possible tests before proceeding, and one of these tests was the SDMA (IDEXX), which I heard about a few months earlier, but never had the chance to have it done on Lola.
Her SDMA Index was 20 (range 0-14), when her Creatinine was 3.0 (max 1.9) and Bun was 65 (max 38). These last two lavels were higher than border line because she was coming from a terrible period of sickness for another disease. Right before this, and right after this her Crea and BUN were back to border line values.
So, yes, I think that the SDMA test is a valid method of diagnosis for CKD.
 
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So, yes, I think that the SDMA test is a valid method of diagnosis for CKD.
It sounds like it was used in your case to measure her levels during and after a serious illness - with the latter testing showing much better numbers? Am I correct in my understanding? In that case, I can understand the benefits of the testing.

I am not saying the test is not a valuable one. But, for Feeby, I don't think the vet thinks there is much point in testing her at her age, especially since she is not having any health issues aside from the H-T at this time. I personally think he feels that making dietary changes probably won't prolong her life by any measurable amount, and he really isn't a proponent of kidney food diets in terms of their actual overall benefits.

I do know he is up for other ideas I come across, so the H-T forum offered to provide me with some supplements that might be of benefit for Feeby, and I will look into those when they share them with me. As far as the phosphorus binders, I am still on the fence about whether or not to pursue them, even though the H-T forum thinks she should be on some. Another discussion for the vet and me to have somewhere down the line. Ditto for the SDMA.

What therapies did you give Lola?
 

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It sounds like it was used in your case to measure her levels during and after a serious illness - with the latter testing showing much better numbers? Am I correct in my understanding? In that case, I can understand the benefits of the testing.
Well, I think that the clinic where Lola was in just wanted to test all that was possible to test.
Upon hospitalizing her, I told them she had CKD, so I reckon they just wanted to play safe. They did all the possible tests, as I said, even those that weren't necessary, like the FIV and FeLV snap test. I say it wasn't necessary because I told them she tested negative years before, but they wanted to test her anyway and found out she tested positive to FIV, which was a huge surprise to me!
In this perspective, I think the SDMA test was just part of their routine for a new patient, especially if senior, especially if the owner had mentioned the CKD.

Her adrenal disease at those times was debilitating her a lot, and she was terribly dehydrated, so I think that those high kidney numbers were more related to her physical condition than to her CKD.

I am not saying the test is not a valuable one. But, for Feeby, I don't think the vet thinks there is much point in testing her at her age, especially since she is not having any health issues aside from the H-T at this time. I personally think he feels that making dietary changes probably won't prolong her life by any measurable amount, and he really isn't a proponent of kidney food diets in terms of their actual overall benefits.
Alright, but why is he contrary to testing Feeby? In the worst (best) case scenario, everything will be fine, he will say he was right, you/we were wrong. On the other hand, what if it turns out she has an underlying kidney condition?
This story remembers me when I told my vets that I was suspecting Pallina had a Pancreatitis, and asked them to test her, but they didn't want to. They kept saying that Pallina was fine, she had no clear symptom of the disease, I would have wasted my money on a useless test. I had to raise my voice, and it took me a long while to persuade them into having this test done. I remember they told me "You're wasting your money on an expensive test. Don't come tell us we didn't warn you".
Well, Pallina tested positive to the Pancreatitis, against all odds, and despite no classic symptoms were visible on her.

Sometimes vet should just listen to pets' owners and indulge their requests.

I do know he is up for other ideas I come across, so the H-T forum offered to provide me with some supplements that might be of benefit for Feeby, and I will look into those when they share them with me. As far as the phosphorus binders, I am still on the fence about whether or not to pursue them, even though the H-T forum thinks she should be on some. Another discussion for the vet and me to have somewhere down the line. Ditto for the SDMA.
I tried some phosphorus binders with Lola, but she refused to eat her food with that stuff in it. So we just fed her specific renal food.

What therapies did you give Lola?
For Lola's CKD the first thing the vet prescribed was the Fortekor 5mg, along with a change of diet from her usual food to renal food. A few months later she advised me to give her a Sub-Q every other day (120 ml of RL every second day), which I did for all her life. In her last couple of years I gave her these fluids every day (120 ml every day).
I also added some Vitamins B every day. I used to buy a supplement (human grade), it came in tablets that I would quarter and give her a quarter a day every morning after her first meal.
I also added a mix of probiotics. My aim was to try and replicate the Azodyl, a supplement easily found in the US, but not available in Europe. I had found a "recipe" made by a person who used to work in the pharma industry and that posted this solution on an Italian forum. So, I bought the human grade probiotics he advised, and I would mix them to make something that might resemble the Azodyl. This, too, was given Lola every morning.
In her last year I also gave her some Vitamin E, it came in a liquid form, in small vials, and I would mix a bit of it in her fluids twice a week.

Lots of love did help, I think, along with a great amount of luck. She lived with her CKD for over 10 years, and a few weeks before she died her levels were still border line.
The vets told me that they hadn't ever seen anything like that before. I was so proud of my sweet kitty!
 
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Alright, but why is he contrary to testing Feeby? In the worst (best) case scenario, everything will be fine, he will say he was right, you/we were wrong. On the other hand, what if it turns out she has an underlying kidney condition?
He would run the test if I told him I really wanted it done - I guess I am still in 'evaluation mode' for any changes that might be done to treat her for kidney issues.

Tbh, I think the vet believes she has some level of compromise to her kidney function, if for no other reason than her age (16+). And, I also think that he weighs her age very heavily into his opinion about what is or is not appropriate in terms of treatments for her.

Since the two meds you mention above are prescription only, they will be added to my list of discussion items with the vet. Thanks for sharing with me your regimen for Lola! All will be added to my notes about potential treatments/care for Feeby!
 
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