Hyperthyroidism in Feeby - Questions

WMM201

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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.

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?
Just wanted to add little more information about SDMA bloodwork from my own CKD, hyperthyroid kitty experience, in case it helps you, FeebysOwner FeebysOwner . My cat is probably around 9 years old, and she was diagnosed with CKD (IRIS stage II) based on her bloodwork after a period of illness that her vet believes was a CKD "crash". For kidney bloodwork, my vet always includes the SDMA as part of the monitoring. It's not something I even ask for. I do believe her practice uses IDEXX tests and labs as part of their regular diagnostics, and the SDMA test is proprietary to IDEXX. So, for Mumu's most recent bloodwork, her BUN and creatinine levels were quite good, in the middle of normal, but her SDMA was right at 14, the highest end of what is considered normal (her highest reading had been 20). So based on that, the vet is making sure that Mumu keeps drinking her water and other good things for kidney support. Having that SDMA reading is a nice additional piece of information for the vet to monitor for a fuller picture of the CKD progress, I think, but obviously there are other numbers that you and your vet already have also.
 

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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!
In "my days" Fortekor didn't require a prescription... at least, I can't remember I would need it. It seems to me that I would just walk in the pharmacy and asked for it. I might be wrong, though. I see that now I would need it, I just checked.

All the rest are supplements, the Azodyl too is a supplement, and I'm sure supplements don't require a prescription, at least not here, but it might be different in the US.
I also found out that now the Azodyl is available in Europe too. Good to know that.
 
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FeebysOwner

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This information is probably only useful for those who have a cat with a high phosphorus count, like Feeby.

The low phosphorus food search has pretty much been a bust so far. But, I did find a more recent type of phosphorus control being used - niacinamide - a specific form of vitamin B3 that is not a binder but works by blocking the uptake of phosphorus instead. It seems it is starting to be thought of as a good alternative to the binders that have been more commonly used. One of the H-T forum members shared an article with me about it and I thought I would share it with all of you. Disregard the article's headline title that suggests the information is somehow related only to cats on raw food diets.
 

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Antonio65

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This information is probably only useful for those who have a cat with a high phosphorus count, like Feeby.

The low phosphorus food search has pretty much been a bust so far. But, I did find a more recent type of phosphorus control being used - niacinamide - a specific form of vitamin B3 that is not a binder but works by blocking the uptake of phosphorus instead. It seems it is starting to be thought of as a good alternative to the binders that have been more commonly used. One of the H-T forum members shared an article with me about it and I thought I would share it with all of you. Disregard the article's headline title that suggests the information is somehow related only to cats on raw food diets.
When I had to deal with the CKD in my cat Lola, one of the supplements I would give daily was a mix of Vitamins B, so the B3 was in the mix. I had read that this complex of Vitamins was good to reduce the absorption of toxins, but now I read that the phosphorus as well can be blocked, so I did a good thing.
I recently learnt that Vitamin B3 in the form of Nicotinamide, along with Chaga Mushroom powder, is suggested in the therapy for FIP during the administration of the GS drugs.
 
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FeebysOwner

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I haven't had the chance to have a full dialog with Feeby's primary vet, but did speak with her back up vet today. Feeby had tests done on Tuesday, and her BUN and Creatinine are increasing. The creatinine now 2.8 from 1.8 a month ago (range 0.6 - 2.4) which from what I can recall actually puts her in the upper range of Stage 2 of kidney disease, per felinecrf.com & IRIS. She could even be in Stage 3 according to IRIS if there were SDMA numbers available. But, the H-T forum members don't seem to think SDMA is all that reliable, and neither does my vet. As a side note, her phosphorus level is down a bit, but not within the range that the H-T forum folks think is more appropriate for her age.

What happens at this point? What do I need to investigate so I can be prepared to ask the right questions of her vet next week?

I guess I am a bit overwhelmed right at this moment, probably need to take a step back, and re-read information from the above referenced web site. I haven't even gone back through this thread to collect information.

I guess I am just kind of lost - none of this should be, nor really is it, a surprise, and yet I feel stunned.
 
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neely

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I guess I am just kind of lost - none of this should be, nor really is it, a surprise, and yet I feel stunned.
I don't have any answers to your questions but I also talked to Carleton's vet this week regarding how long he can/should stay on the Methimazole. We will have to repeat bloodwork although not yet and check his urine. I go back and forth with my concerns too and the more I read the more questions I have. It sounds like you have a good relationship with your vet and back-up vet so I hope they can offer some guidance for Feeby. 🤗
 
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FeebysOwner

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I don't have any answers to your questions but I also talked to Carleton's vet this week regarding how long he can/should stay on the Methimazole.
Thanks. As far as I know the H-T is almost kind of a separate issue anymore. Going through radio-iodine won't resolve the kidney issue - from what I know at this point it wouldn't change or reverse the kidney problems. I just need to better understand when they say H-T masks kidney issues - do they mean that the kidney issues already exist but are hidden in test results because of what H-T does to the numbers. I don't know. I thought I knew more than I feel like I really know.
 
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Another update for those who might be having the same/similar issue. For years and years now, Feeby has had bouts of e-coli bacteria in her bladder. I've come to find out that UTIs of this kind - and, others as well - can increase creatinine. And, apparently cats with hyperthyroidism and/or kidney issues are pre-disposed to UTIs.

Feeby's case is a bit backwards though, so I will have to ask the vet about the timing. She was on an antibiotic for about 12 days after her 3/23 bloodwork showed a high level of bacteria in her urine - her creatinine was 1.8 at that time. Her last bloodwork (5/11) still shows bacteria in her urine - but, less than before, yet her creatinine jumped to 2.8. The H-T forum group thinks such a drastic increase in her creatinine in just over a month would seem to indicate a connection to the bladder bacteria. I have also joined the CKD forum and am in the midst of asking them about this too. If/when I get additional information/thoughts/opinions from them, I will share them here.

I am guessing that she will be put back on antibiotics - probably for a much longer period of time - to see if the bacteria can be reduced, and perhaps see her creatinine level decrease a bit. So, it looks like she will be getting more blood/UA testing long before I had expected to have to put her through it again. :( In the meantime, I will continue on with the D-Mannose as well.
 

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Another update for those who might be having the same/similar issue. For years and years now, Feeby has had bouts of e-coli bacteria in her bladder. I've come to find out that UTIs of this kind - and, others as well - can increase creatinine. And, apparently cats with hyperthyroidism and/or kidney issues are pre-disposed to UTIs.
As far as I know, an infection in the bladder can go up to the kidneys and cause damages, hence the increase of the creatinine.
My sweet Lola had an early CKD (she started having the first symptoms at the age of 6), and what I noticed later in her life was that she was prone to cystitis twice a year, always in the same months of the year, but all tests were always clear, and it was clearly an idiopathic cystitis, so, it seems it was the other way round, but anyway she had to be treated someway.
 

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Feeby had tests done on Tuesday, and her BUN and Creatinine are increasing. The creatinine now 2.8 from 1.8 a month ago (range 0.6 - 2.4)
For years and years now, Feeby has had bouts of e-coli bacteria in her bladder. I've come to find out that UTIs of this kind - and, others as well - can increase creatinine. And, apparently cats with hyperthyroidism and/or kidney issues are pre-disposed to UTIs.
You know I had a kidney scare with my Hima recently. Her CREA was 2.0 when her BUN and phosphorus were well within the normal range. Three weeks later crea was down to 1.4 mg too. That's also when I learned several different things can increase creatinine temporarily. And that it should be especially suspected if the elevation is less than 1mg than the normal range. We have always heard BUN being more reactive to things like dehydration and it's true but apparently it's also not uncommon CREA reacting. (In fact the first time I heard about it was from someone I follow on Instagram. Her Siamese cat had a bit increased crea to normal bun, they all freaked out Siamese being prone to CKD, but there was nothing wrong with kidneys and the number was presumed to be a reaction to dehydaration / fasting / stress which can all temporarily increase CREA. You're right also UTI. I suspect Hima could have had UTI before the first test as she was often not going out to the yard at nights as she normally did so at least was going 10-11 hours without peeing. But it's also possible the boiled turkey breast pieces I gave the day before the test increased her crea. (She fasted for 9 hours before the test and her last boiled turkey breast was hours before that.) On the day her crea was normal, I didn't give her almost any meat as a treat that week. If you also give meat as treats, it might make a difference not to before the next test.

A good vet once told me CKD shouldn't be diagnosed without ultrasound of kidneys + urine test, in addition to the blood test. SDMA is cheaper than ultrasound and less stressful for the cat, so if the elevation is mild, in Turkey they first go with SDMA and re-check BUN/crea couple weeks later.
 
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As far as I know, an infection in the bladder can go up to the kidneys and cause damages, hence the increase of the creatinine.
I haven't yet read that the infection has to reach the kidneys before creatinine will be affected. From what I have been able to glean so far, even an infection that resides in the bladder can impact creatinine. But, I am still reading up on what I can find.
A good vet once told me CKD shouldn't be diagnosed without ultrasound of kidneys + urine test, in addition to the blood test. SDMA is cheaper than ultrasound and less stressful for the cat, so if the elevation is mild, in Turkey they first go with SDMA and re-check BUN/crea couple weeks later.
MY vet is not an advocate of SDMA, nor actually is the H-T forum group - I don't know yet about what opinion is held by those in the CKD forum group. I know my vet explained it, but apparently I didn't digest the information thoroughly, so I continue to research the pros & cons of SDMA to see if I can figure it out. While I haven't had the SDMA run as of this time, the BUN/creatinine have been checked 5 times since her H-T diagnosis. She had held steady with the creatinine until this last check when it jumped to drastically - so far most folks (including you) seem to think there is a another underlying cause - other than kidney function - for the big change.
 

Antonio65

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I haven't yet read that the infection has to reach the kidneys before creatinine will be affected. From what I have been able to glean so far, even an infection that resides in the bladder can impact creatinine. But, I am still reading up on what I can find.
So, may it be that the infection enters the system through other ways and it alters the creatinine?
 
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So, may it be that the infection enters the system through other ways and it alters the creatinine?
That is what I am still trying to figure out!!! I am hoping to begin to get some attention from the CKD forum (seems to be slow going so far with them) and see if they have some thoughts. I sure hope there are other reasons than the infection reaching Feeby's kidneys - from I know at this point, that is a lot harder to treat than bladder infections.
 

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That is what I am still trying to figure out!!! I am hoping to begin to get some attention from the CKD forum (seems to be slow going so far with them) and see if they have some thoughts. I sure hope there are other reasons than the infection reaching Feeby's kidneys - from I know at this point, that is a lot harder to treat than bladder infections.
Yes, a kidney infection is hard to treat and rather dangerous. Even in humans.
 

WMM201

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Thanks. As far as I know the H-T is almost kind of a separate issue anymore. Going through radio-iodine won't resolve the kidney issue - from what I know at this point it wouldn't change or reverse the kidney problems. I just need to better understand when they say H-T masks kidney issues - do they mean that the kidney issues already exist but are hidden in test results because of what H-T does to the numbers. I don't know. I thought I knew more than I feel like I really know.
Hi FeebysOwner FeebysOwner . I was just on the phone with the radioiodine technician at Ohio State plus my own vet this week about Mumu's HT, and the thing about unmasking kidney disease is that when the T4 is under control, the kidneys come down from its HT hypermetabolic state. That hypermetabolic state was pushing way more fluids through the kidneys than normal metabolism, making the filtration rate related numbers look better in blood tests than they actually would in normal circumstances. So once the body is back to normal metabolism with controlled HT, the actual filtration ability of the kidneys is revealed, or unmasked. If the cat has kidney disease, you'd see it accurately now with the kidneys performing at their actual capacity. Treating the HT isn't harming the kidneys; the damage is already done and the disease would progress.
 
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Yes, dangerous. It might even be, in the worst case scenario, life threatening, or giving you permanent damages. I had an experience in the family.
Well, if it has happened, it has happened. We will just have to deal with whatever comes.
 
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