Newly Diagnosed Hyperthyroid

[Dos Gatos]

Forgive me if this gets long but I’m just trying to find if anyone else has experienced this (waiting for approval to join the H-T forum.) My 16yo cat Echo was recently diagnosed with hyperthyroid. Her level (I assume T4) was 13.1 which I was told was pretty high. All other bloodwork was normal except slightly elevated liver enzyme but I was told that often comes along with hyperthyroidism. We actually found out she was hyperthyroid “on accident” when she went to the vet for constipation, which has been a chronic struggle for her for half her life. She used to be 16 lbs but after a severe bout of colitis 3 years ago, she went down to about 12. Since sometime last year, I noticed her getting very thin but she was still eating and seemed happy. Because she gets so stressed at the vet, we decided at her age we would just leave her alone and sort of assumed her IBD possibly progressed to lymphoma. As long as she was happy and eating, we didn’t do anything (in hindsight, I feel horrible about this because she could have been diagnosed sooner.)

By the time she went to the vet 2 weeks ago, she was down to 8lbs. The diagnosis of H-T makes so much sense based on how she has been for the past 8-ish months (Hyper, restless, even more vocal than normal, some days ravenous.) Vet put her on 2.5mg metrimazole transdermal every 12 hours, which we started 6 days ago. She was fine the first few days but 2 days ago she started seeming a little lethargic, not eating much, and almost seems a little bit unsteady at times in her back legs. She still jumps up, demands attention, and is drinking but is just not herself. I’m mostly concerned about her not eating much since she is so painfully thin and can’t afford to lose more. I spoke to the vet office this morning and they said this could just be her thyroid level coming down but if we’re concerned we can bring her in. Would you bring her in or just wait a few days and see how she is? We have some appetite stimulant that we can give her to see if that helps. Thanks I’m advance for any advice you can give!

 

[Antonio65]

Hi Dos Gatos , and welcome to TCS.
I'm sorry to read about your cat diagnosed with HT.
You said you're waiting for approval to the HT forum, which I joined 4 years ago for my cat. One of the first things the people in that forum will tell you as soon as they learn your history is that the dosage your vet prescribed for your cat is too high, and they will advise you to lower it down to 1.25 mg twice a day. And I agree with them.
The lethargy you are noticing in your cat is very likely the consequence of the too high dosage.

If I were you, I would discuss with the vet about the possibility to have your cat treated with the I-131, radio-iodine, which is a one-off injection that will fix the problem for good. Of course your vet, or a specialist, will have to assess if your cat is a good candidate for the treatment, but if she is, then you'll be able to solve the issue once for all and your cat will live longer and happier.
The methimazole, the eargel you are using now, can only cope with the effects of the disease, it can't treat it. The disease will progress anyway, despite the treatment, and will involve more organs, while the methimazole will have some side effects on the system.

I recommend the I-131 treatment above all, it was one of the best things I did for my cats, and i would do it again if needed for a future cat.

 

[Dos Gatos]

Hi Dos Gatos , and welcome to TCS.
I'm sorry to read about your cat diagnosed with HT.
You said you're waiting for approval to the HT forum, which I joined 4 years ago for my cat. One of the first things the people in that forum will tell you as soon as they learn your history is that the dosage your vet prescribed for your cat is too high, and they will advise you to lower it down to 1.25 mg twice a day. And I agree with them.
The lethargy you are noticing in your cat is very likely the consequence of the too high dosage.

If I were you, I would discuss with the vet about the possibility to have your cat treated with the I-131, radio-iodine, which is a one-off injection that will fix the problem for good. Of course your vet, or a specialist, will have to assess if your cat is a good candidate for the treatment, but if she is, then you'll be able to solve the issue once for all and your cat will live longer and happier.
The methimazole, the eargel you are using now, can only cope with the effects of the disease, it can't treat it. The disease will progress anyway, despite the treatment, and will involve more organs, while the methimazole will have some side effects on the system.

I recommend the I-131 treatment above all, it was one of the best things I did for my cats, and i would do it again if needed for a future cat.

Thanks for your response! I will definitely ask the vet about lowering her dose. I was curious if her issues could be from too high of a dose.

I am interested in the I-131 therapy but have not been able to find anywhere near me that does it (east coast central FL.) Echo does not travel well at all so I am concerned about the stress for her having to drive a few hours. Also at 16, I’m not sure if she has any other illnesses going on that would possibly be life-limiting, making the high cost of therapy not worth it. I am pretty sure she has kidney issues that are going to be unmasked once her thyroid levels come down. Her kidney values were borderline high 3 years ago but now they are normal so I think they are artificially lower.

We are definitely wanting to do what is best for her, just trying to figure out what that is. I worry that maybe we caught the H-T too late and she can’t come back from it.

 

[FeebysOwner]

Hi. Feeby (16+ yo) was diagnosed last October. She was pretty asymptomatic, other than the weight loss (17.5 pounds down to 13.4 within a couple years), so we are not sure when her actual H-T kicked in. She too may now be exhibiting some signs of kidney issues as well. Technically, there is no 'coming back' from H-T, it is a matter of getting it under control, monitoring for kidney/other related issues, and determining if she is a good candidate for radio iodine. Coming back from H-T can only be accomplished with the radio iodine treatment. I am still on the fence about how to treat Feeby long term...

I could go through her whole story, but what I really wanted to do by reaching out to you is to ask if you checked with the VCA Hospital network? There are 4 along the east coast from Ormond Beach to New Smyrna Beach - although they may not all offer the radio iodine treatment. There is another VCA practically down the street from me (south Seminole County) that I do know offers it. I live in Winter Park, just north of Orlando. Find A Hospital - VCA Animal Hospitals (vcahospitals.com)

The key is to get her T-4 within acceptable range, monitoring her at the 3 week mark after starting meds, then again in 4 more weeks, and so on, depending what her numbers look like. I do know that her H-T needs to be stabilized before moving on to radio iodine, as I am sure you are already aware - it sounds like you've done a fair amount of research.

The H-T forum will be very helpful in answering your questions and discussing associated issues with the meds and related health factors.

 

[Antonio65]

She can definitely come out of her HT, regardless her age and level of disease. The facility where they can do the I-131 will also adjust the dosage of radio-iodine according to the level required.
Make sure that the facility you will find/choose has the in-house scintigraphy test capability. This test is key to adjust the level of radio-iodine that suites Echo's needs.

As for other diseases she can have, only a thorough visit and test can tell you that.
My cat was 16 at the time of her treatment, had an IBD, she was coming out of a pancreatitis, she was developing a cholangio-hepatitis (which we found out later on), had a border line CKD and at the facility where she received her radio-iodine they found out a mysterious chest issue.
Nonetheless, they concluded she was a good candidate and she was treated perfectly, she came out of her HT a few months after the treatment.

I am not able to suggest you any facility near to you. I'm Italian, live in Italy and we don't have any facility for this in our country. I drove up to Belgium, over 600 miles north (12 hours drive). It was long, but it was absolutely worth it.

 

[Dos Gatos]

Hi. Feeby (16+ yo) was diagnosed last October. She was pretty asymptomatic, other than the weight loss (17.5 pounds down to 13.4 within a couple years), so we are not sure when her actual H-T kicked in. She too may now be exhibiting some signs of kidney issues as well. Technically, there is no 'coming back' from H-T, it is a matter of getting it under control, monitoring for kidney/other related issues, and determining if she is a good candidate for radio iodine. Coming back from H-T can only be accomplished with the radio iodine treatment. I am still on the fence about how to treat Feeby long term...

I could go through her whole story, but what I really wanted to do by reaching out to you is to ask if you checked with the VCA Hospital network? There are 4 along the east coast from Ormond Beach to New Smyrna Beach - although they may not all offer the radio iodine treatment. There is another VCA practically down the street from me (south Seminole County) that I do know offers it. I live in Winter Park, just north of Orlando. Find A Hospital - VCA Animal Hospitals (vcahospitals.com)

The key is to get her T-4 within acceptable range, monitoring her at the 3 week mark after starting meds, then again in 4 more weeks, and so on, depending what her numbers look like. I do know that her H-T needs to be stabilized before moving on to radio iodine, as I am sure you are already aware - it sounds like you've done a fair amount of research.

The H-T forum will be very helpful in answering your questions and discussing associated issues with the meds and related health factors.

So far Winter Park is the closest I-131 facility I have found to me (I am in Melbourne.) I am going to try the appetite stimulant today to see if I can get her eating more and then will call the vet back tomorrow to see about getting her back there just to check her out. The last time she was there 2 weeks ago, they were just trying to treat her constipation and we agreed to do a senior blood panel. She probably needs to be checked out more thoroughly. I just feel like her recent symptoms must be due to the medication since they started a few days after starting the med. I was really hoping we would avoid side effects with the transdermal but I guess a dose that is too high could have adverse effects on her.

 

[fionasmom]

Fiona herself was hyperthyridic. She took oral Felimazole 1.25 twice a day. She did not do the iodine treatment but I would not discourage anyone from looking into it. I was not overly informed about it at the time which was a big part of the reason we did not proceed. However, I do/did talk to Dechra on a somewhat regular basis as my dog uses one of their products. The tablets do come in the 1.25 dosage; however, it is generally accepted that if you are going to do the transdermal approach that you will need the higher dose as they factor in mitigating circumstances such as another pet licks some off, etc. Almost as if they think it might not absorb so you need to go higher but if you used a pill you would be sure the cat got it. They do recommend the 2.5 dosage, as does a lot of veterinary literature, so stand your ground when you ask about the dosage being reduced or questioned which I definitely would do. Fiona had no side effects at all except the one where I had to buy her expensive wet food so that she would swallow the pill. She would never have allowed transdermal, so it was a moot point.

 

[WMM201]

Hi Dos Gatos . Sorry to hear that your cat has been diagnosed with H-T, and that she isn't having a good appetite. My cat was diagnosed in March, and I just want to say that the H-T forum many people here have suggested has been great. Based on their advice, I asked my vet to lower Mumu's methimazole ear gel dosage to 1.25 mg twice daily (total of 2.5 mg daily), and that has been effective for her so far. You may need to keep playing with the dosage, but it's better to add more meds than to have a kitty be hypothyroid (with the lethargy and lack of appetite that comes with it), because that is much harder on their kidneys. Good luck!!