Newly Diagnosed Hyperthyroid

[FeebysOwner]

I'd keep your current course before introducing some other med/treatment for gas. It still sounds like he wants to eat when he wants to eat. I'd try as hard as you can to make sure he has food available to him 24/7 (or close to it anyway). The fact he howled, you fed him, and he went back to sleep said he was hungry.

P.S. Good on the 'no vomiting'!!! Let's hope it keeps up!

 

[mommytobuck]

So we are on day 9 since a throw up. And actually my cat has gained .2 lbs. Yesterday I did get stuck out of the house for 8 hours and didn't plan ahead and yet, didn't see any throw up when I got home. Though he let me know he was hungry.

Starting to wonder. I mean I am just not that "with it" that I can stave off throw ups by my action -- especially when he was throwing up every 72 hours before - and I am wondering if something else happened.

- Perhaps it really is related to fur? My cat's belly was shaved for the ultrasound. Though it is only about 1/4th of his total fur, it is fur that he has the most access to with his tongue. I.e. he might have a lot of fur on his backside but he can't reach it easily. Also I purchased those "fur gloves" and have been combing him daily (he really likes it and purrs loudly). But it is very difficult for me to comb his belly (he is sensitive) so likely that is an area that didn't get touched ever.

- Change of food / dish. I cleaned his dish and put in new food. Perhaps the old foods were causing problems? This new kitten food (Meow Mix) is really one of the only things I changed. I had cleaned his dish before so... not sure about that but perhaps the food in the dish. He loves the Meow mix so much he eats every last bite.

 

[FeebysOwner]

It could be one of those options above, or as you thought before the Meloxicam, or actually a combination of all of them!

On the off chance the belly hair does have something to do with it, try to do one small, light stroke somewhere on his belly area in the middle of your glove brushing sessions. Maybe over time, you can start to get him used to it enough to eventually allow you to groom his whole belly!

Whatever it is/was, let's hope he keeps up his 'streak'!

 

[Caannes]

know it’s really frustrating when you’re worried about you kitty and can’t get results or answers. I hope things either improve with your vet or you find a new one. I also hope kitty gets better soon.
I admit to being a bit confused about what exactly his labs were and when in relation to his starting felimazole. But my 2 cents any way. I’m not a vet but am an MD whose cat was recently diagnosed as hyperthyroid and treated with methimazole during lockdown, then I131 over last Christmas (oh, I’d love to have you as houseguests but I’ve got a radioactive cat ).
Ppl may be mistaking methimazole 5mg tablets with felimazole 2.5 mg coated tablets. Several vets I spoke with and papers I read concurred with your vet (and mine) who said 2.5 twice a day was a starting dose. That said, my boy ended up only needing 1.25 twice a day. Methimazole is much cheaper and a tablet easily cut in quarters. The positive thing about felimazole (from what I can see) is at 2.5 and coated, the average pet parent doesn’t need to be splitting pills and wearing gloves (or being very good at hand washing) like with methimazole (because you don’t want to accidentally get it in your mouth). Back to dosing. I gave him the 2.5 twice a day until his follow up test and then we adjusted it down a bit. By the end of a year his numbers were creeping up and had he stayed on methimazole I could see he might eventually be on 2.5. I strongly urge people not to decide doses on their own. Even as an MD I do as my vet says, and if I strongly disagree I look for a new vet while still giving the dose prescribed.
Hyperthyroid cats behave a lot like you describe. I know if my boy (even before being hyper) got too hungry he would throw up. Once I started him on methimazole he had to take it with food or he’d throw up.
kidney disease can be masked by hyperthyroidism, and untreated it can worsen kidney disease and cause heart problems. That part is correct and if anyones interested I can explain the boring medical reasons.
as for his age and i131–from the cats point of view it’s like going to the vet and staying there a couple of nights—no anesthesia. Your vet can go over all the pros and cons of just doing methimazole (felimazole) or the i131.
good luck!

 

[mommytobuck]

I strongly urge people not to decide doses on their own. Even as an MD I do as my vet says, and if I strongly disagree I look for a new vet while still giving the dose prescribed.

I think my boy is a little bit "hyper" but now I have had a chance to do some reading and multiple sources do not call for treatment at the point my cats labs are at now. There is so much on the internet about possible fluctuations in the thyroid results that I don't think I can justify it. But we will see. His T4 was 2.7 (in the middle) and his Free T4 was 58. Just slightly above normal. All the information I have seen on the net tells me that the free T4 should be much higher to diagnose hyperthyroid with a normal (but even gray area) T4.

Unfortunately this vet has over diagnosed my cat in the past so I have reason not to trust, when I get another over diagnosis.

The good news is that my pet insurance initially denied all his claims but now is paying them so hopefully I take him for a follow up in about 6 months. With a new vet. If at that time the numbers have gone up I will treat.

But bad news... my cat did throw up last night. But good news.. he did go over 11 days without a throw up. That is a milestone. He has throw up 4x for the entire month. I he continues to go about 11 days or longer we may be ok. But if not, I will have to visit a new vet earlier.

 

[Caannes]

Was he on felimazole when the T4 was 2.7, and what is the normal range for both that and the FT4?

 

[mommytobuck]

Was he on felimazole when the T4 was 2.7, and what is the normal range for both that and the FT4?

No he was on no drugs.

T 4 -- Normal level is 1.0 to 4.0 (my cat's score 2.7)
Free T4 Normal is 10-50. (my cat's score 2.8).

 

[FeebysOwner]

His T4 was 2.7 (in the middle) and his Free T4 was 58. Just slightly above normal. All the information I have seen on the net tells me that the free T4 should be much higher to diagnose hyperthyroid with a normal (but even gray area) T4.

A T-4 of 2.7 - with or without the H-T meds - is actually a reasonable reading. How long did he take the H-T meds? Do you have him on H-T meds now? Sorry, just need a refresher from you on this!
One thing I want to point out about the free T-4 - that test is really only of value BEFORE any meds are ever given, and in conjunction with the T-4 at the time of 'diagnosis'. After that, the free T-4 is no longer used as a proper gauge for assessing hyper-T. So, if Buckwheat had been on meds at some point before that free T-4 was taken, it essentially renders the number worthless.

Having said all that, Buckwheat doesn't appear to need H-T meds, just monitoring for it - and the next testing should be no more than 6 months beyond the last testing.

But bad news... my cat did throw up last night. But good news.. he did go over 11 days without a throw up. That is a milestone. He has throw up 4x for the entire month. I he continues to go about 11 days or longer we may be ok.

Let's just hope he starts the streak all over again! It may not be that he will ever stop entirely, so don't get too concerned just yet!

 

[mommytobuck]

So, if Buckwheat had been on meds at some point before that free T-4 was taken, it essentially renders the number worthless.

He was not on any drugs for Hyperthyroid when he got the blood tests. The vet gave me drugs.. I gave him 1 pill... (2.5mg) and stopped when it appeared to be too high. He has been drug free since then.

So I just feel with those numbers the throwing up is unlikely to be related to that.

He does have some symptoms that make me wonder, such as I find his claws thicker at the base... and of course... the weight loss and muscle loss, but I am a big believer in "first do no harm" and I think I should hold off until you can clearly see a problem.

 

[FeebysOwner]

He was not on any drugs for Hyperthyroid when he got the blood tests. So I just feel with those numbers the throwing up is unlikely to be related to that....He does have some symptoms that make me wonder, such as I find his claws thicker at the base... and of course... the weight loss and muscle loss, but I am a big believer in "first do no harm" and I think I should hold off until you can clearly see a problem.

If he had not been on any meds when those tests were done, then the vet really should have told you what I said - "let's re-check in six months". IMO, recommending meds with those numbers was premature.

In so far as the thicker claws - pretty common in older cats. You can search for information on your own, as opposed to taking my word for it. And you can do the same regarding weight loss and muscle mass loss - also common in older cats. They alone are not really good enough reasons to believe there is a health issue - beside aging - going on with your cat.

I think your biggest issue to follow is the vomiting - if it picks back up, and if hair is always involved, you really do need to look at natural remedies to try to help him with that. Things like I think were previously suggested to you - a dab of butter/margarine for him to lick from his paw or your finger or a drop or two of olive oil/fish oil in his food - a couple times a week. That along with regular brushing of course. And, after brushings, sometimes it helps to use unscented, hypo-allergenic wipes to 'finish off' hair removal.

Some also suggest adding a tsp of pumpkin to his food as added fiber which seems to help a cat's digestive tract better process hair. So, if other simple options don't work, you could give this one a go.

 

[Caannes]

I assume by “not on meds” you mean he’d never been on methimazole Or felimazole prior to the labs. Being on those meds during or prior affects both T4 and FT4.

I’m not a vet but in the species I treat, FT4 is much more accurate than T4. So I can see if FT4 is elevated and he has signs of hyperthyroidism the inclination to call it that. I could also understand wanting to wait a month or two and repeating tests (as long as he’s doing well), sooner if he changes. If at some point he was on methimazole/felimazole that alters the waiting time.

But it sounded like maybe two different vets told you he’s hyperthyroid? At any rate, in the species I treat we don’t mess around “watching” hyperthyroidism for very long because of the risk to the cardiovascular system as it goes untreated.

good luck finding a cause, treatment, and a vet you can trust. I’m so blessed in the one I have

 

[mommytobuck]

I think your biggest issue to follow is the vomiting - if it picks back up, and if hair is always involved, you really do need to look at natural remedies to try to help him with that.

I feel like a detective.

The thing is... I have tried all the remedies for hair balls... for some time now (September at least) Pumpkin, Cat Lax, other Hair ball remedies... and I never saw benefit. Hair is always involved in the throwing up but it is so slight. As if it is hair the cat consumed right before throwing up. Like the hair got in the way of the throw up.

On the other hand, I feel like it is a big clue, that he went 11 days without throwing up after having his belly shaved, there is just less there for him to intake. Thought that might not mean anything as I saw someone who's cat had Feline Lymphoma who actually shaved their cat to avoid the throwing up (thinking it was hairballs) only to have them start throwing up without any hair. I have said for a while whatever it is seems to build up.. and when it reaches a critical point... he throws up.

I continue to be on the side of some IBD / possible slow growing lymphoma... etc. But people have told me that aging itself can cause more hair balls because of loss of motility and there is some evidence of that as my cat rarely eats his entire food at one go.

This is leading me to wonder if perhaps the dose of these remedies -- Cat Lax etc.. butter needs to be increased... or doubled.. perhaps in giving them the dose listed for the normal cat ... my cat needs more?

 

[mommytobuck]

I assume by “not on meds” you mean he’d never been on methimazole Or felimazole prior to the labs. Being on those meds during or prior affects both T4 and FT4.

Yes that is what I mean.

I have one vet I saw while the other one was out. They are in the same practice. They are backing each other up. I don't think that is a surprise. But both are in the same practice.

Hyperthyroidism in cats: should we be routinely testing for early diagnosis?

The most commonly used laboratory test to confirm a diagnosis is the determination of serum total T4 concentration. Free T4 testing has also been used, but is less suited as a screening test due to elevated levels in some euthyroid cats giving a false positive reading (Norsworthy et al, 2002). Thus free T4 levels can only be interpreted in conjunction with total T4 levels that are above the reference range to confirm hyperthyroidism (Scott-Moncrieff, 2012).

 

[Caannes]

Yes that is what I mean.

I have one vet I saw while the other one was out. They are in the same practice. They are backing each other up. I don't think that is a surprise. But both are in the same practice.

Hyperthyroidism in cats: should we be routinely testing for early diagnosis?

He did the FT4 at the same time as the T4?
Are these the only two vets in your area?


so was your kitty ever on hyperthyroid meds? If so for how long and how long ago? Regardless, whatever the cause it needs to be sorted out. I hope you can find a vet not too far away. In the meantime I hope he gets better

 

[FeebysOwner]

I feel like a detective...Hair is always involved in the throwing up but it is so slight. As if it is hair the cat consumed right before throwing up. Like the hair got in the way of the throw up...This is leading me to wonder if perhaps the dose of these remedies -- Cat Lax etc.. butter needs to be increased... or doubled.. perhaps in giving them the dose listed for the normal cat ... my cat needs more?

I am quite sure that many cat owners feel like detectives at some point in time, and the older a cat gets, the more that seems to be the case - sans conclusive evidence of a health problem.
There is no 'standard dose' for things like butter or olive oil - it is part detective work in that it requires experimentation. I cannot imagine that a dab of butter a day, or a couple of drops of olive oil per day would be too much. If that doesn't seem to keep the hairball related vomits at bay, then add some more, and so on. It is always best to 'start low and then increase slow(ly)'.

Btw, since you mentioned IBD/lymphoma again, did you ever receive the detailed report of the ultrasound results? What you provided previously sounded like a simple summation, not with the normal detail that is traditional of an ultrasound report.

 

[mommytobuck]

so was your kitty ever on hyperthyroid meds? If so for how long and how long ago? Regardless, whatever the cause it needs to be sorted out. I hope you can find a vet not too far away. In the meantime I hope he gets better

No. Never on hyperthyroid meds. I do plan on going to another vet in about 6 months from now. Though I don't hold out hope. I have had about 6 vets for my cat and I thought they all sucked. If I followed whatever they said without question my cat would likely be dead by now. 100% my cat has made it 16 years due to my persnickety nature and the internet.

What you provided previously sounded like a simple summation, not with the normal detail that is traditional of an ultrasound report.

No but I didn't know there was more detail. But they were supposed to get back to me with a quote for a biopsy of the lymph nodes.. and they haven't.

 

[Caannes]

I went back and reread the entire chain (without cats helping from my lap this time). If I understand, Buckwheat had weight loss, vomiting, and normal T4, which was followed by a FT4 (I assume bc he had HT symptoms but a nml T4) which came back at 58 with upper limits of nml being 50. He was started on felimazole 2.5 twice a day three wks ago but only took two doses. He had an US that showed some lymph node abnormalities (possible infection vs cancer), but you are trying to decide about doing a FNA bc you’re not sure you’d treat if cancer.
I think you definitely need a vet you can trust to help you with your decisions re next steps in testing and treatment. In the meantime I’m hoping buckwheat’s tummy does better and praying for his full recovery.

 

[FeebysOwner]

No but I didn't know there was more detail. But they were supposed to get back to me with a quote for a biopsy of the lymph nodes.. and they haven't.

Ask if there is a more detailed report - there really should be one that includes comments about all the organs seen in the abdominal ultrasound - 'remarkable' or not. And the summation you received is very vague about these 'nodes'. Nodes where? Although, later the summation suggests they might be related to the GI tract, because that is where they mention possible biopsy, they also make no other remarks about the GI tract. If one assumes that nothing mentioned means they found nothing else notable, then it would seem other than these nodes, the intestinal tract looks fine???

And, no - NOT for a biopsy, but rather for a follow-up ultrasound including FNA (fine needle aspiration) cytology. You don't want a biopsy as that is invasive surgery.

 

[mommytobuck]

Ask if there is a more detailed report - there really should be one that includes comments about all the organs seen in the abdominal ultrasound - 'remarkable' or not. And the summation you received is very vague about these 'nodes'. Nodes where? Although, later the summation suggests they might be related to the GI tract, because that is where they mention possible biopsy, they also make no other remarks about the GI tract. If one assumes that nothing mentioned means they found nothing else notable, then it would seem other than these nodes, the intestinal tract looks fine???And, no - NOT for a biopsy, but rather for a follow-up ultrasound including FNA (fine needle aspiration) cytology. You don't want a biopsy as that is invasive surgery.

Sorry there must be some lost in the weeks break..

1. I did get a detailed report, reporting on every single organ. Each organ has sentence report. The vast majority of those are perfectly normal. The only organ that was abnormal was his kidneys. But still nothing that screams CRF.

2. The final summary says

Other:
- Ileo-colic nodes are mildly enlarged and mottled with hyperechoic omentum adjacent

Abdominal Assessment:
- Kidneys: r/o chronic degenerative disease vs acute on chronic. Infiltrate possible though not classic for lymphoma
- Nodes: r/o marked inflammatory vs early infiltrated

Plan - Abdominal:
- GI and node biopsies would likely be needed for definitive diagnosis
- Monitor renal values over time
- If aggressive lymphoma suspected clinically, could attempt FNA of nodes and kidneys under anesthesia but cytology is less useful for small cell lymphoma/inflammatory disease;

3. Yes sorry I am still waiting for them to give be a quote on the FNA of "nodes".

4. Upon questioning about this very confusing report my vet said

The nodes are enlarged but without looking at the cells inside, we do not know why. The can be enlarged due to local inflammation, but cancer is a potential. Lymphoma is a cancer of the lymph node systems but there can also be cancer there spreading from somewhere else. What he means about the action items is if the cat is showing signs of Lymphoma, and technically weight loss and vomiting could be signs (but vague and from other diseases as well).
I can put together an estimate for the cytology vs the biopsy.
We did a lot of answers from the tests to rule out certain things, so that is really good. Diagnostics are always a process of elimination.

 

[Caannes]

Unfortunately (as I often tell my relatives asking me about their radiology results)—X-rays and ultrasounds aren’t 100% diagnostic. No matter what it looks like on films you need a piece of it “in a pan” to send to the lab for the final answer, otherwise it’s a best guess. So there’s no way to tell from these particular results—but on the positive side they don’t show other abdominal tumors, for instance. Open (surgical) biopsy carries more risk than a needle biopsy with Ultrasound…but needle biopsies can miss getting the piece of tissue most needed. That’s a risk-benefit analysis to do for all three options: no test, FNA, or open biopsy, that you need to do with a vet you trust, keeping in mind (as it seems you have) the age and other health problems of Buckwheat and what you’d do differently with the results.
wishing you the best