Pallina, Hyperthyroid Cat

[buffy2011]

Hi everybody,
Meet Pallina, my cat. Her name might sound funny to a not Italian ear, but over here it's a rather common name for a femal cat, it means "Little Ball". She's 16 yo, I found her on a freezing morning in January 2002 and took her home. My idea was to finding her a good home but, as you can imagine, I didn't find it.
View attachment 181420
In this picture you can see her, the photo is 5 years old, but she's just the same.

She's always been in a very good health, her trips to the vet were for the vaccines only and for blood checks once or twice a year.

Her appetite had always been very good, she would eat so much that she was round, as her name would lead you to think. Her weight was around 10 to 11 lbs (4.8 to 5.2 kg), she was round and soft.

Then last year in May, I noticed she was eating less and less and her weight was obviously decreasing. It was when Lola, my other cat who now is at the Rainbow Bridge, was very sick from a rare disease.
Pallina is a very sensible cat, I thought she was sensing the dramatic situation and was losing her appetite.
But when Lola bounced back to a very good condition in the two months before the surgery, Pallina was still going down, so I took her to the vet that ran a blood test and an ultrasound scan. He found a cholangitis and a slight inflammation of the upper tract of the digestive system, so his diagnosis was of hyperthyroidism. This first diagnosis was confirmed by the blood test with the thyroid levels above the high range. Her weight was down to 8.4 lbs (3.8 kg)
It was quite a surprise to me, because all her symptoms were opposite to the hyperthyroidism. She was eating less, she was quieter, sometimes lethargic, not aggressive, no diarrhea and no faster heartbeat.
The vet told me that Pallina has a not common form of hyper-T, called Apathetic Hyperthyroidism.

She was put on Methimazole in tablets, 1.25 mg twice a day, but after 5 weeks we repeated the blood test and found out that she was having troubles with her kidneys, likely related to the medicine. The thyroid levels dropped a lot, so the vet adjusted the dose to 0.625 mg of Methimazole twice a day. The pill I was giving her is 5 mg and tiny, I had to break it into 8 pieces, a close to impossible mission. Because of this imprecision the thyroid levels were going to move up again, the vets decided to switch the therapy to the transdermal gel.
This is working fine, the application is precise and easier to administer.

During those months her appetite was deteriorating and she started eating less and less and vomiting more often. We had another ultrasound scan done and the inflammation of the liver area had increased. They also found a diffused inflammation of duodenum.
I asked the vets to run a test for pancreatitis. At first they refused because Pallina had no symptoms of it and the test is an expensive one, but I insisted and they did it. The test was positive for pancreatitis, Pallina was given a shot of Convenia and that was all.

We scheduled a visit with a nutritionist and the doctor stated that Pallina has an intolerance to some ingredients and protein, so her diet was changed to a protein that she had never eaten before (pork) and the carbohydrates quota was replaced with a small amount of boiled amaranth seeds.

Pallina liked this new diet, she started eating not less than two 80 g cans a day and her weight was going to increase. She wasn't vomiting anymore.
Then, all of a sudden, on a morning of two weeks ago she refused to eat her wet food and for the whole day she just nibbled it. I thought it was just a "no" day for her, but the issue repeated three more times in the last two weeks. Furthermore she started vomiting again, but she isn't vomiting food as it happened in the past, just gastric juices, as it happens when a cat has their stomach empty. Despite the hunger and the vomiting, she wouldn't eat her food.
Then, on the following day, everything is fine again.

I can't understand what's going on, neither can the vets. Her weight has now dropped to 6.6 lbs (3.0 kg).
All this vomiting of juices is also dehydrating her. She drinks a lot (the only clear sign of a hyperthyroidism), about 100 ml on average.
Other than this, she is rather lively, alert and active.
In the last days she has become a lot more talkative, opposite to her usual being silent and discreet.

Since the beginning of this story in last summer I told the vet that my intention was to have Pallina treated with the I-131 therapy.
Unfortunately this country is backdated, our legislation does not allow veterinary clinics to handle and dispose of this radioactive material, so in this medieval country we can't treat a hyper-T cat unless we go abroad.
In Europe there is a number of clinics that can do that, at different protocols and prices.
I asked the vets to gather information about those clinics, I gave them plenty of time to do that, but after many months I'm still in the dark and I had to look for bits of information on my own and I have finally found two clinics where the treatment can be done to the highest and most modern protocols.
Only one of the two can be directly accessed by the pet owner, the other one is a referral clinic and they don't deal with others than the vets.

I sent an email to the first clinic and am waiting for a reply.
What I would like to understand is why she has an intermittent appetite and sometimes she refuses the food that she liked a lot a few hours before.
I would also like to read experiences from other people who had the same problem with their cat, treatments, solutions, outcomes.

Thanks so much for the bottom of my heart.

Hello, I just had my cat to the vets for vomiting and drinking a lot and eating like a pig. The thoughts were hyperthyroidism but I had extra blood work done and she said the numbers were high but she doesn't have it. So right now were are trying to find out if it is a food allergy. But my main reason for answering your post is because if my cat had the hyperthyroidism I was going to do the I-131 radioactive therapy, because the vet told me giving your cat the Methimazole causes all kinds of problems. And it sounds like that's where your problems are coming from. This medicine works on all the other organs and makes problems. I really hope you can get your cat the therapy. Good Luck.

 

[Antonio65]

Hi everybody!
We're home!!! Two days earlier than we expected.
Pallina has been discharged from the clinic this morning at 9:30.
I thought to do the same thing as one week ago, to split the journey in two and have a stop halfway. But because I left early from the clinic and I wasn't too tired, I drove straight to home, 1070 km in 12 hours!
It was a long drive but it was worth it
This way I saved a night in a hotel, a dinner, a breakfast and a lunch.

Pallina is doing fine, she's happy to be home, but she's a bit confused. The first thing she did was drinking 150 ml of water altogether with an empty stomach, so she vomited all the water 10 minutes later
Now she's asking for some water and doesn't want to eat... I left her very little water in her bowl, I'm afraid she will drink only and vomit afterwards.

She lost 60 g of weight since Monday and 200 g in a week... Hopefully now that she's back home she will gain some weight.
We'll have a check on her level in 4 weeks time.

The doctor this morning explained me the aftercare, but she also told me that all the precautions in the guideline are for an extreme safety measure, and even if we don't follow them strictly we will receive little or no harm.
Before discharging Pallina they checked her radiation level with a Geiger counter and it's 20 times lower than the maximum level allowed by local laws. The doctor said it's going down very quickly and probably the two-week safety period is even too long, but better safe than sorry.

I was the first Italian to go to that clinic ever, and as far as I know probably one of the few in the whole country to have done such a thing.

I'll keep you updated in the next few days

 

[Antonio65]

The post above was sent 24h ago, but it appeared just now... I wonder why.
I'm very disappointed, I spent 15 minutes writing it rather than taking care of Pallina and going to bed.
I'm very disappointed!

 

[babiesmom5]

All here were wondering, a bit worried we had not heard, but thought no news was probably good news. We are just glad all of you are now home safely. You all need to rest!

Yes, 1070 km in 12 hours was quite a haul, but for the best to get Pallina home quicker.
Years ago, to beat a bad snowstorm heading north, we drove straight home from Florida, a total of 1710 km in one stretch with a diabetic cat. We stopped at Kentucky Fried Chicken for dinner and ate in the car in order to share it with our cat. She loved it!

I think Pallina perhaps felt dehydrated from the trip and gorged on water. You don't want her to throw up however. Would a shot of Cerenia settle her stomach? You could ask your Vet.

No doubt Pallina was under a lot of stress, both from the trip and the clinic. She welcomes the familiar environment of home again and being with family. Hopefully she will begin to regain the weight she lost with love and encouragement from you.

That is commendable that you were a pioneer from your country for the I-131 treatment! Perhaps you can share your experience with your fellow Italian cat lovers. No doubt there are many Italian cats who could benefit.

All here wish Pallina a full and speedy recovery. Cats send purrs!

 

[Kitten70]

Antonio,
Just wanted to let you know I have been following Pallina's progress. I was captivated by your Lola story since I discover this forum recently and so I am now with Pallina's story! I am very happy everything went well and you are back home. You and Pallina are in my thoughts.

 

[Antonio65]

Years ago, to beat a bad snowstorm heading north, we drove straight home from Florida, a total of 1710 km in one stretch with a diabetic cat. We stopped at Kentucky Fried Chicken for dinner and ate in the car in order to share it with our cat. She loved it!

I imagine how hard it was for you to drive over 1,000 miles in one stretch... especially when your speed limits are much lower than hours.
I was at 130-140 km/h (80-87 mls/h) on the highways. How long did you take for such a long trip?

I think Pallina perhaps felt dehydrated from the trip and gorged on water. You don't want her to throw up however. Would a shot of Cerenia settle her stomach? You could ask your Vet.

She didn't throw up anymore. She just filled her empty stomach with at least 200 ml of water in one shot. During the trip back home I would stop every couple of hours to see if she was thirsty. In one or two occasions she was terribly thirsty.
My opinion is that they never gave her water in the week she was at the clinic. I wouldn't explain such a crave for water. But how can I be sure of that? I don't think I can ask them about it...

That is commendable that you were a pioneer from your country for the I-131 treatment! Perhaps you can share your experience with your fellow Italian cat lovers. No doubt there are many Italian cats who could benefit.

I would probably share my experience with other people if I have the chance, but I don't think I'm going to explain my vets what I have done because they left me alone in this issue. They never gave me a bit of help. I had to find the info, I had to find the clinic, I had to take contacts with them and arrange the needed blood tests and the trip and all the rest. All my efforts to have my vets involved failed. So why should I explain or teach them?

 

[Antonio65]

Antonio,
Just wanted to let you know I have been following Pallina's progress. I was captivated by your Lola story since I discover this forum recently and so I am now with Pallina's story! I am very happy everything went well and you are back home. You and Pallina are in my thoughts.

Kitten70 ,
thanks for your encouraging words and for following me!
This forum is no doubt the best ever, we all feel like a family and the others' stories are like ours.
I'll keep you all updated about it.
I'm also going to write a more detailed report of what I did and saw up there.

 

[Antonio65]

Hello, I just had my cat to the vets for vomiting and drinking a lot and eating like a pig. The thoughts were hyperthyroidism but I had extra blood work done and she said the numbers were high but she doesn't have it. So right now were are trying to find out if it is a food allergy. But my main reason for answering your post is because if my cat had the hyperthyroidism I was going to do the I-131 radioactive therapy, because the vet told me giving your cat the Methimazole causes all kinds of problems. And it sounds like that's where your problems are coming from. This medicine works on all the other organs and makes problems. I really hope you can get your cat the therapy. Good Luck.

B buffy2011 ,
Luckily we received the therapy and hopefully things will be better in the near future.
I hope your cat will be soon diagnosed for his/her troubles. Intolerance or allergies are hard to spot and treat. And it takes time to understand whether we are on the right path.

I wonder why your vet said your cat doesn't have a hyper-T though the blood works say the levels are high. If I were you I would see another vet for a second opinion. The thyroid is important, any delay in the diagnose and treatment can lead to other troubles.

 

[babiesmom5]

Our trip north took about 18 hours. We arrived home at 3 am and just beat the snowstorm. When we awoke the next morning, there was over a foot of snow on the ground! This trip was made with the cat who later got the I-131 treatment.

We hope Pallina is relaxing and relieving stress. Perhaps they did not give Pallina enough water at the clinic to reduce the amount of radioactive cat urine waste they would have to discard? You will never know, and you cannot ask. You got her back safely; now she can have plenty of water, food and whatever she needs in the comfort of home.

I can understand your reluctance to share the information about the clinic with your vet, but here is another thought. Another innocent hyperthyroid cat, who has a responsible caring parent like you willing to travel and bear the cost may ask their vet for information and if your vet could tell them of your experience, another cat may be cured...thanks to you.

I am surprised of the reluctance of vets in Italy to recommend the I-131. Why do you think that is? Pallina is very lucky to have a loving parent who researched this procedure. Pallina has no doubt expressed her appreciation to you!

Lots of healing thoughts for Pallina are being sent!

 

[Antonio65]

Perhaps they did not give Pallina enough water at the clinic to reduce the amount of radioactive cat urine waste they would have to discard?

Well, I think that with the 400+ cats cured every year it could be a problem for them to take in account.

I am surprised of the reluctance of vets in Italy to recommend the I-131. Why do you think that is? Pallina is very lucky to have a loving parent who researched this procedure. Pallina has no doubt expressed her appreciation to you!

It's not reluctance, it's ignorance.
They know nothing, they don't think they need to get informed because nobody will ever ask them anything like that. People don't even know that this possibility exists.
One of the times I asked them for this treatment they said that in 30+ years of experience in their job I was the first one willing to venture in such an ordeal.
Thinking of spending a thousand euro for the treatment of a cat is generally out of discussion for the average owner. A vet bill of 150 euro is seen as exceptional.
I spent in excess of 10,000 euro in less than a year to try to save my sweet Lola and I would have spent twice as much if necessary, but all the vets I met so far told me I am one in a billion. In their life-long experience, 99.99% of people would let their pets die rather than drying their bank accounts out.
Furthermore, going abroad involves that people have to speak in another language other than Italian. Over here the knowledge of a foreign language is equal to null. It's rare that an Italian person would speak English or French fluently. The language barrier would be enough to discourage anybody to arrange a trip abroad, especially when the terms needed to sustain a conversation are specifically medical.

 

[Antonio65]

A week is gone. My God, it seems yesterday that I was up there in Belgium. I still have those places in my eyes

Another week to go under special management, though I haven't been very diligent to the rules they gave me, I touch her a lot and don't wash my hands every time or I would live in the bathroom. Furthermore she rubs on my legs often, I should shower several times a day.
For good measure I will behave according to the "warning mode" until the end of the month.

Pallina is doing fine. There are days when she's hungrier than in others, but I think that it mostly depends on the outside temperature. Today is hot here (31°C / 88 °F) and she's quieter.

In three weeks time we'll run a new blood test to check whether her thyroid levels have gone down a bit, I do hope so, I feel so scared...
We'll also run an ultrasound as requested by the IM doctors in Belgium to understand more about those fluids in Pallina's chest.

 

[Moonli]

Hi, Antonio

How is Pallina?
We live in France and until June 20st had two cats. Moonli died from intestinal lymphoma just shy of her 17th birthday.
We miss her very much.

She had i131 treatment in Paris a year and a half ago. She was first treated with felimazole but couldn't handle it. She almost died because of it. Although radio iodine treatment exists here, I had to go through the same ordeal than you and find my way there all by myself. I really wish I had done it before (she was diagnosed 4 years ago} because it probably would have made a difference in the sense that hyperthyroidism basically destroys every organ.
But in Paris they keep the cats for three weeks and I think it is very stressful, especially on an older cat.
Now, my other cat, 17 too, has been diagnosed hyperthyroid too after a total T4 test. I still need to have this confirmed with palpation but I am not very optimistic.

This is why I wanted to have your feedback on this clinic in Belgium although your Pallina has to be retested before she can be considered out of trouble. It takes at least three months to know if a cat is euthyroid.
I wanted to know how long you stayed there and how much it cost you for tests and i131 shot and if you had any advice.

BTW. the keeping you informed thing didn't work well here either: They kept telling me she was doing fine but when I got her back she looked like a skeleton and was all smelly and scruffy. I did see the main doctor, though. who was both very competent and a fine man.

But three weeks is too long. Dr Peterson who is the american expert explains very well why it is unnecessary.
Especially when you know that humans with much higher doses walk home the same day...
Best

 

[Antonio65]

Hi, Antonio
How is Pallina?

Hi M Moonli ,
Pallina is rather fine, thanks for asking!
Just like you write, we have to wait for the first check-up visit and probably the second in November before knowing what the trend is.

We live in France and until June 20st had two cats. Moonli died from intestinal lymphoma just shy of her 17th birthday.
We miss her very much.

I'm very sorry for that, I know your pain very well

Although radio iodine treatment exists here, I had to go through the same ordeal than you and find my way there all by myself. I really wish I had done it before (she was diagnosed 4 years ago} because it probably would have made a difference in the sense that hyperthyroidism basically destroys every organ.

I know how hard on other organs the hyper-t is, that's why I wanted to begin this treatment as soon as possible. Just like yours, my vets were deaf.

This is why I wanted to have your feedback on this clinic in Belgium although your Pallina has to be retested before she can be considered out of trouble. It takes at least three months to know if a cat is euthyroid.
I wanted to know how long you stayed there and how much it cost you for tests and i131 shot and if you had any advice.

The clinic itself is rather good, not exceptionally clean because they treat many different ailments for many different animals, cows and horses included.
But the staff were kind and competent. They asked me everything about Pallina, they wanted to know every single detail. But they were probably too hasty in taking notes because the report they returned to me contains some errors.
They give cats a dose of I-131 proportionate to the thyroid damage, so if things go as planned the cat shouldn't become hypothyroid.
Pallina was admitted on Monday 7th at noon (the appointment was at 9 am!), she was visited, she had an chest ultrasound because they heard a slight heart murmur. The ultrasound revealed a little amount of free fluid around her heart. This issue has to be reviewed during the next visit at my vets' on Sept 11th.
Because of this problem the vets ran some more tests on that Monday. The scintigraphy and I-131 injection scheduled for that morning were then postponed to the next day, on Tuesday. This delay, though, didn't change anything in the discharge that was on Friday morning around 9:30 am.
So in all she stayed there a little fewer than 5 days, Monday at noon to Friday at 9:30 am.
She was fine at the discharge, she had lost 100 grams of weight, but this was expected, she doesn't adapt to new environments easily. Overall she was fine and nice.

The estimated cost was 900 euro, but because of extra ultrasound scans and X-ray the final cost raised to around 955 euro.
On the morning of the admission there were more people from other parts of Europe, all told me that they were there because of lower costs compared to other countries. One person was there for the second time, she had another cat treated two years before and that cat was now fine!

The advice they gave me was not to cuddle her for long time during the day, to touch her only for a few minutes a day and always wash hands afterwards. Not to let her sleep or curl on us (but she never did that).
I had to store the dirty litter from her tray of the first two weeks in a different bin a little away from the house and not to dispose of that litter for at least three months to allow the radiation to die out. The advice was to wear disposable gloves during the cleaning of the tray and wash hands afterwards.

As a matter of fact the litter thing was the only advice I followed. I let Pallina come close to me and rub against me as long as she wanted. Probably I risked too much, but I didn't want to leave her alone for such a long time.

If you need to know something else do not hesitate.
Take care!

 

[Moonli]

Hi, Antonio

Thank you so much for your quick answer!
I am glad that Pallina is doing fine. She has to go through the hypo phase until her thyroid works again. Then, she'll be her good self all over again.

They all lose some weight because of the heavy discharge of thyroid hormone due to the tumor being destroyed by iodine 131. It also is a strain on their heart which is probably why they did an ultrasound to Pallina: They did one to Moonli too.
Her heart murmur disappeared after treatment. so did her bronchitis and recurrent otitis. And that was a relief!

I'll get in touch with the clinic to see what they require/accept from previous vets as far as tests go.
5 days is so much better than the three weeks we get here! For the costs, the tests are more expensive here, not the actual shot and 3 weeks stay that cost 800€. We paid 1200€ total.

It is good to be able to exchange on this here: I wonder how I would have done if the net didn't exist... I had to contact Dr Peterson in New York to get Dr Rosenberg contact in Paris and actually demand a referral from the vet down the street!

Talking about best kept secret...

Best

 

[Antonio65]

I think that it's time for a bit of an update

On Sept 11 Pallina had a blood test done, on the the next day she had an ultrasound scan for her abdomen and chest.
When she was admitted at the clinic in Belgium the vets noticed a slight heart murmur and a thorax scan revealed some free fluid around her lungs and heart.

The scan done on Sept 12 found a good abdomen, much better than some months ago, the GI tract is fine, so I could think that the new diet is doing a great job in keeping her inflammation under control.
But there were still fluids in her chest. The vet aspirated all the fluid with a big syringe and it was 55 ml of fluid. It was orange/pinkish in color. A sample of fluid was sent to the lab that returned with a report of many lymphocytes diffused in it.
The advice they gave me was to do nothing, just repeat the test at the end of this month with a new chest scan.
I weighed Pallina on Sept 12, when we returned from the vet, her weight was 2.870 kg (6 lbs 5.3 oz)

The blood works were fine. Her liver levels have much improved though they aren't good yet. Creatinine and BUN have improved a lot. This is strange. The vets in Belgium told me that I should have seen a worsening in that department and that I had to expect the creatinine to go over 3.0 after the treatment. It was 2.3 at the end of July, 10 days prior to the radioiodine, now it's 1.7.
The fT4 level is now 10 (range 5-20 pml/l), was 30.7 before our trip to Belgium.
The T4 level is now 12.9 (19-65 nml/l), was 124. This low level of T4 must be something of expected, it seems.

I have sent all reports to the vets in Belgium 10 days ago, I'm still waiting a comment from them.

Yesterday we had the follow-up ultrasound scan, as required.
Pallina's heart is fine, not enlarged. There's a hint of a murmur but not to the extent of being worrying, it's so faint and almost invisible.
But her chest was full of fluid again. They drew about 105 ml of fluid this time, it's a lot of fluid, nearly twice as much as the last time, and it was apparently pressing on her lungs.
According to the vet this amount of fluid should have made her breathing difficult, but I didn't notice any difficulty, neither did the vet both with his eyes and with the instruments. So this is strange.
The fluid was orange/pinkish and murky, cloudy, as the other time.

This ruled out that the fluid originates from a heart disease or failure. Her heart is fine and perfect. In the case of a heart failure the fluid would have been clearer, nearly transparent.

The vet also measured the specific weight of the fluid, which is 1.025. This ruled out the FIP that would have given a heavier fluid. Furthermore Pallina has absolutely no symptoms of any kind.

So this would leave us with a probable diagnosis of lymphoma, but the vet didn't see any enlarged lymph node. He only saw a slightly larger lymph node in the mediastinum of Pallina's chest, but the vet says that its small size does not justify the fluid in her chest. So they can't determine what's going on!
A sample of this fluid was saved for testing. I had to take it to the lab myself to make sure I can have the report tonight around 8 pm.

The vet told me not to worry. The last time a vet told me not to worry I began a long nightmare with an oral squamous cell carcinoma for Lola!

Any decision will be taken after reading the report.

Pallina is still doing fine, I see no bad signs or strange behaviour. She eats two 85g can of wet food a day, she eats avidly like never in the past 15 months, she drinks regularly, uses her litter normally and she's lively and active. She shows no pain or discomfort. As I said earlier, she has never shown any difficulty at breathing, she sleeps fine. Apparently everything is fine.
She hasn't vomited anything since we came home from Belgium.
I weighed her yesterday, before going to the vet, she was 3.170 kg, but when I weighed upon returning home she was down to 3.070 kg (due to the fluid drawn from her chest), so she's gained 200 grams in 16 days. This sounds good.

I hope to have a proper answer to this issue!
The vet told me "do not wrap your head in bandages before you break it", a typical saying in this part of the world, meaning "do not worry for something that hasn't happened yet".

Do you have any idea or comment on this?
Any idea of what this fluid might be? Or what we should do now?
Thanks!

 

[babiesmom5]

While I am happy to hear that Pallina is much improved as result of the I-131, I am so sorry that now there are fresh worries re the fluid. Sometimes with our kitties, it's one thing after another; you get one thing solved and another issue crops up. You feel jerked...almost like you have whiplash!

I don't have answers, but know you will stay on top of it. I hope fervently that the fluid turns out to be of no concern. Meanwhile, give Pallina a hug from me. Baby Light, sitting on my lap right now sends warm purrs to Pallina.

 

[Antonio65]

Update
Ten days ago Pallina had another blood test to check on her levels. It was 90 days since the I-131, so we did what I was requested.

She had an ultrasound chest scan to see if the fluids in her chest were still there, and they were. The doctor drained it and sent it to the labs. I'll will write about this in my other thread.

The blood works weren't too good, this time.
Her liver levels have worsened a lot. Creatinine and BUN have increased a bit. The vet thinks that the diuretic that Pallina is taking since early October could have had effects on her kidneys, so he prescribed a different med.

ALT 336 [10-60] , was 284 in September
ALP 239 [10-150] , was 204
GGT 34 [0-10] , was 3
Creatinine 2 [0.5-2.0] , was 1.7
BUN 41 [10-30] , was 22

Despite these numbers, Pallina is doing rather fine. She has been eating her usual 160 grams of wet food (always the same kind), she is her usual, visits the litter tray regularly. She is still taking her supplement for the liver, I can't understand why her liver levels went so high.

The fT4 level is now 6.08 (range 5-20 pml/l), was 10 in September, was 30.7 before our trip to Belgium.
The T4 level is still <12.9 (19-65 nml/l), like in September, was 124 in July. The T4 is very low, we don't know how much. The machine can't read levels below 12.9.

According to these levels Pallina should HYPOthyroid now, I still don't know if this an expected effect of the therapy or if something went wrong. However she shows no signs whatsoever.
I had sent the results to the Belgium doctors both in September and now, but I haven't received a reply yet.

Any suggestion or thought will be greatly appreciated!

 

[babiesmom5]

Cats can develop what is called "iatrogenic hypothyroid" after radioiodine treatment. Generally, the serum T4 values in cats with iatrogenic hypothyroidism are already low by 1 month after I-131 treatment and stay low thereafter. Most of these hypothyroid cats become quite symptomatic by 3-6 months.

Cats can also develop what is called "transient hypothyroidism" after I-131. This usually resolves in 1-3 months after treatment. Therefore one has to wait at least 3 months before evaluating the cat for permanent iatrogenic hypothyroid. If permanent, then the cat has to be given thyroid hormone supplement.

At this point, you do not know if the hypothyroidism is just temporary or permanent. I have found a good article which discussed this topic. You may wish to share with your vet.
Hope this is some help.

http://www.wvvma.org/wp-content/uploads/2016/04/Feline-IatrogenicHypothyroidism.pdf

 

[Antonio65]

Thanks B babiesmom5 , I think this is the reason why the vet at the Belgian clinic asked me to run test at 30, 90, 180 days after the treatment.
So far we should still be in the fuzzy phase of the post-therapy, hopefully in February we should know something more.

Today Pallina has been feeling better, she ate 3 cans of food!
Of course it's all thanks to cypro and ranitidine, and things could reverse when I stop the meds. I think I will keep the pills and shots until the end of this week.
As from tomorrow I will try and reduce the dose of cypro, from 1/4 pill to 1/8 pill and see if it's still working.

I have browsed through the link you gave me, looks very interesting. Tomorrow I will look into it more thoroughly... it's 11:15 pm over here

 

[Antonio65]

A bit of an update for this thread too.

I asked my vets to have Pallina checked for her thyroid even if we weren't in the due time.
Next test should have been done in February, but the last two tests gave back strange results, numbers that would say that Pallina might have been HYPO-thyroid.
My vets don't know much about post I-131, the vets in Belgium did not reply to my emails until a few days before Christmas and told me they would have gotten back to me in the first week of January. And I'm still waiting...

This time I asked my vets to have the serum checked at two different labs to make sure that the numbers were right.
One of the labs should have been their regular external lab (so we could have a comparison with past tests), the other one had to be chosen among very reputable labs and they chose one that I know as highly reliable.

Pallina had her blood taken on last Monday, Jan 8th. Yesterday I receveid the report from the new lab, an hour ago the report from the regular lab.

New Lab
T4 = 1.67 ug/dl [0.9-3.45 non hyperT / 3.45-5.0 slightly hyperT / >5 severe hyperT]
fT4 = 13.40 pmol/l [5.4-25.5 non hyperT / 25.5-40.0 slightly hyperT / >40 severe hyperT]
Canine TSH = 0.10 ng/ml

Regular Lab
T4 = 15.4 nanomol/l [19-65]
fT4 = 12.3 pmol/l [5-20]

The vet told me that the fT4 is very similar in both lab, so he has considered the two labs as equivalent.
The T4 is expressed in two different ways. The vet told me that he has converted the nanomol/l to ug/dl and 15.4 became something around 1.34. It appears that seen as "15.5 nanomol/l" it is lower than the range, but transformed into "1.34 ug/dl" it is in range, weird, though.
It seems there's no way to validate the TSH for cats, so all labs refer to Canine TSH, and given that Pallina's TSH is very low, this means that she couldn't be considered HYPO.
However the vet told me that we can definitely consider Pallina as euthyroid and he was pleased to have this cross check between the two labs done, in order to assess the reliability of them both. He thanked me for the opportunity I gave him.

It seems that the trip to Belgium was very well worth it!