Steroid problems with hyperthyroid/renal disease cat

[Ryamllad]

Hello, our girl Olga is about 18 years old. Just over four years ago, she was diagnosed with hyperthyroidism. She was denied radiation treatment due to her renal values. She has done well despite her diseases up until the past year. Since then, she's had chronic infections, has lost significant weight and muscle mass, and in the past month her interests revolve around food, water, and us. Her bloodwork has shown her thyroid levels closer to normal than they have been in a long time, but her kidney values have deteriorated rapidly. Since she also shows signs of possible lymphoma, our vet recommended a low dose of steroids.

Keeping in mind that this is only day 3, so far she seems miserable. She paces around, making sad yowling cries, wanders from dish to dish, and can't seem to rest. She is still eating and drinking plenty. I guess what drew me to this site is that I don't know if I want to continue the steroids, or just bump up her methimazole, which we'd started before the steroids. I've kept her at the lowest amount I could get away with over the years and again, she has done well up until the past year.

I know her time with us is limited and 18 is a respectable age for a cat. We've always followed her lead. But should we keep with the steroids since she seems so unhappy since we started them? It seems counterintuitive to her well being watching her go through this with a new medication meant to make her remaining time more comfortable.

Our vet is wonderful, but will be on vacation this week.

Thanks for any advice or past experience!

 

[Furballsmom]

But should we keep with the steroids since she seems so unhappy since we started them? It seems counterintuitive to her well being watching her go through this with a new medication meant to make her remaining time more comfortable.

If this were my boy, (and it may well be in the not too distant future), I would see about increasing the methimazole. I'm not familiar with steroids, --is there any chance that her body would become more accustomed to it? I'm not clear, what are the steroids intended to accomplish?

 

[mrsgreenjeens]

If her thyroid values are near normal, why would you want to increase the methimazole? It's her kidney values that are out of whack, correct? Additionally, the steroids tend to lower immunity, so if she's been having more infections, seems to me using steroid will make the infections even worse. I get that if she has Lymphoma the steroids might help, but that is a guess, not a diagnosis, correct?

So, are you doing anything for her kidney issues? I think it's wonderful that she is still eating because that's usually the first thing that wanes with kidney disease. Wonder why the weight loss and muscle wasting if she is eating well and her hyperthyroidism is under control? Is she getting enough protein in her food? I assume she is eating a well balanced diet? Did they check her for diabetes as well as everything else? Just asking, not assuming anything. But I'm thinking they ran a complete blood panel which should show glucose.

I know you said your Vet is on vacation, but is there someone else there at the practice next week? Steroids aren't something you can just stop, they need to be taped off. Not sure if three days is ok to cut off or still need to be tapered, but I would definitely think you should talk to a Vet at the practice and let them know how she is reacting.

 

[Ryamllad]

Thanks for the replies! She has been on a renal diet for years now. We also have been giving her fluids every other day or so at home.
Her thyroid levels had bumped up slightly in the last bloodwork panel, and they never were as low as they would be ideally, so the vet had suggested bumping the methimazole and agreed it was a good move. We were hoping the steroids were going to help her gain weight, lower any inflammation and muscular discomfort she is experiencing, and slow the progress of the lymphoma - which her past bloodwork has indicated. (I'm sorry if I wasn't thorough enough in my original post!) As always, having a pet uncomfortable makes me uncomfortable! We're just doing the best we can and as long as she is interested in staying around we want to help her. Which she's been pretty good up until a sharp decline in the spring and so far this summer.

 

[Ryamllad]

It seems a direct reaction to the steroids that she is wandering around, looking confused, and making horrible, sad sounds. We were asked to monitor her breathing, which has been normal so far. Since we started out on a really low dose, I'm hopeful that if I can taper off and maybe give a very tiny does tomorrow she might be all right. I can try to call another vet tomorrow.

 

[FeebysOwner]

Hi. What struck me was your comment about her interests being around food (and water and her family). This is typically a prime symptom of hyperthyroidism. Howling, pacing, wandering are also typical symptoms. What are her chemistry panel values and her T-4? Those would help to know as to whether they are or are not playing a role now. Do you track them so you can see ups/downs/patterns? I personally would not raise the methimazole and give her steroids concurrently. When too many changes are made at once, you have no idea what is causing what.

I have to echo all of the above comments. As in, what are these signs of possible lymphoma? How well is she eating/drinking? What are her litterbox habits like? Muscle mass loss is common in all elderly cats, but can be even more impacted by their diets, especially ones specifically for things like kidney/renal issues. They are generally woefully inadequate in terms of protein, which it has been more recently deemed as inappropriate that CKD cats need less protein.

Just for reference, my cat is 17+ yo, with hyperthyroidism/kidney disease, and after a few inconclusive ultrasound results they just wanted me to treat her as if she had IBD or lymphoma. I have not yet done that because so far what I have learned, I am not inclined to believe it. She eats/drinks/uses the litter box fairly normal. She doesn't vomit and does not have abnormal stools.

 

[mrsgreenjeens]

OK, so you already bumped up her methimazole, per your Vet, AND added in the steroid, have I got that right?

Is it possible the methimazole is causing her to react this way? I must admit I know nothing about hyperthyroidism, but once thought my cat had hyPOthyroidism because he was acting as you are describing, and trying to eat everything he could get his paws on. (He had neither, but did have a UTI!)

At this point I'm really not sure what to advise other than try to talk to anyone at your Vet's practice tomorrow and get their take on it. I wasn't able to find the Pred (assuming that is the steroid you are giving) has side effects like you describe, but that doesn't mean it can't happen.

 

[Ryamllad]

Well, we gave them both at our vet's direction, and it was also suggested by another vet a month or so ago but I was hesitant to try them. I felt like her T-4 levels had continued to go up due to her behavior. This is going on our fifth year of seeing her behavior and that's what it seemed like her me, her eating a ton of food. I think her T-4 was just over 5 in her last panel, where earlier in the year and last year it's been between 3-4. Her weight loss and constant eating, plus her increased lymphocytes in her bloodwork and elevated kidney values suggest it's a blend of everything and probably not just one disease at this point.

Since we've started the steroids, and she has only had about four doses, it's like she's hyperthyroid all over again. Almost as if we've given her no methimazole at all. She's also much thirstier than normal. I honestly feel like they're not right for her at this time, and maybe we need to get her T-4 levels straightened out instead.

 

[Ryamllad]

Her last bloodwork was done about three weeks ago. We had her in to see the vet again this past Friday, where she prescribed the steroids and slight raise in methimazole.

Thanks again, everyone!!

 

[Furballsmom]

On that subject, what are you feeding her?

 

[Ryamllad]

On that subject, what are you feeding her?

She eats Royal Canin renal diet, E, T, and D varieties. She hates K/D and won't have anything to do with it. We'd started out years ago on Y/D for her hyperthyroid condition until we switched to renal diets.
If we can't get her to eat anything, she also likes the Tiki Cat pouched food. I read a ton of labels until I found that one.
She also has a VERY delicate stomach, so switching foods or trying anything new can be a disaster!

 

[Furballsmom]

This could have something to help;
Kitten Glop Recipes - Supplementing Cats and Kittens with nutritious formula you make at home: presented by Bengal Cat breeder Foothill Felines.

I know she's eating, but there might be something in this as well regarding the weight loss;
Any Good Tips To Get Your Cats To Eat? Share Them Here!

 

[mrsgreenjeens]

Steroid can definitely cause increased thirst. Increased lymphocytes do not necessarily indicate Lymphoma. Do you know what they were? Many things can cause them to increase...not to say it isn't Lymphoma, but as indicated above, does she show any signs of it? Usually not eating or uncontrolled diarrhea is how it's discovered.

I think you are right in that getting the hyperthyroidism under control seems like it is first priority.

 

[LTS3]

See if there's anything here you can discuss with your vet: Journal of Feline Medicine and Surgery - Balancing hyperthyroidism and concurrent chronic kidney disease

 

[Ryamllad]

Steroid can definitely cause increased thirst. Increased lymphocytes do not necessarily indicate Lymphoma. Do you know what they were? Many things can cause them to increase...not to say it isn't Lymphoma, but as indicated above, does she show any signs of it? Usually not eating or uncontrolled diarrhea is how it's discovered.

I think you are right in that getting the hyperthyroidism under control seems like it is first priority.

They've been abnormal for every blood draw since January. I wondered if it had to do with perhaps chronic infections, since she'd responded well to covenia injections after she struggled with kidney infections last year. She is also slightly anemic. She's hanging in there but this has been a long and hard road this past year for her. It's tough for anyone to pinpoint exactly which issue is causing what, you know? But I can say this for sure, those steroids threw her for a loop! We gave her fluids this afternoon, I gave her the second dose of methimazole for the day (she'd been on one half a pill before), and she gradually seems to be winding down.

Up until the past couple of weeks, we didn't think she was really close to the bridge, but it's crossed our minds recently.

 

[Furballsmom]

Sweet baby cat, you have a really good team on your side!!

 

[mrsgreenjeens]

How's she doing today? Did you get in touch with a Vet and ask about stopping the steroid?