Cat with hyperthyroidism

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Magda
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Cat with hyperthyroidism

Post by Magda » Sun Feb 09, 2020 10:11 am

My cat, Arthur, got diagnosed with hyperthyroidism last month. We started him on Vidalta tablets, 10mg. My main worry was about how would we cope with giving him tablets but it turned out to be easy, I wrapp it in a bit of cheese and he loves it. He got sick couple of times during the first two weeks and he got his second blood test. The vet was happy, his t4 went down to 15, his kidneys are ok so we were told to continue with Vidalta. Unfortunately a few days later he started to throw up, a lot and violently, few times a day. The vet insisted that we continue with the tablets but every second day, that didn't really work as he threw them up anyway. I spent a week crying, took him to vet again. When he is not throwing up he seems like a happy cat and vet didn't find anything else obviously wrong with him. He told me to stop Vidalta for a week and give him anti sickness medication twice a day. As long as he gets that medication he is fine, but when we missed it one day he threw up again. So the problem is still there, just masked by the medication.
The vet's plant was to continue with anti sickness meds and after a week to reintroduce Vidalta every second day while still giving him anti sickness liquid. I do want to treat his hyperthyroidism but I am really scared of giving him Vidalta ( the week without it ends tomorrow ). I feel like I am poisoning him slowly. I asked about changing his tablets but the vet really liked the blood results and would like to try to give Vidalta a bit more chance. Anyone had similar experiences? Can the side effects pass?
Last edited by Magda on Sun Feb 09, 2020 3:27 pm, edited 1 time in total.

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Re: Cat with hyperthyroidism

Post by booktigger » Sun Feb 09, 2020 10:47 am

My neighbours cat was similar on tablets, we tried all the variants with no success. What worked for her was the transdermal gel as it it used on the ears so doesn't go through the digestive system

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Re: Cat with hyperthyroidism

Post by fjm » Sun Feb 09, 2020 11:00 am

The radio-iodine treatment is expensive but extremely effective - it would be worth discussing it with your vet.

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Re: Cat with hyperthyroidism

Post by Magda » Sun Feb 09, 2020 11:01 am

I was thinking of the gel, but I think it will be a struggle every day. He hates the feeling of anything wet. He even hates the anti flea drops on his back, gets properly terrified by it. (But surprisingly he is good with injections, blood tests etc. )
Also if we ever go on holiday my neighbour will not be able to apply anything to his ears, while tablets he eats with no problem.
I may go for the gel if i have to and once he is ok sign him up for the radioactive iodine treatment. If he qualifys for it.

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Re: Cat with hyperthyroidism

Post by Kay » Sun Feb 09, 2020 11:02 am

other options for HT in cats are Felimazole, surgery or radioactive iodine treatment

vets in the UK, especially older ones, aren't always au fait with the latest thinking, and Vidalta was the only option back then, so I would suggest you do some serious googling so you can become familiar with the other options

when I had a cat with HT my vet wanted to start him on a high dose of Vidalta, but I'd done my research, and suggested starting on a low dose of Felimazole, which brought his levels down without ever making him sick

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Re: Cat with hyperthyroidism

Post by Mollycat » Sun Feb 09, 2020 11:11 am

We had the radioiodine but while we were waiting we controlled her levels on Hills y/d diet. Must be given absolutely exclusively as it's extremely reduced iodine, that's the 4th option. If you're planning on having radioiodine that might be worth looking into as a temporary measure. It brought Molly's T4 down from 70 to 30 instantly.

And I wasn't even all that strict with it, just cut out the highest iodine treats like dairy and reduced meat treats, but zero commercial treats.

The problem with surgery is the high rate of recurrence and then the third or so of cats who have extra thyroid material deep in the chest that can't be got with surgery. So you can go through two rounds of surgery only to find you still have the problem.

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Re: Cat with hyperthyroidism

Post by Magda » Sun Feb 09, 2020 11:21 am

I am scared of surgery, I like the idea of radio- iodine, sort of resigned myself to the fact that I would spend a fortune on him this year. But he needs to be healthy and stable before that treatment. I asked the vet about twice a day felimazole which he said it's an option but for some reason he is insisting on pushing with Vidalta first. Maybe I need to be more assertive, but I want to trust him.
Also there is one thing on Arthur's blood test that worries me. His creatine kinase is 389 ( was 290 a month ago). I don't really know what it means, but I know it is high and needs to be less if I want a radioactive iodine treatment. The vet was happy with his blood results but he didn't mention the creatine levels at all, like it's not important..
Last edited by Magda on Sun Feb 09, 2020 1:21 pm, edited 1 time in total.

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Re: Cat with hyperthyroidism

Post by Magda » Sun Feb 09, 2020 11:23 am

I looked at the diet option but I have two other cats at home.. they keep moving in with me, I really wanted just a one cat, life would be much easier.

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Re: Cat with hyperthyroidism

Post by Magda » Sun Feb 09, 2020 11:46 am

Can I ask where did Molly have her radioiodine treatment? I am in North London and I was considering the center in Harlow. Bristol looks very professional but it's so far.

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Re: Cat with hyperthyroidism

Post by Mollycat » Sun Feb 09, 2020 11:55 am

Bristol, Langford. My vet said it was considered the gold standard. There is also Rowe near Bristol but I preferred Langford. No regrets. It is just two appointments, the assessment for 2 days then drop off and collect for treatment, but potentially that is 4 times there and back or a couple of night in a hotel and still 3 trips there and back. The treatment was £2,500 but then there are follow ups at your own vets at £100 or more a time, we ended up around £4,000 in total including the initial diagnosis 3 sets of tests. However if your cat is on tablets for life it can easily clock up to the same or more, plus the inconvenience. Molly was 11 when diagnosed and is unpillable so we really had no choice with her. And she is extremely nervous so I was a wreck all the way through and the £4,000 includes reiki every time I have to load her into the carrier.

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Re: Cat with hyperthyroidism

Post by Kay » Sun Feb 09, 2020 4:05 pm

I used Rowe to treat my cat, but there are more choices now than back in my day

my vet did the testing for Rowe, so I only had to make one trip to deliver him and another to collect a fortnight later, but he was a fairly straightforward case - every cat is different I suppose

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Re: Cat with hyperthyroidism

Post by Magda » Sun Feb 09, 2020 4:18 pm

Both clinics in Bristol looks very good. But 3 hrs in the car will be a nightmare for Arthur and me.. There is a place called Forest vets in Harlow which is only 40 mins drive from my home and I am tempted with this one simply because of the distance.
But it seems that Langford does more tests than anyone else so I am a bit torn..

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Re: Cat with hyperthyroidism

Post by Kay » Sun Feb 09, 2020 5:29 pm

as I understand it, Langford (and Glasgow) are the only centres which take difficult cases as well as the more routine ones, such as cats with thyroid cancer, which requires much more powerful treatment and a longer stay, but there is no reason I can see why they would be better for less complex cases. If the Harlow place is confident to treat your boy then I would trust them, as they surely would not take risks which would jeopardise their success rate.

If you however do decide to go further afield, my experience when travelling to Gloucestershire from West Wales with a very nervous cat was made infinitely easier by hiring an animal courier for the trip, who took me too - he was in the body of the van inside a large crate with his usual litter tray and bedding, and tolerated the journey both ways without a murmur.

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Re: Cat with hyperthyroidism

Post by Mollycat » Sun Feb 09, 2020 5:33 pm

I must admit I didn't consider much alternative, as my own vet simply said the words gold standard in the same sentence as Langford and it was a done deal. Rowe probably are just as good, I am only biased because I have used their Bristol branch (not Wootton where the I131 is done) and am not fully comfortable with them. I grew up with Langford being THE best top vet school in the country and no evidence to back that up.

In all honesty a 3 hour car journey is the least of a cat's worries at Langford. The assessment is two full days of tests including blood tests, urine tests, blood pressure (they take this with a tail cuff), eye exam, cardiac ultrasound, abdominal ultrasound, radiology, cystocentesis whatever that is, and scintigraphy if they feel it's needed. This accounts for £1400 of the Langford total cost after £240 discount and the actual treatment £1100. In Molly's case they identified that her potassium was low and supplemented it from admission onwards. They don't like your own vet running the tests because their equipment gives them consistency of results, although when she was first diagnosed they asked my vet to take bloods for them to test in their lab as they thought something was wrong because Molly (bless her) was a little unusual. I think the post treatment tests were samples taken at my vets sent to Langford's labs as well. On admission for treatment bloods are re-run, and again on discharge, at which point they also give you a full report on the HT-related eye and heart changes they see, any abnormalities or normal wear and tear also on the bones, they comment on hormone levels and liver enzymes, it really is a full in depth health check with changes pre to post treatment.

In Molly's case as her liver enzymes were up higher than they would expect for just hyperthyroidism, and as we continued battling with digestive problems for 8 months and she is still hypokalemic and still has raised ALT, knowing she had such comprehensive testing like the ultrasound allows us to rule out certain liver problems now without having those tests all over again.

The injection itself is really nothing, the price differences are in the testing. Are you doing this on the insurance? I paid for mine, she is not insured. If it hadn't been a fixed package price I might have been tempted to skip some tests to save money. I'm glad I didn't do that. Be sure that the insurance will cover ALL the tests if they are priced up separately and don't start quibbling about something not being necessary. I can also heartily recommend animal reiki to calm a cat before the journey, this can be done remotely and at the time it's needed. We also had Pet Remedy plug in and spray, and if I had remembered I would have given her Zylkene. I also invested in a wire cage and Molly definitely prefers that to a standard plastic or fabric carrier.

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Re: Cat with hyperthyroidism

Post by booktigger » Sun Feb 09, 2020 5:44 pm

Cystocentesis is acquiring a urine sample by inserting a fine needle into the bladder, supposed to be more accurate

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Re: Cat with hyperthyroidism

Post by Mollycat » Sun Feb 09, 2020 6:23 pm

booktigger wrote:
Sun Feb 09, 2020 5:44 pm
Cystocentesis is acquiring a urine sample by inserting a fine needle into the bladder, supposed to be more accurate
Ah thank you I suppose I could have googled. Glad I didn't know at the time anyway!

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Re: Cat with hyperthyroidism

Post by Magda » Sun Feb 09, 2020 6:39 pm

I don't have an insurance. I also don't know how old my cat is. I have him for 12 years but he was an adult when I took him. He could be 14 or 20.. I am not sure if I want to subject him to so much stress. Blood test and urine test takes 2 mins at my vet who is 5 mins away from home. I may try to do just the nesseccary testing at my vet and use the closest clinic for radioiodine treatment if his health is ok.

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Re: Cat with hyperthyroidism

Post by fjm » Sun Feb 09, 2020 8:34 pm

Pippin went to the Hyperthyroid Cat Centre in Wetherby. My vet took blood samples, etc, and we sent them to the Centre's preferred laboratory to ensure consistency. They also did further blood tests and blood pressure tests when he arrived and before he left, and follow up blood tests were processed in the same way. The total cost, two years ago, was rather more than £2000, and when he first came home he was so wobbly from arthritis and the muscle loss caused by the hyperthyroidism I really wondered if I had done the right thing. But two years later he has regained some muscle and is contented and comfortable - I would recommend the treatment to anyone who can manage the cost.

The main consideration when deciding if it is suitable for a particular cat is how well their kidneys are functioning. HT can mask kidney disease, which can then get much worse when the thyroid hormones are brought under control.

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Re: Cat with hyperthyroidism

Post by Mollycat » Sun Feb 09, 2020 9:44 pm

Magda wrote:
Sun Feb 09, 2020 11:21 am
Also there is one thing on Arthur's blood test that worries me. His creatine kinase is 389 ( was 290 a month ago). I don't really know what it means, but I know it is high and needs to be less if I want a radioactive iodine treatment. The vet was happy with his blood results but he didn't mention the creatine levels at all, like it's not important..
Sorry missed this earlier. Seems creatine kinase is an enzyme that is usually used to assess muscle damage or injury, but is also found to be high in a range of metabolic diseases and in cats that have not eaten for a while. Try googling it, there is no point me googling and passing on messages, you can do that yourself. It may be that CK is expected to be high with hyperthyroidism, I don't know.

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Re: Cat with hyperthyroidism

Post by Magda » Mon Feb 10, 2020 9:46 am

Thank you so much for all the comments and advice. I think I need to take a step back and focus on the first stage of the treatment. I need to find what medication he can take without getting sick first and once he is on something for couple of months I will start arranging the next step. I think I will follow the vet advice any try Vidalta for another week, I am pretty sure it won't work and he will continue throwing up but at least I would have tried and my vet would have to accept it and switch the meds. I suspect we will end up with the ear gel at the end.

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Re: Cat with hyperthyroidism

Post by booktigger » Mon Feb 10, 2020 1:35 pm

Mollycat wrote:
Sun Feb 09, 2020 9:44 pm
Magda wrote:
Sun Feb 09, 2020 11:21 am
Also there is one thing on Arthur's blood test that worries me. His creatine kinase is 389 ( was 290 a month ago). I don't really know what it means, but I know it is high and needs to be less if I want a radioactive iodine treatment. The vet was happy with his blood results but he didn't mention the creatine levels at all, like it's not important..
Sorry missed this earlier. Seems creatine kinase is an enzyme that is usually used to assess muscle damage or injury, but is also found to be high in a range of metabolic diseases and in cats that have not eaten for a while. Try googling it, there is no point me googling and passing on messages, you can do that yourself. It may be that CK is expected to be high with hyperthyroidism, I don't know.
I also missed this. Was it just his creatnine that was high or was his urea high too?

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Re: Cat with hyperthyroidism

Post by Mollycat » Mon Feb 10, 2020 1:58 pm

booktigger wrote:
Mon Feb 10, 2020 1:35 pm
I also missed this. Was it just his creatnine that was high or was his urea high too?
Not creatinine, I thought it was a mistake too - creatine kinase isn't the same thing as creatinine. In fact I found this in a BMJ page and I'm doing that laugh like of course how silly when I actually have no idea what they are talking about:

"Rapid Response:
Creatine versus Creatinine
You could call it hair-splitting, but it seems a small mistake has
occured concerning the nomenclature of the enzyme ‘creatine kinase’ (EC
2.7.3.2): several times the enzyme was called ‘creatinine kinase’. The
enzyme creatine kinase catalyzes the formation of phosphocreatine from ATP
and creatine (and the reverse reaction). Other names for this enzyme are
‘ATP:creatine N-phosphotransferase’ (this systematic name is not usually
used in a clinical setting) or ‘creatine phosphokinase’ (which is a bit
obsolete by now). More information on the nomenclature of this enzyme can
be found on http://www.chem.qmul.ac.uk/iubmb/enzyme/.
The existence of an enzyme called creatinine kinase, has not been
reported yet."

Creatinine the one we're all familiar with in failing kidneys would most likely make the cat unsuitable for I131 but if this is creatine kinase that could be a totally different story. Creatine kinase is from the breakdown of muscle so could it be something to do with loss of muscle in hyperthyroidism or is this a mistake?

You know when things suddenly turn really weird??

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Re: Cat with hyperthyroidism

Post by Magda » Mon Feb 10, 2020 2:03 pm

His urea was 11.4 at the first blood test and 15.7 after two weeks of medication. It was described as "pre renal" on his results.

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Re: Cat with hyperthyroidism

Post by Magda » Mon Feb 10, 2020 2:05 pm

It was definitely creatine kinase, maybe that's normal with hyperthyroidism and that's why the vet didn't really worry about it.

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Re: Cat with hyperthyroidism

Post by Mollycat » Mon Feb 10, 2020 2:30 pm

Magda wrote:
Mon Feb 10, 2020 2:05 pm
It was definitely creatine kinase, maybe that's normal with hyperthyroidism and that's why the vet didn't really worry about it.
I've been reading instead of working oops - seems there are 3 enzymes in creatine kinase, one indicates muscle damage, one indicates brain tissue damage and the third indicates heart muscle damage. But it's not normal in hyperthyroidism.

Creatinine is produced from muscle damage but is normal, we all have some, but higher levels show a kidney problem because the kidneys usually regulate the levels and so that shows the kidneys are not working properly.

If he is at least 12 years old and pre-renal a proper assessment would decide if he is suitable for radioiodine. My girl was 11 and her kidneys were in excellent condition before she had her treatment then borderline stage 1 afterwards. The reason the treatment can bring out kidney problems (and they won't do it if the kidneys are not very good) is because the high blood pressure resulting from hyperthyroidism can artificially make the kidneys work better. It's also the high blood pressure that damages the heart and eyes, which is why hyperthyroidism should not be left untreated. Molly was showing early signs of heart thickening and one eye had some damage. None of this was anything to worry about but I'm glad we had the full range of tests including scans etc for her treatment, a full MOT as I call it.

There is a waiting list in most centres, we had to wait 5 months, and while you're waiting they want the hyperthyroidism controlled so that they can see what the cat is like controlled and uncontrolled. In a small number of cases it can be cancerous, about 2% I think, and if it is the cat won't respond to diet control and I'm not sure about meds, so you know if it is. In that case it's surgery or a very large dose of radioiodine and keep them in for up to a month and obviously the cost escalates, but it is rare.

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Re: Cat with hyperthyroidism

Post by fjm » Mon Feb 10, 2020 2:50 pm

Magda wrote:
Mon Feb 10, 2020 9:46 am
Thank you so much for all the comments and advice. I think I need to take a step back and focus on the first stage of the treatment. I need to find what medication he can take without getting sick first and once he is on something for couple of months I will start arranging the next step. I think I will follow the vet advice any try Vidalta for another week, I am pretty sure it won't work and he will continue throwing up but at least I would have tried and my vet would have to accept it and switch the meds. I suspect we will end up with the ear gel at the end.
I think this is a very sensible approach. You need time to process the diagnosis and consider the options, and to establish whether he has any other health issues. Pippin was diagnosed late in 2017, and was on Felimazole twice a day for several months. I decided on radio-iodine treatment, and chose to book him in for the end of February 2018 as the drive involved crossing the Pennines and I hoped the worst of the weather would have passed by then (Ha! Remember the Beast from the East? Guess whose check in date coincided with the worst of the snow!). By then he had had all the necessary preparatory blood tests, and came off medication for a few weeks to give an accurate pre-treatment baseline. I have known cats do well on medication alone for years, although eventually the increasing production of thyroid hormones can exceed what it can counteract.

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Re: Cat with hyperthyroidism

Post by booktigger » Mon Feb 10, 2020 7:27 pm

Hmm, if his urea has gone up on the thyroid meds, it could indicate his thyroid was masking a kidney issue. What was his creatnine?

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Re: Cat with hyperthyroidism

Post by Magda » Mon Feb 10, 2020 10:25 pm

I don't know his creatnine levels. My vet reckons his kidneys aren't the problem based on the blood test result.

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Re: Cat with hyperthyroidism

Post by Miabrevera » Fri Feb 14, 2020 11:49 am

You should get insurance for sure.
I had pet insurance for my cat trought https://petinsurancefinder.com/dog-health-insurance/. It was like $22/month and they reimbursed 90% of the vet costs. You have to sign up while the cat is healthy and there's a waiting period before it will kick in, but it's worth it for sure if anything ever goes wrong.
Last edited by Miabrevera on Fri Feb 28, 2020 12:54 pm, edited 2 times in total.

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Re: Cat with hyperthyroidism

Post by Mollycat » Fri Feb 14, 2020 9:31 pm

Miabrevera wrote:
Fri Feb 14, 2020 11:49 am
You should get insurance for sure.
I had pet insurance for my cat trought petinsurancefinder. It was like $22/month and they reimbursed 90% of the vet costs. You have to sign up while the cat is healthy and there's a waiting period before it will kick in, but it's worth it for sure if anything ever goes wrong.
Not sure how this is going to help for a cat that has already been diagnosed. With insurance you always get half of what you pay for. Insurances pay out half of the premiums they collect - some types of insurance a little more, some a little less. They have to pay wages, premises and profits out of your premiums as well as claims. Premiums go up and conditions get excluded.

I've never had a cat insured and had 30 trouble-free years, just the odd blood test, neuter, minor illness and one nose skim for skin cancer, none of it memorably expensive. Even if the premiums had been £20 a month, that would have been £15,000 to get maybe £500 back. The last 2 years have cost us £7,000 and the insurance would have paid less than half of that, just £2,500 less excess.

A credit card with a high limit and a savings account, and not a penny goes on costs or profits. Insurance means paying premiums only to find you still have to pay out because of some hidden clause or because your cover wasn't expensive enough.

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