Cat Chat Feline Forum

Hey everyone.
I have a 16 year old cat, Jo who has had hyperthyroidism and is finally at a normal level. My vet has asked me if I would like to pursue surgery. I'm unsure because of the following:
I am devastated at the thought of this (because I went through it with his brother) but I think he may have chronic kidney disease. His eyes look sunken and dry, his coat is still poor and shedding a lot. Skin seems dehydrated and he still drinks a lot. Yes I have read the forums that hyperthyroidism masks kidney disease. I'm going to call the vet tomorrow and see if they can check his kidney levels but I'm almost positive about the diagnosis because I've been seen it before.
I've also read some bad things about Hills prescription kidney diet, and only switching to wet food is the way to go. His brother with CKD wouldn't eat any of the prescription diets anyway and I tried a bit with Jo and he really didn't care for it so it's basically a waste of money for me.
I know how to give Sub-Q fluids but I hope we're not there yet.
My heart drops knowing this is probably the road I'm taking again because it was horrible and I feel for anyone who has to go through this with their babies.
But I want to do something different this time around. Please give me all your advice, supplements, food you have tried, etc.
He does get canned food twice a day along with dry but I'm thinking about dropping the dry food. And I have two water fountains that he loves. But I'm seriously willing to try anything new!
Thank you again!
Jessica & Jo

Welcome to the forum.

Just to confirm it is hypERthyroid as in your post, not hypO as in the title? Hypo is rare in cats and hyper fits.

How is it controlled at the moment, with medication? There are now four options, an ultra low iodine diet made by Hills so I guess you won't be a fan of that and it won't help if Jo has ckd; the medication; surgery; and radioactive iodine. I'm not sure why the possibility of ckd is the thing that puts you off surgery? What put me off surgery was the 70% of cats who need a second surgery and then 30% who are still hyper because of extra thyroid gland material deep in the chest where surgery is not possible. If you can afford it and Jo is suitable, a radioactive iodine injection is considered the gold standard one off cure. Has your vet mentioned this option? If not, perhaps because it is done by a few specialist centres and is very expensive.

How often are Jo's bloods being done? I'm surprised the vet hasn't been discussing any drop in kidney function with you along the way. More directly - if Jo has been having regular 6 monthly blood tests to keep track of the thyroid issue, a drop in renal function significant enough to cause the symptoms you describe should have been spotted in the blood results before symptoms appeared.

It sounds like you must have had an awful experience before with Jo's brother's kidney failure and if he refused all renal food I can see why. But each cat is individual, there are dozens of foods wet and dry for kidney support. I don't know what bad you've read about Hills renal, I'd be interested because my girl is on the dry, my ckd boy had it my first ckd girl was healthy on Hills dry only (because it's all there was back then) for 8 years. You might find this website helpful, and if you are in the US the food guide will be some use (which is no good for us here in the UK) - in the UK we don't usually do sub-Qs but the condition is mostly managed with diet and appropriate phosphate and protein binders and other additives according to blood and urine test results guiding appropriate treatment for the stage and individual.

Dry food isn't an evil to be avoided at all costs, the renal dry is usually much better accepted than the wet and some cats show a big improvement even if the wet is normal food and only the dry is changed to renal. Also, cats are not us, the high volume of water throughput is not necessarily good, it comes at a cost. Too much fluid can flush away minerals like potassium, and reduce the acidity of urine which in cats is supposed to be relatively strong to neutralise bacteria in the urinary system. Too dilute urine can cause rather than prevent urinary infections. Don't think that pumping a maximum amount of fluids into a cat is always a good thing.

My girl was 12 when she had the radioactive iodine and had ckd on leaving the hospital, it was untreated for 2 years until March this year when bloodwork showed it was appropriate to start a renal diet. Her urine output immediately reduced and I am not strict with the diet. She is 14, fat, affectionate and happy, and will not be having sub-Qs or anything else.

One more thing you could ask your vet about is Fortekor. Originally developed as a heart drug for dogs, it has been licenced for renal support in ckd cats for years now. It works by increasing blood flow to the kidneys (like hyperthyroidism without the high blood pressure) and can slow the progression of ckd and possibly even reverse some (not all) of the damage already done. If Jo is ok taking tablets it must be worth asking, I was offered it but refused because my cats don't do tablets and they were fine without it.

Excellent advice from Mollycat - the website mentioned is https://www.felinecrf.org. Finding a renal food they will eat is a bit of a hassle, but it does make a big difference if you can find one that is accepted.

fjm wrote: ↑Fri Aug 20, 2021 7:19 am Excellent advice from Mollycat - the website mentioned is https://www.felinecrf.org. Finding a renal food they will eat is a bit of a hassle, but it does make a big difference if you can find one that is accepted.

Oops thank you yes that's the one (you know me too well, or maybe I repeat myself too much!)

I'm also surprised his kidney function hasn't been monitored while they have been checking his thyroid, esp knowing the link. If you are right and he does have CKD, there may be limited options to treat his hyper-t, I know my vet likes to keep thyroid levels a bit high when they also have CKD, as the extra blood flow helps the kidneys. I've never heard anything negative about Hills renal food, although I haven't used it much, I've found some of the other brands more palatable. I've had a couple that I've only changed their dry food and left their wet food, and that has been enough to get their levels back to normal limits. At least you are going to get his bloods done, so you will know what you are dealing with, fingers crossed for you and him

Thanks everyone.
Yes it is hyperthyroidism, sorry about that mistake. He is on liquid methimazole twice a day. The vet has mentioned the possibility of the hyperthyroidism masking CKD but hasn't mentioned bloodwork to keep a check on it as we've had so much trouble getting his thyroid level normal. I'm in the USA and my vet has only recommended surgery. I'm not against surgery but I'm hesitant because he's 16 already. How much longer could this prolong his life if he has CKD? I've read forums that say "dry food is terrible for the kidneys" and I've started to feel like that's true. I was hoping someone else might have similar thoughts. With my Taq (age 14 CKD) he became VERY picky and I tried all the renal foods with no luck so he just got whatever he would eat. I know my vet is a typical veterinarian and will push for the renal dry food but I'm going to ask questions about it. Jo still has a hefty appetite so I want to offer the best for him!!
I did re-read the forum on Hills prescription foods and people were commenting on the poor quality ingredients and the lawsuits against Hills, Royal Canin and Purina. I'm not sure though so I was interested in others thoughts since this I haven't heard this before.
Taking him to the vet after work for full bloodwork. I will update you on the results, but thanks for all the responses! I have read all the info from that link when I was going through this with Taq l, but thank you anyway.
Jessica and Jo

Unfortunately there are some really evangelical devotees of cat diets only too ready to tell you you're murdering your cat if you don't feed exclusively exactly what they feed theirs, whether that is home made raw preparations, the most expensive wet available, formula dry or some ridiculous and usually terribly unbalanced concoction "because he's a pedigree" as if that made him not a cat. Ignore these nuts. between any randomly selected forum members I bet we could find cats fed any diet or combination of the above who have lived well into their 20s without ever needing to see a vet. Don't be afraid of dry. It has more carbs than you'd ideally want, but it's not poison, even for renal failure. Raw which is touted as the optimum closest to their natural diet, doesn't stop them getting kidney failure - that is a cat's weak spot and increasingly common as cats live so much longer now. Canned diets may be linked to hyperthyroidism, indoor life contributes to a whole list of increased disease risks. There are worse evils than biscuits.