Help please - hyperthyroid cat, vidalta and now early stage renal failure

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fairy100
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Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by fairy100 »

Looking for advice please as so confused and only want what is best for precious cat who has recently become part of our family. Will try to make this simple - I have blood test results here but cannot read/ understand them.


Hyperthyroid old cat (nearly 15 years) who has been on 10mg vidalta since March 2015. Increased to 15mg Vidalta in March 2017.

Cat had full medical check at end 2017 - very skinny and continuously crying for food. Thyroid fuction was at 46 (ideal range 7.5- 55) so increased to 20mg Vidalta which has been taking for 50 days.

Recent check up - good news is he has put on 10% body weight in 7 weeks and does not cry for food now BUT thyroid levels has gone up which suggests it is not working which should mean he would not put on weight but he has and vet cannot explain this. Heart rate has gone down but bloods show signs of early renal failure (which part of the blood test is this?), some teeth need removing and vet can now hear a slight heart murmur - none of which were apparent on examination 7 weeks ago :(


I am very confused. It seems hyperthyroidism can mask renal failure as the increased blood pressure it causes can hide poorly functioning kidneys. However am confused as blood results suggest that hyperthyroidism is worse (level has gone up) but (a) cat has put weight on and (b) renal damage apparent now but was not in blood tests 7 weeks ago which should not be the case if hyperthyroid is worse (as blood pressure should be higher and masking renal damage but it is not).

Vet wants to up the vidalta to 25 mg now but I am not sure that makes sense if it is becoming less effective? Need to consider hyperthyroid, early renal faiure (diet?) and to a lesser extent teeth issue. Also if we manage to improve the hypothyroidism will this not just cause an even bigger renal failure issue?

Please can someone advise - we love him and are very confused. Will find the money for radioactive iodine therapy somehow if we need to and this is best course.
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Lilith
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by Lilith »

Hi and welcome - very sorry to hear about your boy - having had a cat treated for hyperthyroidism and having another cat recently diagnosed with ckd I can imagine how you're feeling.

I'm no good with technical stuff but there are people on here who are - you've come to the right place. My Mouse went to the Wetherby Centre for radio-iodine treatment and it was like a miracle cure; she was skinny and screaming for food but is now a great hefty placid lump again.

As I say, there'll be other people along who are more knowledgeable than me but just wanted to say hi, and don't lose heart - all the best and fusses to your boy x
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by Janey »

Hi, I’ve had a few elderly hyperthyroid cats now. My first two cats when they got older (myself too at the time!) we were all on Carbimazole, only my hubby wasn’t! I since had two other cats who were hyperthyroid and they did well on Carbimazole, and it worked for me too. One of them had high blood pressure etc when we first adopted him but with thyroid treatment was able to come off the tablets for that. His kidneys did eventually fail, but he was about 21 by then and we adopted him at 17. I just wonder if a change of medication may help? The other thing is thyroid levels can alter quite often, day to day I was told, hence why it can take a while to get diagnosed, which happened to me. If you have a good vet and trust her, then I would go with what she recommends personally.
fairy100
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by fairy100 »

I raised this with the vet who is new to cat and seen him twice over 4 months (as I have only just got him). I said rather than just keep upping the vidalta as now being suggested could we swap to different medication. He said said if cat not doing well on Vidalta then swapping to a different medication will probably not improve things - not sure if that is correct though.
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by fjm »

My cat Pippin has recently undergone radio-iodine treatment, so your dilemma is one I can sympathise with.

My understanding is that hyperthyroidism is usually caused by a benign tumour on the thyroid gland. The gland itself only produces hormones when they are needed, the tumour pumps it out constantly, and continues to grow, producing more and more and therefore needing escalating doses of medication to damp down the symptoms. Remember blood tests are a snap shot - the results could be influenced by how long it was since his last dose of medication, whether he was fed before blood was taken, etc, etc, so it is possible that the current dose is actually controlling levels quite well.

Radio-iodine treatment will destroy the tumour and bring down thyroid levels, but as you already know, if the increased blood flow from the rapid metabolism has been masking kidney problems these may be exacerbated when the metabolism slows down, or they may develop even if there have been no earlier signs. Similarly with blood pressure and heart problems - there are no guarantees that resolving the hyperthyroidism will cure these, and they may get worse. So it is a matter of gathering information then discussing the options with your vet. As a guide, Pippin's radio-iodine treatment, including pre-admission tests, follow up, additional medication for high blood pressure, etc, etc came to around £2,250. On the one hand, it has cured his hyperthyroidism and he is doing well. On the other, he was doing well on Thyronorm, and if he now develops CKD that may prove as life-limiting as the HT.

To help your research and understanding, Tanya's site has excellent information on CKD and hyperthyroidism: http://www.felinecrf.org/hyperthyroidism.htm
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by Antonio »

I'm sorry that you and your cat are going through this situation.
I'm sure you know that hyperthyroidism cannot be controlled long term. You're adjusting the dosage of Vidalta, but you will never win. The (benign) cancer in her thyroid will keep growing and you can't increase the meds dose forever.
HT also affects heart and liver, along with kidneys. The same does the med.

In my opinion you should consider a definitive therapy for her thyroid (surgery or radiation). This will fix most, if not all, other issues. I can tell you this from experience.
My cat was also diagnosed with a slight heart murmur and kidney failure, but these things seem stuff from the past. Her renal levels went a bit up and down during the months of the therapy with methimazole.

What levels did your vet checked? Did she/he run BUN and Crea only, or SDMA as well?
Sometimes the Crea can go higher if the cat is a little dehydrated.

My cat was HT and was treated 8 months ago and now she's so fine that I can't even remember how bad she was whe we began the therapy with meds and all.
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by Kay »

re medication, vets in the UK seem to be rather behind when it comes to the latest thinking on HT treatment - in the States, for instance, Vidalta has long been dropped in favour of Felimazole, which tends to cause less stomach problems, and can be administered in smaller doses

I too went down the radioactive iodine route, in 2014, with excellent results, but my cat was only 11 at the time

I would recommend you use the internet to find out as much as you can, and especially US sites, and be prepared to educate your vet - especially https://groups.yahoo.com/neo/groups/feline-hyperT/info - and ask for all the blood test results so you can use them for your own research
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by booktigger »

I'm sorry to hear this - my understanding is that kidney issues limits surgery/iodine treatment as it will make it worse and you can't adjust the meds to help the kidneys. I do wonder though, teeth can make kidney values worse, so wonder if that is more of an issue than you think. If you can post urea/creatinine levels, there are enough of us on here who can read them and give advice. Vidalta and Felimazole do work in different ways and normally if one doesn't work, you would swap to the other.
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by fairy100 »

Antonio wrote:I'm sorry that you and your cat are going through this situation.
I'm sure you know that hyperthyroidism cannot be controlled long term. You're adjusting the dosage of Vidalta, but you will never win. The (benign) cancer in her thyroid will keep growing and you can't increase the meds dose forever.
HT also affects heart and liver, along with kidneys. The same does the med.

In my opinion you should consider a definitive therapy for her thyroid (surgery or radiation). This will fix most, if not all, other issues. I can tell you this from experience.
My cat was also diagnosed with a slight heart murmur and kidney failure, but these things seem stuff from the past. Her renal levels went a bit up and down during the months of the therapy with methimazole.

What levels did your vet checked? Did she/he run BUN and Crea only, or SDMA as well?
Sometimes the Crea can go higher if the cat is a little dehydrated.

My cat was HT and was treated 8 months ago and now she's so fine that I can't even remember how bad she was whe we began the therapy with meds and all.
Thank you so much for this - I had not understood until now that you can never win regarding these meds. Did your cat have radiation to treat HT? I have read elsewhere that heart murmurs and kidney failure were reasons not to be approved for this so interested if this is the course you took as was looking at this regarding our cat but then thought it would not be possible. If I have understood what you have said it looks like the methimaxole therapy took a toil on renal levels?

I am a newbie cat owner so not sure what BUN and CREA is or SDMA. I would like to attach the 2 blood test results I have but cannot seem to attach on here - does anyone know how I add an attachment please - it says it does not accept pdfs? These show, I believe, an increase in thyroid levels (was 46.6 now 65.3) (at a time Vidlata has been increased from 15g to 20g and a 10% increase in body weight which I believe are inconsistent with each other). Thanks so much.
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by booktigger »

If you can convert to a jpeg it may work - in the UK we test Urea and Creatnine, Antonio is in Italy hence his reference to BUN. SDMA is a relatively new test that picks up kidney failure at 30% loss, Urea and Creatnine doesn't pick up till 70% loss. You are right, he shouldn't be gaining weight while his kidney values are going up
fairy100
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by fairy100 »

Thanks. Been mucking around with jpegs but site now saying files are too large so trying now to post as photos - hope this works. There should be the blood tests for March 2018 and previous test done in December 2017. Thanks very much.
Attachments
December 2.JPG
December 1.JPG
March 2018-Dec 2017 blood tests.pdf.JPG
March 1.JPG
fairy100
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by fairy100 »

If you click on these sideways on photos they should enlarge and show up the right way :) Thank you.
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by booktigger »

I just turned the phone on its side! :D his Urea is high but creatnine is well within normal limits so might not be CKD, that can be related to dehydration or infection. I also find it interesting that the T4 top up is normal, I've not seen that in a result so I'd question that. If it is similar to the Free T4 test, its more reliable. Did they suggest anything for his high ALT (a liver test)?
fairy100
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by fairy100 »

booktigger wrote:I just turned the phone on its side! :D his Urea is high but creatnine is well within normal limits so might not be CKD, that can be related to dehydration or infection. I also find it interesting that the T4 top up is normal, I've not seen that in a result so I'd question that. If it is similar to the Free T4 test, its more reliable. Did they suggest anything for his high ALT (a liver test)?
Please bear with me as we are ignorant of all these things. What can cause high urea? Think vet said the increase in 3 months in the creatinine was what was of concern. What does T4 top up test for please and what does a "normal" result suggest - is this something you do not expect in HT cat or in any cat (i.e. a non HT one?) and why? Nothing mentioned about high ALT at all - what can high ALT mean - liver issues too? Poor sweet cat :(
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by booktigger »

Sorry! As I said, high urea alone can be dehydration or infection which could be tooth related in his case. His creatnine might have gone up in 3 months but still normal. As I said, I've not seen a T4 top up so you'd have to ask the vet, but if it's similar to a Free T4, it's more accurate than a T4 test. High ALT is normal with hyper-t, every cat I've had with it has had that, just didn't know if the vet had said anything.
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by Antonio »

Hi @fairy100,
Yes, you can never win with the therapy against HT, and the meds can give more issues.
My cat Pallina, was treated with I-131 August last year, when she was 16 years and 3 months old, in Belgium, because over here in Italy there are no I-131 facilities.

She was diagnosed a year before, August/September 2016, and was put on methimazole since. At first she was taking pills, but they were giving her some stomach issues, so my vet switched the therapy to eargel methimazole. It was much easier to administer and the dosage was more precise. Nevertheless we had to frequently adjust the dosage according to the results of the blood checks that we were doing every 5-6 weeks.
I was insisting on having Pallina treated with I-131, but due to the fact that we have no facilities, my vets couldn't help, so I had to find a place, and had to do it myself, and found the facility in Belgium.

Pallina had an unusual form of HT called Apathetic, which gives none of the classic symptoms of HT. She wasn't desperatley hungry, as a matter of fact she was eating much less. She wasn't hyper-active or edgy, she was much quieter than usual. Her coat was fine. And so on.

Pallina developed a slight renal failure likely induced by the methimazole. I sent all the reports to the clinic in Belgium and they said she was a good candidate for the radio iodine therapy anyway.

When the day for this treatment came, she was visited at the Belgian clinic and those vets found a slight heart murmur and they were going to cancel the treatment! They checked and scanned Pallina all day, and then decided to go on.
Pallina was kept in isolation at the clinic for 4 days before being discharged.

Now, after 8 months she is much better, and will be 17 yo in a month time.

BUN is another name for Urea, Crea is short for Creatinine, SDMA is a recently developed test by IDEXX to early diagnose renal failures.
Your cat has high UREA, likely induced by HT, but the Creatinine is fine, though increasing. Also ALT is high. Sometimes HT can give liver trouble as well.
Your vet measured Total T4 but not fT4. Both levels are necessary to assess the stage of HT.
If you're going to refer to a I-131 clinic, they would like to have a history of reports for both levels.

Hope it helps.
If you have more questions, I'm here ;)
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Re: Help please - hyperthyroid cat, vidalta and now early stage renal failure

Post by Supergirl1327 »

Firstly i apologies gor writing on this feed, im new on here and dunno whar im doing yet.
anyone got any advice or whats worked best for there kittys. Iv got 2 16year old brothers gizmo diagnosed throid prob 18 to 2 years ago, hes on the liquid thyroid.
Smudge diagnosed 2 to 3 weeks ago and is on Vidalta 10mg at the min. Im wanting to put them both on the same medication but unsure which way to go.
Only good thing so far about Vidalta is its once aday.
Anyone know which wud be the best. They both have heart murmurs too, and smudge suspended IBD. I dnt have a clue which one is safer for them and causes less side effects.
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