Advice about thyroidecomy

[Ottilie]

We have a 12 yr old female rescue cat who has hyperthyroidism. We have been medicating her with methimazole fairly successfully - she won’t take pills and refuses the liquid.

Until now we have been determined not to look at surgery because we thought that might mean she would need medication to replace what has been removed, but the vet has suggested we are at the threshold of suitably for surgery so we are looking at it again.

What I’ve discovered is that if successful she should need no medication and recovery is very quick.

Ottilie is a very sensitive and nervous outdoor cat who had an awful start in life so we want to do the best for her. Any personal success stories and/or advice would be gratefully received

Thanks

[Mollycat]

You won't be short of stories here, quite a few of us have been through hyperthyroidism with a range of different treatments.

Firstly do you realise there are two more options? The four are:
Medication
Surgery
Extremely strict extremely low idiodine diet
Radioactive iodine

Medication you know about.
The diet is only made by Hills, comes in dry and canned pate, and must be given absolutely exclusively - no treats - for life, and not all cats like it.

Surgery has a serious drawback. Cats have two thyroid glands, hence no need for thyroid hormone if one is removed. But when one goes, in around two thirds of cats, the other will later need removing too, ending up back on medication. Plus, in a little under a third, there is extra thyroid gland material deep in the chest where it cannot be removed, and often this is the problem stuff, putting you through two rounds of surgery and back to square one or worse.

The 4th option is very costly up front but for a 12 year old cat can easily work out cheapest over lifetime, and it is the absolute gold standard. It's a single injection of radioactive iodine, curative in 95% of cats (and re-treatable if needed) with a lot of tests and normally 2 weeks hospitalisation. The tests are not fun but in the long term also the least invasive and intrusive for the cat. Not all are suitable and drawbacks (other than the price) include possible temporary hyPO thyroid, and because blood pressure drops so suddenly mild renal failure can show up post treatment. You have to realise that it shows as a result of treatment, if it does it was there all along masked by high blood pressure.

My girl was 11 when diagnosed by chance, and immediately put on the list for radioiodine. She had her treatment 6 months later and in between her levels were beautifully controlled on the diet, which she loved, and I wasn't even strict with it because I knew it was temporary. Afterwards she had loose stools for some months, low potassium which is easily fixed, and very early stage renal failure which I am not even treating it's so mild.

There is an excellent blog-like diary of radioiodine on this forum in the health section, have a look, it's a great read for anyone setting out on that journey or considering it as an option.

One possible reason they don't present radioiodine as an option straight away is that it is done in specialist licenced centres. There are less than a dozen in the whole of the UK. Whereas a thyroidectomy is often performed by your own vet. If you can and want to go that way, my advice is don't take the cheapest (around £1000+) - mine cost £2500 but the testing was so thorough. Also if you want the surgery try to get a scintigraphy test which will reveal if there is any extra thyroid material in the chest rather than the trial and error of simply removing the gland that is palpably enlarged.

My Molly is also an extremely nervous and very sensitive soul, indoors by choice because the big wide world was too scary for her. I have to be honest it broke my heart and very nearly my nerves to send her to hospital for 2 weeks, but 14 months on I would not consider anything else. I had someone send her reiki which helped her a lot and now I add this to every vet visit as routine.

[Ottilie]

Thanks for your reply. I look forward to hearing more from everyone here

Re: Radiation - We are in Guernsey so it would involve flying off island. Not an easy thing at the moment

Re: Medication - We’ve tried everything on offer and the ear gel is the only thing she will tolerate.

She gets very anxious and we are determined to make the right decision for her rather than what we want, if you see what I mean

[fjm]

Pippin had the radio iodine treatment, and I would highly recommend it if you can make the travelling work. Pip was very arthritic even then and got very wobbly during the confinement stage but made a good recovery once he could be more active.

[Kay]

just a thought, but I wonder if there are any radioactive iodine centres in Northern France?

[Mollycat]

She gets very anxious and we are determined to make the right decision for her rather than what we want, if you see what I mean

Absolutely, My girl is very anxious and everything I do, even my choice of furniture and how it is arranged, takes her into account. I even have to pack freezer food in a separate bag so that she can inspect the rest of the groceries while I put that away.

I don't want to seem to be pushing for the radioiodine but if she is a suitable candidate it really is the gold standard of care with the minimum of number of trips to the vets, no stitches, no risk of infections, and the highest cure rate. However it does involve a really unpleasant 2 day assessment and then the worst fortnight of your life while she is in having treatment, I make no bones about it, it is tough on us humans, and not nice for the cat but probably less trauma for an anxious cat than surgery. They will take blood and urine, test blood pressure, sedate and scan, and in some cases the scintigraphy as well - my Molly is a minimum handling sort of cat who is docile at the vets simply because she is terrified into complete submission, so you can imagine how I felt thinking of her being continually put in her cage and taken out again for more tests and all the while thinking she had been abandoned for the third time in her life to this awful place and people. After the injection they are left alone for a week, monitored by remote camera, fed and watered and litter dealt with, but left alone. Then another round of tests before you can pick them up. We chose it because I could not risk having her need surgery a second time and still end up on tablets because there is no way to give her tablets, and I would not like to risk the cone of shame and pulled stitches with her - basically there was no choice for us.

This is where I had Molly treated https://www.langfordvets.co.uk/small-an ... ive-iodine but there are others. Two visits (one for assessment and one for treatment) but all other tests pre and post can be done by your vet and samples sent to the hospital's lab. I do understand the added complication of travel for you but the waiting list should take care of travel restrictions and if she is stable on medication or diet in the meantime that is no problem anyway. Out the other side of it all I can honestly say I would have travelled and stayed in hotels to get an almost certain cure rather than risk multiple surgeries and medication.

I'm guessing you would have to wait for surgery anyway at the moment?

For a simple and direct comparison of treatments - https://www.hyperthyroidcatcentre.co.uk ... reatments/ and this is a really good realistic down to earth summary of each treatment and its advantages and disadvantages. My vet's own cat has had the surgery twice and is still hyperthyroid and on daily medication.

[fjm]

I used the Hyperthyroid Cat Centre in Wetherby, as it was one of the nearest for me. All the preliminary tests were done by my own vet, so the first trip was to drop Pippin off - just as the Beast from the East struck, which made the drive across the Pennines rather hairy! I think the time they have to stay in isolation at the hospital is gradually being reduced as protocols are refined, so you may find there is some flexibility depending on where you chose to go.

My experience with Pip is detailed here: viewtopic.php?f=13&t=6789&p=49429&hilit=Pippin#p49429

My vet did say that the thyroidectomy had a very high success rate if done by an experienced surgeon, but was very definite that radio-iodine i the gold standard treatment.

[Mollycat]

Just a thought, if you do prefer the surgery route, would there be anywhere you could at least have the scintigraphy done so that you don't end up having two lots of surgery only to discover then that she is one of the ones with extra tissue deep in her chest?

[Ottilie]

We’re just starting to investigate so haven’t heard of scintigraphy. It’s unlikely, but we’ll look into everything.