# Toothless hyperthyroid cat doesnt want to eat- help!



## Darkcat (May 27, 2010)

I have a 12-ish yr old kitty that had 9 teeth removed and who is also hyperthyroid. I'm having a hard time getting her to eat. She went to the vets last week, and they adjusted her meds and checked her mouth. The vet seemed to think her not wanting to eat is behavioral (perhaps she associates eating with pain?)

She's clearly hungry, but when I give her food, she licks at it for a few minutes then "covers it up" and walks away. I've tried wet food, soupy food, diced food, fillets, and every combination of consistencies of canned food I can think of. I even tried boiled chicken as a treat, and she'll eat a little and then leave it. I don't know what else to do.

Suggestions?


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## doodlebug (May 13, 2006)

Have the vet prescribe an appetite enhancer (cyproheptadine is one I've used with success). With the hyper-t she may be having an overproduction of stomach acid making her nauseous. You may need an anti emetic, many people use Pepcid...but you need a specific formulation and I don't know the dose...maybe someone will have that info. You may also have to assist feed her to get her going.


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## Darkcat (May 27, 2010)

Thanks for the tip. I'll bring it up with the vet. She seems hungry, and she'll ask for food, she just won't eat it. I syringe feed her when I know she's not getting enough on her own, and she clearly feels better afterword, but she really hates the process.


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## laurief (Jun 22, 2008)

Darkcat said:


> I have a 12-ish yr old kitty that had 9 teeth removed and who is also hyperthyroid. I'm having a hard time getting her to eat. She went to the vets last week, and they adjusted her meds and checked her mouth. The vet seemed to think her not wanting to eat is behavioral (perhaps she associates eating with pain?)
> 
> She's clearly hungry, but when I give her food, she licks at it for a few minutes then "covers it up" and walks away. I've tried wet food, soupy food, diced food, fillets, and every combination of consistencies of canned food I can think of. I even tried boiled chicken as a treat, and she'll eat a little and then leave it. I don't know what else to do.
> 
> Suggestions?


I've got some questions:

How long ago were the 9 teeth removed? Were dental x-rays taken during the procedure and/or at the follow-up checkup? Were fluids administered before, during, and/or after the procedure? Was pre-procedure bloodwork run, and if so, do you have a copy of the lab results that you can post here?

Exactly what meds were administered during and prescribed after the dental procedure, and in what doses? Is she still taking meds related to the dental procedure, and if so, which meds and in what doses? If she's no longer taking dental-related meds, when did she stop taking them? 

When she tries to eat, does she give any indication of mouth discomfort (head tilting, teeth gnashing, lip licking, etc.)?

When was she diagnosed hyperT? Which thyroid med is she taking and at what dose? At what dose was the med started, when was it adjusted, and what was it adjusted to?

Is she taking any other meds for any other reason? If so, what is she taking and in what doses?

Sorry for all the questions, but your answers may provide clues about her current inability/unwillingness to eat. The more specific and complete information you can provide, the more likely we'll be able to provide relevant insights and suggestions.

Laurie


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## westfayetteville (Sep 22, 2011)

With the pepcid A/C the dose is 1/4 tablet in the AM and 1/4 tablet in the PM.

*Please consult your vet* if your cat refuses to eat for more than a day. An appetite stimulant such as Cyproheptadine or Reglan, or even a feeding tube, may be needed. A cat that does not eat for more than 24 hours runs the risk of developing Hepatic Lipidosis, a life threatening condition.
Ask your vet for a feeding syringe, or buy one made for infants.
If you need to syringe or tube feed your cat, there are several formulas that can be used easily in a feeding syringe. The first is Stage 1, all meat and broth baby food, with no onions, veggies or cornstarch, mixed with a spoonful of plain, unsweetened, full fat yogurt and a little warm water. Gerber and Beechnut are two popular brands available in the US - please be sure to check the ingredients. If this is fed for anything more than a few days, a pinch taurine should be added to it. A minimum of 9 or 10 ounces should be given over a 24 hour period.
Another formula that needs no supplementation and is often better received by the cat is pureed Fancy Feast in the cat's favorite flavor, mixed with a spoonful of the same type of yogurt and some warm water or no salt chicken broth. Usually, 6 ounces of food daily will suffice, but larger cats or severely malnourished cats may need more.


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## Darkcat (May 27, 2010)

I can give some answers now, but not specifics until I get a hold of her record. The teeth were removed a few months ago.She was diagnosed hyper T a few months before that. She was eating pretty well after the dental, and just recently started to do the lick a few bites and walk away. If I lock her away from the other kittes she'll eat some more over several hours, but not as much as she needs to.

No x rays were taken during the dental to my knowledge or at her follow up. Exam was visual. She was on Clindamycin (sp?) prior to her dental for a week-ish? 10 days? after. She's not on that anymore, and the vet didn't see any signs of inflammation in her mouth. No drooling or bad breath.

Ni indication of discomfort when eating. She never even gave any any signs of discomfort before we found out about her teeth.

She's on methimazole 5mg for the hyper T, 1 pill in the am, half a pill in the pm, up from 1 pill/day before.

A little back story on her, she was abandoned at 7 m old and pregnant by our neighbors when they moved away. She's 12y now. She knows she was left, for a long time after she'd flip if she saw a moving van. She had behavioral issues, biting and kicking if she didn't get her way. It took a long time to work her through that. She doesn't throw bit/kick tantrums any more, but she's never lost the 'tude. She hates being medicated and growls when I do it (I use a piller followed by a little water to wash it down). She's a sweet girl at heart, but she always put on a tough front.
*
*


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## doodlebug (May 13, 2006)

OK...wait a minute...when were the teeth removed and when were the meds adjusted? Was she eating OK before the meds were adjusted? Side effects from the methimazole could be causing her not to eat.

BTW...have you tried the transdermal gel or having the methimazole compounded into treats? A little more expensive, but way easier to administer. Maggie wasn't thrilled with the gel, but she ate the treats as long as I rolled them in freeze dried chicken dust. Also since your cat is only 12, have you considered radioactive iodine treatment? Expensive upfront, but less expensive in the long run (assuming the cat lives a few years). Maggie had it done last week and is doing awesome.


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## Darkcat (May 27, 2010)

Timeline (I'm bad at time gauging with no reference or chart in front of me): 
Rose starts vomiting immediately after eating
Blood test diagnosed hyperthyroid. 
A few months later her teeth were pulled.
She was eating pretty well.
She starts licking/walking away 

Btw, she did have blood work done before her dental.

Hyper T med timeline -
diagnosis, 1 5mg pill/day
1st blood test after reduced to half a pill a day
2nd test upped to 1 pill/day
3rd test upped to 1.5 pills a day (1 in am, .5 in pm)
next test in 7 weeks now

I haven't tried the gel, but might switch to that since she hates the pills. There's also a food that is supposed to help (Hills y/d), but her house mates would get into it, so I decided not to go with that. I hadn't really looked at the iodine yet, but did a bit of initial research when she was first diagnosed. It might be good for me to look further into it? Surgery?


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## laurief (Jun 22, 2008)

Here are the things I'd still like to know to round out this picture:

ALL lab results, including dates and results (*with the lab's reference ranges*) of ALL thyroid tests AND the pre-dental bloodwork

The date she started exhibiting appetite loss, relative to the date of any methimazole med adjustments

A couple of possibilities come to mind. First, the latest methimazole increase may have caused digestive upset and/or hypOthyroidism, either or both of which can cause inappetance. If her T4 level at her latest test required a med increase, I, personally, would have increased only 1.25 mg daily (making her dose 3/4 pill a.m., 1/2 pill p.m.), AND I would retest in 3 weeks - not wait 7 weeks.

It's also possible that if this latest med increase has achieved euthyroid (normal thyroid levels), it may also have unmasked previously masked kidney disease. This is not an uncommon occurrence, since uncontrolled hyperT is known to sometimes mask renal failure (meaning that while the cat's thyroid hormone levels are still elevated, the kidney-related blood values may appear to be in normal range even when the kidneys are sick). This is another reason not to wait 7 weeks until the next retest. If your cat is in renal failure, the sooner you know it, the better. Renal failure can certainly do a number on a cat's appetite.

So, here are my suggestions for you to consider and discuss with your vet:

1) Decrease the methimazole to 3/4 pill a.m. and 1/2 pill p.m.

2) Retest TT4 and a liver and kidney panel 3 weeks after maintaining the same methimazole dose consistently (if you do reduce her med dose, wait for 3 weeks after the dose reduction before having her retested). 

When you do schedule her next retest (and any future retest), make sure to withhold food for at least 8 hrs prior to the blood draw AND schedule the blood draw so that it is performed between 3-8 hrs after her latest methimazole dose.

It's late and I have hungry cats circling my feet. I'll write more tomorrow.

Laurie


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## Darkcat (May 27, 2010)

Working on getting her records. I did do a sort of test with her today. I opened a can of one of her favorite foods and let her smell it. She went nuts for it, no sign of turning her nose at it the way I'd expect if her tummy was upset. And she was hungry, she came to get me to feed her later on. But then she takes two bites and walks away, then goes back to telling me she's hungry. I'm baffled. She's also playing, etc normally.


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## laurief (Jun 22, 2008)

That's fairly typical behavior for a cat who is experiencing nausea. At some point, they get so hungry that they'll eat in spite of the nausea. Then when they aren't so hungry anymore, they'll be more likely to succumb to the nauseous feeling and not eat, in spite of mild hunger.

You still need to check her thyroid, kidney, and liver blood values to try to identify the source of her nausea so that you can manage it effectively and appropriately.

Laurie


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## Darkcat (May 27, 2010)

I can't make heads or tails of this chart, but next to T4 it says 6.2 *1.5-4.8 UG/DL
CHOL 144 90-205MG/DL. This was done 3/06.

She was diagnosed hyperT 9/30/11 (my time guess was wayyy off). Her dental was on 12/13/11, and there's a note that she was eating well after her dental.


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## laurief (Jun 22, 2008)

Darkcat said:


> I can't make heads or tails of this chart, but next to T4 it says 6.2 *1.5-4.8 UG/DL
> CHOL 144 90-205MG/DL. This was done 3/06.
> 
> She was diagnosed hyperT 9/30/11 (my time guess was wayyy off). Her dental was on 12/13/11, and there's a note that she was eating well after her dental.



OK, here's how to read her lab results:

T4 6.2 (1.5-4.8 )
CHOL 144 (90-205)

In this case, T4 is the thyroid test, your cat's T4 result was 6.2, and the lab's reference (normal) range for T4 was 1.5-4.8. The asterisk designated that your girl's result was outside of the reference range. So, your girl's T4 was high at that time. Does the lab report designate whether the T4 test was a Total T4 (TT4) or a Free T4 (FT4)? One thing you need to understand about T4 is that in a healthy cat, the T4 naturally lowers as the cat ages. I can't remember your cat's age, but assuming she is an aged girl, her T4 should ideally be in the lower half of the reference range.

CHOL stands for cholesterol. Your girl's cholesterol of 144 was within the lab's normal reference range of 90-205.

OK, now, what are the dates and results of any other thyroid tests or retests you've had done on her?

Laurie


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## Darkcat (May 27, 2010)

The test doesn't designate TT4 or FT4. She's 12-ish years old btw.

Prior results:
9/30/11-T4 7.4 *1.5-4.8 

11/1/11 1.1*1.5-4.8 (this number didn't copy well and is VERY hard to make out. I do know it was low, however)

Dec 13/11 pre-dental blood work (all normal) no thyroid panel run I don't think?

1/10/12 T4 8.0*1.5-4.8

3/6/12 T4 6.2*1.5-4.8


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## laurief (Jun 22, 2008)

Darkcat said:


> The test doesn't designate TT4 or FT4.


They're probably TT4 tests, since TT4 is the preferred diagnostic test for hyperT.

OK, let's see if I can pull this information together to relate tests to med doses. Please correct me if I get any part of this wrong:


9/30/11-T4 7.4 *1.5-4.8 
started on 2.5 mg methimazole twice daily

11/1/11 1.1*1.5-4.8
adjusted to 1.25 mg methimazole twice daily

1/10/12 T4 8.0*1.5-4.8
adjusted to 2.5 mg methimazole twice daily

3/6/12 T4 6.2*1.5-4.8[/QUOTE]
adjusted to 5 mg methimazole a.m., 2.5 mg p.m.


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## Darkcat (May 27, 2010)

Let me think, the pills are 5mg doses, she was on half a pill 2 times daily on diagnosis (half in am and half in pm). Then they adjusted down to half a pill in the am when it was low. Then it was upped back to the original dose (half in am half in pm - though she did say I could do a whole pill once a day if I preferred). Then this last test she's on 1 pill in the am and half a pill in the pm. Did that make sense?


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## laurief (Jun 22, 2008)

Well, I got it right except for one small adjustment:


9/30/11-T4 7.4 *1.5-4.8 
started on 2.5 mg methimazole twice daily

11/1/11 1.1*1.5-4.8
adjusted to 2.5 mg methimazole a.m. only

1/10/12 T4 8.0*1.5-4.8
adjusted to 2.5 mg methimazole twice daily

3/6/12 T4 6.2*1.5-4.8
adjusted to 5 mg methimazole a.m., 2.5 mg p.m.

Your cat's full daily dosage should always be split into two daily doses. Twice daily dosing creates a much more level T4 throughout the day for your cat, whereas once daily dosing creates T4 peaks and valleys. It would have been better for your cat during the 11/1/11-1/10/12 period if she had been receiving 1.25 mg twice daily rather than 2.5 mg once daily.

There are some pretty wild swings in your cat's T4 results between tests. This makes me wonder about the timing of her dosing relative to the blood draws. In order for her future retests to relate as closely as possible to each other, you should schedule her retests so that they have similar timing between last dose and the blood draw. For instance, I give my hyperT cats their meds at 8:00 a.m. I schedule retests for 11:00 a.m. - 3 hrs after the last med dose. I also withhold food for at least 8 hrs prior to the blood draw. I keep this timing consistent from retest to retest. Blood for T4 retests should be drawn between 3-8 hrs AFTER the most recent med dose. Just keep your timing as consistent as possible.

Laurie


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## Darkcat (May 27, 2010)

Will do. I noticed the wild swings once you explained the numbers to me. I left a message with the vet about giving her pepcid in case it is the meds that are causing her lack of desire to eat. The vet was gone for the day (had an appointment) so I should hear something tomorrow.


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## laurief (Jun 22, 2008)

Pepcid reduces stomach acid. It won't help if she is nauseous due to the increased med dose. I'd be a lot more inclined to decrease her methimazole to 6.25 mg daily (3.75 mg a.m., 2.5 mg p.m.) instead of 7.5 mg daily. If your vet doesn't want to decrease the dose at all, it might help to evenly divide the doses, giving her 3.75 mg a.m. and p.m. (which would equal the same amount you're giving now).

Just to help you out with the math a bit ...

1 pill = 5 mg
1/2 pill = 2.5 mg
1/4 pill = 1.25 mg
1/2 + 1/4 pill = 3.75 mg

If you don't have a pill cutter, get one (they're cheap). In the meantime, any pharmacist could cut the pills for you.

Laurie


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## Darkcat (May 27, 2010)

Gotcha. I do have a pill cutter. Thanks for the advice. I'll try that.


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## Darkcat (May 27, 2010)

Vet called and suggested cyproheptadine. Anyone have experience with this?
*
*


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## laurief (Jun 22, 2008)

Darkcat said:


> Vet called and suggested cyproheptadine. Anyone have experience with this?


Yes, I have used cypro with a couple of my cats. It is a very effective appetite stimulant in some cats, though it does not work for all cats. Also, if too high a dose is prescribed, it can make some cats very agitated and hyper vocal. It's best started at a low dose and increased slightly if it doesn't help stimulate appetite at the lower dose.

More importantly, however, you REALLY need to try to figure out what's causing the inappetance to begin with. Did the vet suggest decreasing the methimazole dose and/or moving up the date of the next thyroid retest and including a liver and kidney panel? If the vet didn't suggest these things, did you? If your girl is in renal failure, or if the methimazole is negatively impacting her liver, the sooner you know about it, the better.

Laurie


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## Darkcat (May 27, 2010)

I didn't think to ask those things.  You have a good point. We only spoke for a brief minute, they apparently had a lot going on. Do you have any other suggestions as to what I else should ask?

I'm very confused abut her behavior. She ASKS for food. She just won't eat it, or enough of it other than a few bites.


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## doodlebug (May 13, 2006)

Asking for food and then not eating it is very typical for a cat that is not feeling well. It's a symptom of a larger problem.

I've used cypro with good results, but I also knew what was wrong with the cat. You need to get to the root cause of the problem and I, like Laurie, am betting it's the methimazole or her kidneys. 

I think I mentioned that Maggie was hyper-t (she just had radioactive iodine treatment last week). At one point her meds pushed her T4 levels too low and her appetite went down. She was due for a blood test that week (she went in every 2-3 weeks while we were trying to stabilize her dosage) and once her med was reduced her appetite went back to normal in less than 2 days. 

You really need to push the issue with the vet and get her in for a new T4 test asap...7 weeks is way too long. And as Laurie mentioned make sure there is a gap between med time and her test time and be consistent about it going forward. My vet recommended 5 hours.


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## laurief (Jun 22, 2008)

Darkcat said:


> I didn't think to ask those things.  You have a good point. We only spoke for a brief minute, they apparently had a lot going on. Do you have any other suggestions as to what I else should ask?


You may need to advocate strongly for what you want done for your cat. The most advantageous relationship you can have with your vet is one of partnership, not servitude. It is often a mistake to blindly follow your vet's recommendations. If your vet isn't exploring the root of your cat's current problem and is trying, instead, to just treat the symptom, it's up to you to request, and, if necessary, to insist upon the necessary diagnostics.

Your vet is a paid consultant. You are your cat's primary caretaker. YOU have the final word in anything that does or doesn't get done to your cat. You need to communicate what you do and don't want very clearly with your vet. If your vet is too busy to communicate clearly and completely with you, find another vet who can give you and your cat the time and attention you need and pay for.



> I'm very confused abut her behavior. She ASKS for food. She just won't eat it, or enough of it other than a few bites.


That's very typical behavior for a cat who feel nauseous. Nausea doesn't necessarily mean she's not hungry. It just means that the nausea stops her from satisfying her hunger. You need to find out WHY she's nauseous, and the best first step is to get current bloodwork and see if anything shows up that may explain it.

Laurie


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