# Hyperthyroidism



## ktel (Sep 26, 2012)

My cat -Tiger- had his annual vet visit a couple of days ago and his t4 level was high, 99 on a range of 10-60.

Last year the initial test was elevated at 66 but a subsequent test done a few weeks later came back in the normal range.

The vet doesn't recommend re testing this time as it is well out of the normal range.

We're now moving on to treatment options.

It would seem to me that the 2 main viable options are daily medication or radioactive iodine treatment.

I'm definitely inclined to go the medication route (probably transdermal gel) for now ,based on the hospitalization and associated stress with the iodine treatment.

Tiger doesn't really exhibit any of the symptoms of a hyperthyroid cat i.e. irritability,excessive hunger/thirst/urination or weight loss.

However the vet says that's probably because it's in the early stages.

I have done research on secondary problems that can develop from this condition and definitely want to make sure that I take the right course of action to avoid those.

I would appreciate feedback from people that have a hyperthyroid cat and their experiences with treatment and results etc.

I'm still in 2 minds as to whether I should have a second test done or just move forward with treatment.

As regards medication ,I've been told that an initial dose would be given daily for 6-8 weeks at which time another t4 test would be done to see if the dose needed to be adjusted .

Also because of possible kidney problems due to the medication I understand that blood tests/urinalysis should be carried out , I was told annually but I've also read that every 6 months might be advisable.

In terms of diet I feed him wellness wet and dry grain free , I don't know whether I would need to revisit this.

Thanks in advance


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## ktel (Sep 26, 2012)

hoofmaiden said:


> Honestly, if you can afford it by any means, I would consider the I-131 treatment. It is a CURE and it's not really that stressful. The I-131 centers are set up to provide a comfy environment and it's only for a few days.
> 
> Managing hyper-T cats on meds is hard. You have to keep testing and adjusting, and all you're doing is holding off the inevitable. With I-131 you are curing the problem and 99.9% of cats are completely normal afterwards.


Do you have personal experience with your cat and if so did you go immediately with the I-131 treatment or did you try the meds first ?

At the moment I'm considering going initially with the meds and the re evaluating based on his response.

I don't have un limited funds but in my decision making process that's further down the list than choosing the most effective treatment whilst minimizing stress.


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## OSCARSMOM (Jul 6, 2012)

I think Doodlebug's cat went through the radiation recently. I remember reading a post about it. Hopefully she will chime in.


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## doodlebug (May 13, 2006)

Maggie was diagnosed with hyperthyroid last December. Typically you should do meds for at least a few months for two reasons. First, to ensure they stabilize on the meds. Hyper-T is usually caused by a benign tumor on the thyroid, if the cat doesn't stabilize on the meds, it means that the problem is likely caused by something else (e.g. a cancerous tumor). Second reason is that hyper-t can mask kidney disease. Once the meds control the thyroid you need to have blood and urine tests done to ensure the kidneys are functioning properly. If they aren't, then you might not want to spend the money on the I131.

As I mentioned, hyper-t is usually caused by a benign tumor. If you choose meds, the tumor continues to grow and the medication dosage keeps needing to increase. Eventually the medication can no longer control the tumor. The meds also come with side effects. So if the cat is in otherwise good health, then choosing I131 will cure the problem, as opposed to the meds which will eventually fail and by that time the cat may not be able to undergo I131. 

I chose to do the I131 for Maggie, despite her being 15 years old. Her bloodwork showed that she was in great health. I also knew that trying to get meds into her everyday, twice a day was not a challenge that I wanted to take on. I also didn't want the restrictions that twice a day, 12 hours apart meds would put on my life. Late or skipped doses are likely to make a hyper-t cat sick. And I was planning to get a dog in the spring and figured that the additional stress would just complicate things even more.

My first challenge was the vet that diagnosed her...he wanted to start her on 5mg twice a day. Everything I read said start at 1.25 twice a day. I ended up cutting the dose down myself and found another vet. I started with transdermal gel. Within a few days, she was avoiding me like crazy and every dose I had to come up with some new trick to let me get near her. Then I switched to treats, which she would only eat if I cut them into 4 pieces and rolled them in freeze dried chicken dust. But that worked OK for the long haul (which was 3 months). We upped her dose once and then she went into hypothyroid and we had to lower it. She stabilized at 2.5mg twice a day. Had I started her at 5mg twice a day like the first vet wanted to, it probably would have killed her.

Once she was stable and her blood results looked good, I scheduled the I131 treatment. It was done in Massachusetts at a RadioCat facility. I mention this because different states have different quarantine requirements, so you'll need to find out what it is where you live. Treatment was $1500, but that didn't include the blood tests and x-rays that needed to be done the week before the treatment. In total I think it came to about $2000. 

She had to be fasted the night before. Meds were stopped two weeks prior to treatment. Dropped her off on a Monday, they did the treatment (it's just an injection) that afternoon and I picked her up on Thursday noonish. So she was there for 3 full days. She did fine, but seemed very happy to see me and go home. At home she had to use flushable litter (World's Best) for 2 weeks and I wasn't allowed to cuddle her or have her on my lap for more than 1/2 hour a day for two weeks. She doesn't cuddle with the other cats, so that wasn't an issue...but if she did it would have been the same restriction. Since she sleeps with me, right up against me, I had to segregate her at night in a spare bedroom, but she didn't give me any problem at all.

Her post treatment thyroid numbers are on the low end of normal. The rest of her blood test numbers are fantastic for a cat her age...her kidney numbers were the same as 3 years ago. She had one complication...about 3 months after treatment she started shedding like crazy, seriously dry brittle coat coming out by the handfuls. Googled around and found out that it's an uncommon side effect. Added some fish oil to her diet, brushed her twice a day and it took about 3 months to get back to normal. 

She turned 16 a few weeks ago, she's happy, healthy and still spunky.


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## ktel (Sep 26, 2012)

Hi Doodlebug

Thanks very much for the information

I want to make sure that I am as informed as possible before moving ahead.

I have a lot of questions that I am going to address with the vet today but am also looking to connect with other people in the same situation.

The more I read and think about this the more inclined I am to look into the I131 option.

I want to make sure that I make the right decision based on the best outcome whilst minimizing his stress.

I don’t like the idea of the hospitalization with the I131 but with the medication option there would appear to be numerous side effects and he would still have to go through regular visits and blood tests.


Tiger doesn't really exhibit any of the symptoms of a hyperthyroid cat,

His behavior’s good, he's eating normally, I haven't noticed any excessive urination, no diarrhea, no vomiting etc.

This morning he did seem to drink quite a lot but typically he tends to drink once in the morning and once in the evening when he has his food, which doesn't seem excessive.

He’s pretty active and vocal but he's always been that way.

He's at a healthy weight-11.7lbs- and this has been stable over the last 3 years. Prior to that he used to be a pound to a pound and a half heavier. 

However despite no clinical signs the vet says that's probably because it's in the early stages.

I'm still in 2 minds as to whether I should have a second test done to confirm the diagnosis or just move forward with treatment. I’m not sure if the T4 test he had done was total or free so I should probably ask about that. 


The vet said his blood panel showed that all his organs are functioning normally however I was wondering if an EKG would be recommended to test heart function. 


As regards medication, I've been told that an initial dose would be given daily for 6-8 weeks at which time another t4 test would be done to see if the dose needed to be adjusted.

Everything I have read indicates the re testing should be done after 3 weeks, my vet follows the 6-8 week protocol.

I was wondering if this could be a problem not testing earlier?

I am trying to decide if I should try the transdermal gel or the pills. I can see him getting annoyed with the gel application so perhaps the pills in pillpockets might be better

Did your cat have any side effects or digestive problems with either the gel or pills?

I spoke to the vet’s assistant regarding dosage and she said 0.5mg is to be given twice daily.

This seems to be a lot lower than the 1.25-2.25mg that I’ve been reading about although I understand it’s better to start low and move up slowly to prevent the risk of hypothyroidism.


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## doodlebug (May 13, 2006)

ktel said:


> I want to make sure that I make the right decision based on the best outcome whilst minimizing his stress.
> 
> I don’t like the idea of the hospitalization with the I131 but with the medication option there would appear to be numerous side effects and he would still have to go through regular visits and blood tests.


My thoughts were that with the regular vet visits and blood tests, twice a day meds and me constantly hovering (why is she so hungry today, does she look like she lost weight etc.) would be way more stressful than a few days spent at the vets. It's not 3 days of constant poking and prodding, they receive an injection and then are pretty much left to hang out...just daily care and petting/play if they're interested.



ktel said:


> However despite no clinical signs the vet says that's probably because it's in the early stages.
> 
> I'm still in 2 minds as to whether I should have a second test done to confirm the diagnosis or just move forward with treatment. I’m not sure if the T4 test he had done was total or free so I should probably ask about that.


When he had the second test last year, what was the number? If it came back on the high side of normal I think that's pretty indicative along with this year's test that there's a problem. Hyper-t is one of those things that slowing creeps up over time. A cat without thyroid disease usually has values on the low side of normal. The test you had was probably a Total T4. Doing a Free T4 on a cat with a high Total 4 doesn't provide any additional info. It's typically only used on cats with hyper-t symptoms and a Total T4 within normal limits. Free t4 will catch 6-7% more cases than Total. 



ktel said:


> The vet said his blood panel showed that all his organs are functioning normally however I was wondering if an EKG would be recommended to test heart function.


There's no way for your vet to know that his organs are fine at this point. Hyper-T causes organ function to speed up and can mask failing kidneys. You need to get the numbers down to normal and do another blood test.



ktel said:


> As regards medication, I've been told that an initial dose would be given daily for 6-8 weeks at which time another t4 test would be done to see if the dose needed to be adjusted.
> 
> Everything I have read indicates the re testing should be done after 3 weeks, my vet follows the 6-8 week protocol.
> 
> I was wondering if this could be a problem not testing earlier?


6-8 weeks is way too long imo. Maggie went into hypo-T in under 3 weeks. I noticed a significant change in her behavior at about 2-2.5 weeks.



ktel said:


> I am trying to decide if I should try the transdermal gel or the pills. I can see him getting annoyed with the gel application so perhaps the pills in pillpockets might be better
> 
> Did your cat have any side effects or digestive problems with either the gel or pills?


I think you'll just have to experiment and see how it goes. I found that the extra $$ for the treats were well worth it.



ktel said:


> I spoke to the vet’s assistant regarding dosage and she said 0.5mg is to be given twice daily.
> 
> This seems to be a lot lower than the 1.25-2.25mg that I’ve been reading about although I understand it’s better to start low and move up slowly to prevent the risk of hypothyroidism.


Starting slow is the way to go, but .5mg per day seems really low...but being really conservative is better than overloading so if that's what they want to do, I'd be fine with it.


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## ktel (Sep 26, 2012)

*yes it seems low, however that information was given to me by the receptionist so I'll double check with the vet when I speak to her on Monday*


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## doodlebug (May 13, 2006)

45 is still pretty up there. You can do a retest, but I suspect you're seeing progression of the disease.

I've never really had any luck with pill pockets, they always seem to find the pills and spit them out. A compounding pharmacy can mix the medication into a treat "potion" that is poured into molds and refrigerated. They're similar to the soft and chewy type treats (Zuke's, Perfect Bites etc.). It's mixed at whatever dose you need. One treat in the morning, one at night. Most cats will eat them right up. Maggie is a bit fussy, so I rolled them in freeze dried chicken dust and she was happy.


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## ktel (Sep 26, 2012)

doodlebug said:


> 45 is still pretty up there. You can do a retest, but I suspect you're seeing progression of the disease.
> 
> it was 45 based on arrange of 10-60 so was considered normal
> 
> ...


Excuse my ignorance but when so say a compounding pharmacy, is that something that is arranged with the vet?


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## doodlebug (May 13, 2006)

The vet should know what pharmacies in the area do compounding work and they have to call in the prescription to them. You can also find compounding pharmacies online, your vet would likely write a prescription that you can fax or scan/email to them. 

Here's a link to the local place I use so you can see some more info:

Veterinary : Wingate's Pharmacy: Compounding Pharmacy, Veterinary Compounding Pharmacy, & Women's Health Compounding Pharmacy Nashua New Hampshire


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## ktel (Sep 26, 2012)

ktel said:


> Excuse my ignorance but when so say a compounding pharmacy, is that something that is arranged with the vet?


I have looked into this a little further and from what I understand it can be compounded into the transdermal gel , liquid form or chewy treats most likely through my vet but I would need to check on that.

I am trying to decide which way to go but was thinking I might get both the gel and the pills initially and see which he tolerates

With the pills i was thinking of putting into pockets or mixing with wet food

can the pills be crushed do you know?

Regarding the chewy treats , he is missing a few teeth so I don't know if that would work, it would depend on the size and how much they need to be chewed.

I feed him both wet and dry food but as the kibble is fairly small i don't know how much he actually chews- I hear him crunching on that a bit but I think he 

likely is swallowing a lot of it.


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## SamSim (Oct 7, 2012)

Meenu has been diagnosed with hyperT as well within the last few months! We just had her second visit and blood test on tuesday. When I asked what her numbers were on her first test, the vet told me its a different system from the second test, and that her levels were off the charts, at least 2x the normal amount that it should have been, and over the readable limit, does this make sense? Her second test came down to a whopping 86 with the normal 10-60 that everyone is saying. The vet is not upping her dose and is having us come in for a recheck at the end of the month.

Im glad in one way that someone has a hyperT experience and sorry at the same time that it's happened. I was unaware that the tumor would keep growing despite the use of the pills and that the pills will eventually fail, so thank you for that info doodlebug I will have to possibly contemplate the the other option for the future.

Unlike Tiger, Meenu had lost A LOT of weight and had started puking up her food, either then that, she seemed to eat normally, drink normally, and did not pee any more then any other cat. We had gotten her 2 yrs ago this november and she was overweight (13 lbs). The vets wanted her to shed 3 pounds so we went to work getting her leaned up. Within the last year our so we had found her getting sick, puking many times in the week. It was constant and I was adamant that something was wrong, but others told me "oh this is normal for indoor cats, all my indoor cats were like this when I grew up". I had never had a strict indoor cats (growing up on a farm my cats were indoor and outdoor), and thought I would trust my loved one's opinion, figuring my cats when I grew up got sick outside?? I didn't know any better.
This july I had had enough and brought her to the vet who said she just had a food allergy. By this time she went past the 10 lb weight mark all the way down to 8... A month after switching her and she was puking again. So we drew some blood and she was diagnosed. I look back on it all and wish I had trusted my instincts earlier...I'm not a bad cat mom and I love me Meenu very much. Now we are doing the best we can for her with what we have.

doodlebug, I would like to know a bit more about these pill treats? Do you know if and where you can get them in Canada? I also tried the pill pockets and she wont even eat the treats without the pills in them so that was a bust. Although Meenu is a big pro at taking pills, she puts up absolutely no fuss so I am lucky in that case. I have heard the gel is possibly a little more unpredictable then the pills in terms of the dosage (could possibly overmedicate by putting too much gel on the ear?). I unfortunately do not have the funds currently for the radioactive iodine treatment, and since Meenu is doing well so far on the pills (aka taking them easily, no stress, and has already gained back a pound in between the vet visits!), I will be sticking with them. She is only 9, which seems a little on the young side for a hyperT kitty, so hopefully in that time I can save for the iodine treatment and hr kidneys will still be ok...

Hopefully we can learn and help each other out, ktel, good luck!


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## doodlebug (May 13, 2006)

ktel said:


> can the pills be crushed do you know?
> 
> Regarding the chewy treats , he is missing a few teeth so I don't know if that would work, it would depend on the size and how much they need to be chewed.


I never tried the pills on Maggie, but I seem to remember reading that they taste pretty bad. But you'll want to confirm that. Not sure about crushing them...it might mean that the med is released into the system too quickly and bring the levels down too fast or clear the system too quickly.

The chewy treats are a fairly good size, but you can cut them up. I cut Maggie's into 4 pieces. So she thought she was getting 4 treats...bonus!


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## ktel (Sep 26, 2012)

Hi Samsim,

I only just got the diagnosis yesterday and am doing a lot of research at the moment.

I'm feeling a little overwhelmed to say the least.

I just want to make sure that I don't embark on any unnecessary treatment so am inclined to have a second blood test done first to confirm the diagnosis.

If Tiger had any real symptoms I would move ahead without a second test

Once that diagnosis has been confirmed then I think I'll be looking into the iodine treatment 

However from what I understand medications need to be taken first anyway to get the t4 to normal levels and then check that there aren't any other issues with kidney function or anything else that would need to be treated or prevent him being a suitable candidate.

I have a long list of questions for my vet who I'll be talking to on Monday.


Regarding the medication I and trying to work out whether to use the pills or gel.

I think I may try in the pills in pockets first to see if that works ok and if not try the gel

The treats idea is a good one , I am thinking that I'll go that route if the other 2 options prove problematic

Following his dental surgery a few years ago I did have to use a transdermal gel and a liquid medication every day for a 10 day period

He didn't appreciate it too much but tolerated it, he did get annoyed with me touching his ears so I'm not sure that's the best option for a longer period of time.

I've also used pills in pockets and from what I recall he was ok with them


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## doodlebug (May 13, 2006)

SamSim said:


> Meenu has been diagnosed with hyperT as well within the last few months! We just had her second visit and blood test on tuesday. When I asked what her numbers were on her first test, the vet told me its a different system from the second test, and that her levels were off the charts, at least 2x the normal amount that it should have been, and over the readable limit, does this make sense?


Maggie's number was off the chart on her first test too. The labs here use a different scale, normal is .8-4.0. The top of the range something like 8 and she was over it. Her first follow up after meds was in the sixes.

She hadn't lost a lot of of weight (3/4 lb) but she was vomiting and shedding a lot. I knew something wasn't right, but she didn't seem to be in crisis and it was December and I own a retail store. So I planned to get her into the vet right after New Year's. But she had other ideas and had a bit of a crash the week before Xmas. 

I don't know of any compounding pharmacies in Canada, but you should be able to google it for your area. Although, since she's OK with being pilled I probably wouldn't mess with it...pills are a heck of a lot less expensive.


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## ktel (Sep 26, 2012)

doodlebug said:


> I never tried the pills on Maggie, but I seem to remember reading that they taste pretty bad. But you'll want to confirm that. Not sure about crushing them...it might mean that the med is released into the system too quickly and bring the levels down too fast or clear the system too quickly.
> 
> The chewy treats are a fairly good size, but you can cut them up. I cut Maggie's into 4 pieces. So she thought she was getting 4 treats...bonus!


That's for the information on the treats as that will be an option if the other 2 methods don't work

Between the pills and gel I'm getting the general impression from what I'm reading that pills might ensure a more consistent dose/uptake than the gel
but the gel causes less digestive problems

I'm not too clear which one would be best at this stage


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## SamSim (Oct 7, 2012)

ktel, JUST A THOUGHT but... tiger may also not appreciate being given pills with his dental issues either. I would just say to try either and say which works best. Because she's done so well with pills, I did not bother worrying about alternative methods (thankfully). I would also suggest the redo test like you were thinking (trust your instincts!). It has already been a month and I am still wondering if there is more to hyperthyroidism then what I have gotten so far. I am glad this thread has come up!

When I first heard of hyperT, all I saw was it was life long and that it cant get better, which scared the cr*p out of me! But it is manageable, treatable, and from what i know, does not limit their lifespan provided its properly monitored and treated as soon as its identified. In the end, it could have been much worse.

Get that second blood test if your gut tells you to, and from my perspective, its only reasonable to get retested every 3 weeks and not every 6-8 weeks because (usually) prescriptions are given on a monthly basis, so why not be tested before the pills run out in case tiger will need a bigger dose? 

In your case, Tiger's levels don't seem INCREDIBLY horrible, which means (if he has it) you caught it early and that your request for a second test is understandable. Also, because of the slight height in T4 levels, perhaps your vet is staying on the safe side by suggesting such a low dose? Like doodlebug said, it's better to start low and then heighten it up if it's not helping. It was nice to see the drastic change with Meenu after she started her pills, hasnt puked since and the weight gain is great to see. 

Do you feel like perhaps the pills may be too much because he seems so fine? I was just wondering... I would feel the same if Meenu had no exact signs either : )


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## ktel (Sep 26, 2012)

Tiger doesn't have dental issues right now it was just that a few years back he had a few teeth removed which would mean something larger that needed to be chewed might be an issue

My instinct tells me to have a second test to be sure.

When was your cat re tested following the medication- how many weeks afterwards?


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## SamSim (Oct 7, 2012)

ktel said:


> Tiger doesn't have dental issues right now it was just that a few years back he had a few teeth removed which would mean something larger that needed to be chewed might be an issue
> 
> My instinct tells me to have a second test to be sure.
> 
> When was your cat re tested following the medication- how many weeks afterwards?



My apologies, I didn't mean he had bad dental issues or anything, I was just trying to give another way of thinking about it IN CASE you find that he doesnt like the pills and find yourself wondering why he might be so perturbed about it. All guess-timations  ! Sorry if I offended!

Meenu was re-tested Oct 29th, this past tuesday. She was diagnosed with hyperT on Oct 4th and given her first dose of medication on Oct 6... so basically 3 weeks after first medicating, she was re tested, and with the second test results in, the vet opted away from changing the dosage just yet. We will keep her on the same dose (2.5 mg twice a day) for another month and re test.


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## ktel (Sep 26, 2012)

Hi Samsin,

I wasn't offended at all , I'm sorry if my response made it seem that way! .

I'm weighing up the various options but it's all speculation until I actually try it out 

Did you see a change in T4 level on the retest by the way?


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## SamSim (Oct 7, 2012)

Oh yes a huge jump down apparently. The vet told me the changes over the phone, so I didnt get to see the actual tests, and I was a little confused because she couldnt give me the same scale for the first test as the second test (guessing it was the free T4 vs the other T4 test discussed in previous posts by doodlebug), but the second test showed her levels to actually be "recognized" on the charts, whereas the first one they could not actually give a number becuase her levels were past the reading charts! 

It's down to 86 now out of the average of 10-60, and she said that technically her first test showed at least DOUBLE that amount :| So it did help. And she is on 2.5 mg twice daily. 

That's why I'm also guessing that your vet is only prescribing a tiny dose (because at least tigers levels werent too too high).

Happy trial and error! And dont get discouraged. Like I said, my first vet diagnosed me with the LEAST serious thing that it could be first (a food allergy since she was vomiting). If she had done blood tests, we would have known earlier. Do I regret not being adamant to that vet about getting tests? No, as I believe she didnt want to jump to conclusions of hyperthyroid. And with us telling her she didnt overly eat nor drink, who could blame her?
Re-test if it would give you peace of mind and also a 100% indication its hyperT. Once you're convinced it is hyperT, I would try the pill first since I believe it's cheaper (even moreso if you take the perscription to a pharmacy and fill it yourself: my perscription at the vet=50$ vs at the pharmacy=18$). I havent personally seen any digestive upsets from Meenu since starting them, but you never know, all cats are VERY different 

If you do decide on that second test, please keep us in the know! Hopefully it was just an abnormal spike but you can never be too careful.


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## laurief (Jun 22, 2008)

ktel,

I have 3 hyperT cats and had a 4th (RIP), all of whom I have managed on medication. I choose to use carbimazole rather than methimazole, because carbimazole is less likely to cause the stomach upset that is a fairly common side effect of methimazole. Carbimazole converts into methimazole AFTER it leaves the stomach, which is why it doesn't usually cause stomach upset. Transdermal gel offers the same benefit. It bypasses the GI tract so that it usually does not cause digestive upset. HOWEVER, there are some cats who will experience GI upset even with transdermal methimazole or carbimazole, or oral carbimazole. The best bet is the "start low and go slow" approach to dosing that has already been discussed on this thread. Both of these drugs are very powerful, so it's easiest on the cat's system if they are introduced at low dose to allow the body to adjust to the drugs' effects. If your cat is prescribed methimazole, the recommended starting dose is 2.5 mg twice daily (1.25 mg twice daily if there is known renal insufficiency). If your vet prescribes a higher starting dose, tell the vet that you are not comfortable starting at a higher dose and would rather start with a low dose, retest in 3 weeks, and adjust the dose at that point, if necessary. 

I have my cats' carbimazole compounded into liver flavored chews. Three of my cats gobble(d) them up like treats. The fourth makes me put the chew on the back of his tongue before he'll swallow it. If you Google "veterinary compounding pharmacy canada", you'll find a number of pharmacies where you might be able to get your cat's thyroid med compounded into chewables. Then all you'd need is a prescription from your vet.

I would NOT recommend crushing or otherwise mixing thyroid medication into your cat's food, because you would have no way of knowing if the full dose was ingested. If you want to give the med as a liquid, have it compounded into a flavored liquid, instead.

As has already been noted, feline hyperT is usually caused by a benign adenoma of the thyroid gland. Medication prevents the overproduction of thyroid hormones by the diseased thyroid tissue, but it does NOT slow or stop the growth of the adenoma. As the adenoma grows and causes more hormone production, a higher dose of medication will be necessary to control it. This is why a cat on thyroid medication needs to have bloodwork run several times a year to check thyroid hormone levels and adjust med doses, if necessary. As I already stated, these are very strong drugs with potentially very serious side effects in some cats. They don't cure or slow down thyroid disease. Even thyroidectomy surgery can't guarantee a cure because diseased thyroid tissue can occasionally exist outside of the thyroid glands themselves. 

The only cure for hyperT is I-131. It's curative in more than 95% of hyperT cats with a single treatment. Rarely, a cat may require a second I-131 treatment, and even more rarely a third. As someone already noted, bloodwork can't reliably rule out renal problems in a cat with uncontrolled hyperT, because uncontrolled hyperT can cause ailing kidneys to work hard enough to "look" healthy in bloodwork. The only way to know whether or not your cat's kidneys are healthy is to get his T4 back in normal range (euthyroid) with medication, then run bloodwork to check renal values. This is important, because many I-131 clinics don't feel that a cat with renal insufficiency is a good candidate for I-131 and is better off being managed with medication, instead. For this reason, many I-131 clinics require a methimazole trial first to accurately assess renal health.

I'll post more later, but I have hungry kitties to feed at the moment.

Laurie


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## SamSim (Oct 7, 2012)

doodlebug said:


> Late or skipped doses are likely to make a hyper-t cat sick. And I was planning to get a dog in the spring and figured that the additional stress would just complicate things even more.


My fiance and I have also had a dream of getting a dog, we've been fostering because we want one so bad. With me pilling meenu though, I am also unsure of how I can handle so many different schedules.

I was wondering how "on the dot" you have to be with the 12 hr pilling schedule? My fiance likes to think I am completely anal about needing to give Meenu her medication in 12 hrs intervals on the dot. If I do (hopefully not ever) miss her pilling time by an hour or two... How adverse would that be? She gets fed at the same time as she gets her pill so I doubt that will change anytime soon but... I just want myself (and my fiance) to be informed. Also if we do want to start pilling her at a different time, would there be recommended acceptible increments of time to help her switch to the new time? Anyone have suggestions?


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## ktel (Sep 26, 2012)

Thanks for the information Laurief,

When I spoke to the vet's receptionist over the phone I believe she said that their pills are carbimazole and the trans dermal gel methimazole.

I was thinking of getting a supply of both initially and seeing if he will take the pills and if not move to the gel.

I want to investigate the idea of getting a prescription from the vet and having it filled at a pharmacy as it would appear that it works out much cheaper this way.

I'm not sure if the vet would be ok with that, they didn't mention that option and said I could pick it up there.

The idea of compounding it into treats is good to know and I was thinking of looking into that if he is resistant to the other methods


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## ktel (Sep 26, 2012)

Hi Samsim

Could you tell me which pharmacy you go to

Is it a regular pharmacy or one for pet meds?


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## SamSim (Oct 7, 2012)

ktel said:


> Hi Samsim
> 
> Could you tell me which pharmacy you go to
> 
> Is it a regular pharmacy or one for pet meds?


I just asked them to write the perscription out and i will pick it up. They didnt ask any questions and if they had i would have blamed it on the travelling (we live an hr from the office). I just take it to a normal pharmacy where you or i could get perscriptions filled. All they asked was if it was for my i dog. I told them a cat and they said ok.


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## laurief (Jun 22, 2008)

ktel said:


> When I spoke to the vet's receptionist over the phone I believe she said that their pills are carbimazole and the trans dermal gel methimazole.


In the U.S., carbimazole is only available through compounding pharmacies. I know that it's available in England as a regular prescription. I'm not sure about its availability in Canada. In any event, it's important to note that carbimazole and methimazole are dosed differently, so they're not directly interchangeable. If you start with one and switch to the other, you'll have to go through a second period of retesting and dose adjustments to achieve and maintain euthyroid.



> I want to investigate the idea of getting a prescription from the vet and having it filled at a pharmacy as it would appear that it works out much cheaper this way.


That's certainly the case a lot of the time in the U.S., but I don't know how much Canadian vets typically mark up their med prices.



> I'm not sure if the vet would be ok with that, they didn't mention that option and said I could pick it up there.


Never hurts to ask.

Laurie


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## OSCARSMOM (Jul 6, 2012)

Felix was diagnosed with HyperT about a year after he was diagnosed with cardiomyopathy, so he was not a candidate for the I-131 treatment. Neither our vet or Felix's cardiologist was a fan of the transdermal gel, for the same reasons already mentioned.

I had several of his meds compounded in a liquid form, including his methimazole, for the days that I just couldn't get him to take his pills. The compounding pharmacy gave me samples of their treat flavors, but Felix didn't like any of them, so I went with the liquids. I would put out about a 1/2 tablespoon of food and mix the liquid methimazole into it; Felix liked the flavor so he would eat it mixed with the food. I mostly gave him the pills because his compounded meds were about $180 a month vs about $40 a month for pills. So, we saved the compounded stuff for his "no I won't take my pills" days.

I went through several methods of getting him to take his pills. There was no way we could just pop a pill in his mouth - even his vet couldn't do it! 

Pill Pockets worked for awhile - I found the trick was to not use the entire pill pocket, but just enough to wrap the pill so that he wouldn't taste it. (Be sure you don't handle the pill pocket with the same fingers you use to handle the pill.)

I also used Tender Moments treats - they were soft enough to mold around the pill.

The last method was to put the pill in an empty gel capsule (I got them at my vet's office.) I would then bury the gel capsule in his favorite food and he would usually eat it. I am now using that method with our other cat, Oscar. With him, I have to crumble up a treat and roll the gel caps in them and then put them in his food.

Hope this helps.


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## ktel (Sep 26, 2012)

I will make sure that I use the same medication and not inter change 

I'll be speaking with the vet to clarify what they have on Monday

It's good to know that the carbimazole causes less stomach upsets

I had been planning to try the pills first and if he doesn't take them then move to the gel

Regarding the compounding if i do go that route then I suppose I would need to get a prescription from the vet anyway to get it made up at the other facility.

Do most of you do that or do you also buy the meds from the vet?


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## doodlebug (May 13, 2006)

The gel was not available through my vet so I had to go to a compounding pharmacy. The vet only had pills.


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## ktel (Sep 26, 2012)

I have a question about the blood work that is done after administering the medication .

I understand that this is typically done after 3 weeks , adjustments made to dosage if necessary and then tested after another 3 weeks until the T4 levels are in the normal range.

However I would like to know if the blood work done is only to check T4 or should a more comprehensive panel be done to monitor any potential side effects of the meds.

I have been reading that the meds can cause anaemia and kidney issues and that if so it would be important to catch this early.


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## doodlebug (May 13, 2006)

I'm trying to remember what we did...I think it was just a T4 level after 3 weeks and a full blood panel at maybe 6 weeks. And then she had one more complete test just before I131, which was another 5-6 weeks later.


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## laurief (Jun 22, 2008)

Since I am not made out of money, this is the way I handle blood retesting during the med dose adjustment period. I check only Total T4 three weeks after every dose adjustment UNLESS the cat is exhibiting symptoms that indicate a possible kidney or liver problem (inappetance, vomiting, diarrhea, lethargy, weakness, yellow mucous membranes, etc.). Assuming none of these symptoms are present, I wait until the TT4 has lowered enough that I can reasonably expect the next retest to show euthyroid, then I request a full blood chemistry, TT4, and CBC for that final test.

Please note that normal TT4 for an older cat is at the lower end of the reference range, so don't be satisfied with a TT4 in the upper half of the reference range UNLESS the cat also has renal insufficiency (I'll explain more about the connection between hyperT and CRF later).

Laurie


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## ktel (Sep 26, 2012)

laurief said:


> Since I am not made out of money, this is the way I handle blood retesting during the med dose adjustment period. I check only Total T4 three weeks after every dose adjustment UNLESS the cat is exhibiting symptoms that indicate a possible kidney or liver problem (inappetance, vomiting, diarrhea, lethargy, weakness, yellow mucous membranes, etc.). Assuming none of these symptoms are present, I wait until the TT4 has lowered enough that I can reasonably expect the next retest to show euthyroid, then I request a full blood chemistry, TT4, and CBC for that final test.
> 
> Please note that normal TT4 for an older cat is at the lower end of the reference range, so don't be satisfied with a TT4 in the upper half of the reference range UNLESS the cat also has renal insufficiency (I'll explain more about the connection between hyperT and CRF later).
> 
> Laurie


Thanks for the information, that seems like a good plan of action.

I'm definitely not comfortable with the first test after 6-8 weeks as has been suggested by the vet


I'm assuming that TT4 is total T4

I'm not sure what test was done for tiger- I'm going to check on that
I know the range is 10-60.

However I was wondering if it's a good idea to have total t4,free t4 and tsh tested to be sure of the hyperthyroid diagnosis

I'm asking as Tiger really doesn't have any clinical signs of the disease and I don't want to move forward before I'm sure as treatment itself has it's risks

Of course if he is hyperthyroid then I would want to move forward as soon as possible


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## laurief (Jun 22, 2008)

ktel said:


> I'm assuming that TT4 is total T4


Right



> However I was wondering if it's a good idea to have total t4,free t4 and tsh tested to be sure of the hyperthyroid diagnosis


I, personally, wouldn't bother IF the previous test was a Total T4. But if you're not satisfied with the validity of the results, then go ahead with the full thyroid panel. Be sure to fast your cat for 8-12 hrs prior to the blood draw.

Laurie


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## razzle (May 20, 2010)

Razzle was diagnosed when he was 15. I tried the meds but he just threw up so i did the iodine treatment. It was great. He stayed at the vets for 3 days. It cost a total of $1300.00 in MA. I didn't have to do any x-rays or blood test before it was done. I would do it again.

Kathy


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## Sucha (Apr 28, 2012)

Ktel,
My Nala was diagnosed in 2007 with Hyper T. I took her to the vet because I noticed weight loss, vomiting, excessive drinking and eating. She also had behavior issues. I don’t remember her numbers, but the vet informed me of the options of medicine or the iodine treatment. 
Since Nala was not the best patient when it came to taking pills, I decided to go for the Iodine treatment after doing some research. Trying to give her a pill every day would have been more stressful than 3 days away. A friend’s cat had the treatment and did very well, so that also helped me make my decision. 
Like Doodlebug, I took Nala to the vet (RadioCat in IL) on a Monday, and picked her up on a Thursday or Friday. She too was very happy to see me when I came to pick her up, kneading and purring in the cat carrier while I paid for her treatment, so I don’t feel she was stressed out at all. 
She responded very well to the treatment and lived almost another 5 years. I would highly recommend the Iodine treatment. Keep us posted on your decision and on Tiger’s health.


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## ktel (Sep 26, 2012)

Tiger had a second T4 test and that also came back high- 91 on a 10-60 scale

Also there has been an increase in his water consumption over the past week or so.

We have begun medication.

I am using the transdermal gel at a dose of 1.25mg twice a day

We will be resetting his T4 and other blood values in 4 weeks time

I'm interested in how much people pay for the trans dermal gel

My vet charges $46 for 4 syringes at 2.5mg/0.1ml

Thanks


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