Diabetic, HYPOthyroid after having radioiodine I-131

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mislissa777

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Hi,
I was wondering if anyone has a diabetic kitty that is also hypothyroid. Trina was hyperthyroid & had radioiodine I-131done at the end of Nov. She is now hypothyroid & the Dr. wants to start her on the supplement Levothyroxine (generic Synthroid). As I"m reading about thyroxine online,numerous sites say to use caution when giving it to a cat with diabetes. It can interact with the insulin. I"m not quite sure what "interact" with insulin means. So that is concerning & worrying me. I am going to start the med. this weekend when I will be home to monitor her to make sure there is no reaction to the thyroxine. I'm also getting conflicting info. regarding whether to give it once or twice a day. The Dr. initially said twice & day & then changed it to once a day. But some friends are telling me twice a day would regulate the thyroid better. And also, some websites & a few people said to give the med. on an empty stomach either 1 hour before feeding or 2 hours after feeding. Thyroxine comes in liquid & pills. I got the pills & am planning on using pill pockets. But now I am concerned that the pill pockets will interfere with the absorption of the thyroxine into the thyroid. Since the pill pocket will be wrapped around the pill then she won't really have an empty stomach. I only use a tiny piece of the pill pocket to wrap the pill in but I'm now wondering if I should use the liquid instead. I'd rather use the pills but only if I can give them in a pill pockets. So I was just wondering if anyone has experience/info. using levothyroxine.
Thanks!
Missy
 
Hi, I don't have a diabetic with this issue, but I have a friend whose cat has just had the hypo t condition caused by i131. I have found some information, which I will paste for you and also let you know that in researching this for her, I learned that the condition is almost always temporary. That means you will need to continually test the thyroid until she's off that med because the dose will likely need to be reduced, and maybe repeatedly.

Now how it interacts with diabetes. From everything I can tell, it MAY make the diabetes worse ie: you'll possibly need more insulin. If you do increase the insulin, be wary during dose changes and weaning off of the Levothyroxine as you may need to change insulin doses as a result.
http://www.drugs.com/disease-interactio ... oxine.html
Thyroid Hormones (Includes Levothyroxine) ↔ Diabetes
Moderate Potential Hazard, High plausibility
Applies to: Diabetes Mellitus, Diabetes Insipidus
Since hypothyroidism often obscure or diminish the signs and symptoms of endocrine disorders such as diabetes mellitus or diabetes insipidus, thyroid replacement therapy may aggravate the intensity of symptoms associated with these conditions. Patients with endocrine disorders should be monitored more closely during thyroid hormone therapy, and their medication regimen adjusted accordingly. If thyroid medication is later discontinued, a downward readjustment of insulin or oral hypoglycemic agent may be necessary in patients with diabetes mellitus to avoid hypoglycemia.

From everything I know, thyroid meds are like insulin, they need to be given BID, so I'd ask the doc why the change. re: the Pill Pocket.. you might want to try liquid if you're concerned. I see the reasoning for the empty stomach is to ensure proper absorption, and that's gonna be important for you IMO
 
Conor was getting it only once a day because his dose was so low. Just because humans should take it with no food on board doesnt mean kitties have to. My vet said it didnt matter.

Many drugs say to use caution in diabetics because its a CYA thing, and they want diabetics to tell their doctor about it. Conor is not diabetic so I cant say wether its an issue with cats or not.
 
HI,

my kitty Snuggles has been diagnosed HYPOthyroid as well. He had SRT radiation therapy in August to radiate a pituitary tumor called acromegaly that was causing his extremely insulin resistant diabetes. HYPOthyroid can be a side effect of that treatment, however, looking at Snuggles records it seems he was HYPO before treatment. He started on .1mg Levothyroxine once daily 3 weeks ago and he's been so much better on it. Before he was very lethargic now he has alot more energy. I give it with or without food, doesn't seem to make any difference. As far as the ineraction w/ insulin goes I don't think it means some scary side effect (I've been giving up to 3 u BID Lantus to my boy while on the med) but I could see how that it would be possible that you may need to up the insulin dose if for some reason the meds caused the endocrine system to rev up a bit- no big deal esp since you are home testing and can adjust accordingly. Because of my cats Radiation therapy working, I now only have to give him .5-1.0 unit insulin every 36 hrs the past week so I can't tell any adverse effect on the diabetes from the meds b/c my cat doesn't have traditional diabetes, and hopefully will be OTJ any day now from the radiation working. I will get his T4 levels tested early next week so I will post them here. It will show if we have to up the dosage or stay put. He does seem to have more energy in the evening and I do give him his pill at 6pm, but that could just be his schedule . I did wonder about splitting up the dose 2x a day though so I will inquire to my vet about food/no food , once vs twice daily... But like I said my cat seems to be doing so much better on the meds, no scary interaction w/ the insulin, food doesn't seem to matter. But I agree start it when you are home for the weekend, so you can monitor for anything. I hope I was able to answer your question.
 
Just a very quick comment here :

Is your vet 100% sure that Trina is HYPOthyroid? It certainly is possible, especially after treatment for HyperT, but before treatment is started, you may want to be very sure.

There is something called Euthyroid Sick Syndrome. That means that other conditions (such as diabetes!) can affect the T4 and show falsely low readings, and since Trina is also a sugarcat, that needs to be double checked.

If your vet is unsure, run a Free T4 or a T3 and check that they are also confirming the Dx of HypoT.

Good luck!
 
Thank you everyone SO much for your helpful responses!!!! I also belong to a few thyroid forums on Yahoo & thanks to them I was informed of newer testing being done on the thyroid after having radioiodine done. So Trina has now had 2 full thyroid panels which includes T3's, T4's & TSH. The Endocronogists are continuing to learn & research about how to handle hypothyroid kittys. So the internal Dr. that did Trina's I-131 thinks she is hypo. And so do the members on the thyroid group. So it looks like she will be starting the thyroxine this weekend! As much as I want to try the liquid I"m worried it will upset her becuase my poor kitty also has an itching issue going on & has been wearing an e-collar since August. And the mornings are a little stressful because when I leave for work I have to put the inflatable ecollar on her & she's not crazy about that. When I"m home I keep a more open flexible/soft one on her. But my main reasong for doing I-131 was because we thought her facial itchingn was a reaction to the tapazole she was taking for hyperthroidism. But she is STILL itching her face & will cause sores & bleeding if she doesn't wear the ecollar. I don't know what my next step is with that. Maybe dermatologist, food change....I'm not sure yet! Thanks again for sharing info. about this!
 
Oh yeh... looks like all the bases were covered, and it's true HypoT. My Dev had the same reaction to Tapazole - poor thing scratched himself bloody. :cry: Has the vet taken any skin scrapings to see if maybe it's a dermatitis? Has she started on any new food?
 
Plumb's Vet Drug Handbook simply says:
"In diabetic patients, the addition of thyroid hormones may alter insulin requirements; monitor carefully during initiation of therapy."
 
No skin scrapings were done yet. I think we are all still in shock that she is still itching! We were so sure it was the tapazole!! But that may be my next step....to have skin scrapings done. She started the itching about 5 mths. after starting tapazole. We put her on hydroxyzine & it kept it under control for about 2 years. But this past summer she started causing damage to her face while on the hydroxyzine. She's been off the hydroxyzine for about 2 mths. now & for the past few weeks I hear her sneezing/shishing sometimes. I have never noticed her sneezing before. When she wakes up I notice her sneeze & sometimes when she eats. I have never noticed this before. I don't know if it's a food allergy or maybe something in the house is bothering her. And now that's she off the hydrox. she is showing signs of sneezing. I don't know!

The notationn from the Plumb's Vet Drug Handbook..........do you think it means she may need more or less insulin? I'm not sure how this whole endocrine system works together!

Thanks again!
 
I have a non-diabetic with hypOthyroid, caused by the I 131 treatment. Did not start treatment until about 8 months after because my vets kept insisting it would change. Well her thyroid reulsts never got better so I finally found a vet to prescribe the thyroxine and now she is in the normal range. I also give her her pill b.i.d. and do give it with a pill pocket and it hasn't affected her thyroid numbers. Hope some of this helps. Oh, and you probably already know, to continue with the full thyroid panels for a while to make sure you have that at the correct dose. Good luck!
 
Jill, I'm very glad to hear that you use pill pockets & dose 2x day! That's what I am planning to do!! My regular vet was not familiar with giving thyroxine to a cat either. And she probably would not have. Thankfully the internal Dr. is very familiar with Dr. Mark Peterson & the research he has been doing regarding cats being hypo. & needing thyroxine. Thank you!!!!
 
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