Hyperthyroidism Treatment Dose Questions

[Staci & Ivy]

Hi everyone,
Just checking to see if anyone has experience with hyperthyroidism…

We got some not great news yesterday about Ivy’s thyroid blood results. Her T4 has gone UP since she’s been on methimazole transdermal .625 mg since March when she was diagnosed with hyperthyroidism. Not what I was hoping for .

At diagnosis her T4 was 3.92 at Hemopet, in May it was 4.0 at Antech, and now it was 4.6 at Hemopet.

Hemopet’s suggestion is to either switch to pills (from what I read, the side effects from pills can be really bad. That’s why I was trying to use the transdermal medication) And or increase the dose to 5 or 7.5 mg.

***That seems like a huge increase going from .625 mg BID, so I’m not sure I’m comfortable with such a large increase.

It almost seems like it would be better to go to a smaller increase.
I will have to get some expert guidance on that.

*Her appetite has been good and she’s not lost any weight, no vocalizing (typical hyperthyroid symptoms).

Her other lab results were mostly good from Antech. Her creatinine was 1.0, BUN is 29, she is concentrating urine well 1.060, HCT is 33 (she tends to be in this lower range), T4 4.2, Phosphorus 5.3, Potassium 4.4 (both normal range)
Another question is: is the thyroid masking the true kidney function?

It appears Ivy is not a good candidate for the I131 procedure. I’ve spoken with several clinics and they told me “no” since she’s quite fractious and doesn’t want to be handled. I need to sedate her to go to the vet and also have labs drawn.

Plus she needs insulin, of course and if she wouldn’t eat while she’s staying at the facility that would be a problem as they can’t really intervene and handle the cats.

If anyone has any experience or suggestions on a methimazole dose increase, I’d love to hear your thoughts. Thanks

 

[Daphne and Aida]

Hi Staci,
High T4 does mask the true creatinine value, as long as it isn't well-regulated you cannot really trust those results.
Feloro had hyperthyroidism, he was started with a massive dose of methimazole in pill form and could never tolerate the medication, the I131 treatment was the solution.
There is a fantastic io group for hyperT kitties, I highly recommend that you ask them all your questions, and especially the one about which clinic could eventually manage a fractious diabetic cat during the mandatory stay after I131. Btw, Feloro stayed just 2 days in isolation.
The group's address: https://groups.io/g/FelineThyroidManagement

 

[Daphne and Aida]

Meanwhile, I believe that you're right not to start her on methimazole in pill form, it would maybe be wiser to increase a bit to 1.25 mg BID, and make sure to clean the ear before applying the medication (assuming that you give the transdermal on the ear). A good piece of advice that I've read on the group is to rotate the spots, just like we rotate the insulin injection spots, to do the same with methimazole transdermal. The transdermal isn't as bioavailable as the pill form, so you want to make sure that the ear is clean before applying it.

Just a question: why do you keep changing testing labs? It's usually best to stick to one.

And one last thing: has Ivy's BP been measured? If it's over 150, you want to treat it asap, hypertension is super hard on the kidneys (and in general, on the overall health!).

 

[Staci & Ivy]

Meanwhile, I believe that you're right not to start her on methimazole in pill form, it would maybe be wiser to increase a bit to 1.25 mg BID, and make sure to clean the ear before applying the medication (assuming that you give the transdermal on the ear). A good piece of advice that I've read on the group is to rotate the spots, just like we rotate the insulin injection spots, to do the same with methimazole transdermal. The transdermal isn't as bioavailable as the pill form, so you want to make sure that the ear is clean before applying it.

Just a question: why do you keep changing testing labs? It's usually best to stick to one.

And one last thing: has Ivy's BP been measured? If it's over 150, you want to treat it asap, hypertension is super hard on the kidneys (and in general, on the overall health!).

Thank you very much for your reply, Daphne. I am aware of the thyroid group and I actually made a post there today.
I do use the transdermal compounded medication from a local compounding pharmacy near me.
And you are right about cleaning the opposite ear very well every day. I do all of that which I also learned from them.

They also suggested an increase to 1.25 mg (and not higher. And not to go with the pills at this time). I’m waiting to speak with my vet to let him know what I’d like to do. But I’d like to see what he thinks. (He seems to usually agree with what I discuss with him).

Yes I did have her BP checked and it was ok. We will continue to watch that. Thank you for suggesting that as well.
I’m so glad to hear your kitty had such a short and successful stay for the I131 treatment. (Was that in France?). Here the stay seems somewhat longer than 2 days. Seems like 4-5 days. (I don’t think Ivy would do well for that length of time. She’s very dependent on my and she’s a very difficult kitty).
The facilities I’ve spoken with don’t want to deal with a diabetic or difficult cat. So that’s a big problem for us.

I guess I will need to pick a lab and use one. I did the larger panel with Hemopet since they are better priced for a more extensive panel (but it’s a bit of a pain since I have to ship the serum across the country to get it to them).

Thank you so much for your thoughts and for the information! I appreciate your help

 

[Deborah & Muffy(GA) & Wendall]

I've had 2 cats, one diabetic, treated with i131. Both cats had severe allergic reactions to the oral medications with nausea, vomiting and inappetance. We tried the transdermal form for the diabetic but that just added awful facial itching and swelling to his misery so we didn't even bother trying it for the second cat. Methimazole is nasty, toxic drug that can have some pretty bad side effects and these reactions are not uncommon. Sending them for radioiodine treatment was the best and only choice. Both were there 3 days.

Wendall, the diabetic, was a perfect patient. The couldn't test blood sugar because he was radioactive but did give insulin. I sent along detailed written instructions and a syringe with food coloring to mark his slightly reduced dose.

The second cat, Susie, was a former feral who never really tamed up and handling her for any reason was difficult. Fortunately i131 is given as a single injection, no anesthesia required. She wasn't cooperative at the facility and they were happy to send her home.

My only regret is that I wasted months worrying about possible kidney issues while they were miserable. The veterinarian who administered the i131 said he wasn't concerned about doing a trial on oral meds. As long as the kidneys are in relatively good shape, he recommended going ahead with i131 because both Hyper-T and the drugs used to treat it are so hard on other organs, particularly the heart and kidneys. If another cat were to develop it, I'd go straight to i131 without hesitation.

 

[Diane Tyler's Mom GA]

Hi Staci, I'm sorry Ivy's T4 has gone up. I hope someone will come along and give you some advice

 

[Staci & Ivy]

I've had 2 cats, one diabetic, treated with i131. Both cats had severe allergic reactions to the oral medications with nausea, vomiting and inappetance. We tried the transdermal form for the diabetic but that just added awful facial itching and swelling to his misery so we didn't even bother trying it for the second cat. Methimazole is nasty, toxic drug that can have some pretty bad side effects and these reactions are not uncommon. Sending them for radioiodine treatment was the best and only choice. Both were there 3 days.

Wendall, the diabetic, was a perfect patient. The couldn't test blood sugar because he was radioactive but did give insulin. I sent along detailed written instructions and a syringe with food coloring to mark his slightly reduced dose.

The second cat, Susie, was a former feral who never really tamed up and handling her for any reason was difficult. Fortunately i131 is given as a single injection, no anesthesia required. She wasn't cooperative at the facility and they were happy to send her home.

My only regret is that I wasted months worrying about possible kidney issues while they were miserable. The veterinarian who administered the i131 said he wasn't concerned about doing a trial on oral meds. As long as the kidneys are in relatively good shape, he recommended going ahead with i131 because both Hyper-T and the drugs used to treat it are so hard on other organs, particularly the heart and kidneys. If another cat were to develop it, I'd go straight to i131 without hesitation.

Thank you so much, Deborah. I appreciate the information!! I’m so glad you were able to have the treatment done for your kitties.
I laughed about Susie since I could imaging that’s how they would feel about Ivy (get her out of here!!)

 

[Staci & Ivy]

Hi Staci, I'm sorry Ivy's T4 has gone up. I hope someone will come along and give you some advice

Thanks, Diane

 

[Daphne and Aida]

Thank you very much for your reply, Daphne. I am aware of the thyroid group and I actually made a post there today.

Oh yes! I saw it! I’d follow their advice, of course, Ro is a specialist! What did hypurrcat respond to your email? They’ve responded to my requests with very useful informations each time.

Yes I did have her BP checked and it was ok. We will continue to watch that. Thank you for suggesting that as well.
I’m so glad to hear your kitty had such a short and successful stay for the I131 treatment. (Was that in France?). Here the stay seems somewhat longer than 2 days. Seems like 4-5 days. (I don’t think Ivy would do well for that length of time. She’s very dependent on my and she’s a very difficult kitty).
The facilities I’ve spoken with don’t want to deal with a diabetic or difficult cat. So that’s a big problem for us.

Feloro was treated in Spain, there are just 2 clinics in Europe that follow Dr. Marc Peterson’s protocol with individualised dosage, both endocrinologists of these clinics trained with him. Feloro received just 2mCi, and he was cleared to take the plane in just 48 hours. I’m quite sure that the clinics that follow this protocol in the US adapt the stay of the cat, it just depends on the dose received. I’m sorry that I cannot offer you any solution regarding which facility to go to, I’m certain however that there was another fractious cat that found a clinic and got the treatment, I really don’t remember the name…

I really second everything Deborah says, when there is a treatment to an illness, there is no reason not to do the treatment. In France it isn’t known at all, Feloro is the only cat in the clinic we go to that had the treatment, it’s so weird that vets don’t advocate for it! And methimazole is really nasty. So, if you manage to find a clinic, bring Ivy in!

 

[Seth&Bell]

Sorry you going through this, Staci. I don’t have advice, but I am sending good vibes Ivy’s way . Hang in there

 

[Staci & Ivy]

Sorry you going through this, Staci. I don’t have advice, but I am sending good vibes Ivy’s way . Hang in there

Thank you so much. I appreciate your support so much

 

[Staci & Ivy]

Oh yes! I saw it! I’d follow their advice, of course, Ro is a specialist! What did hypurrcat respond to your email? They’ve responded to my requests with very useful informations each time.


Feloro was treated in Spain, there are just 2 clinics in Europe that follow Dr. Marc Peterson’s protocol with individualised dosage, both endocrinologists of these clinics trained with him. Feloro received just 2mCi, and he was cleared to take the plane in just 48 hours. I’m quite sure that the clinics that follow this protocol in the US adapt the stay of the cat, it just depends on the dose received. I’m sorry that I cannot offer you any solution regarding which facility to go to, I’m certain however that there was another fractious cat that found a clinic and got the treatment, I really don’t remember the name…

I really second everything Deborah says, when there is a treatment to an illness, there is no reason not to do the treatment. In France it isn’t known at all, Feloro is the only cat in the clinic we go to that had the treatment, it’s so weird that vets don’t advocate for it! And methimazole is really nasty. So, if you manage to find a clinic, bring Ivy in!

Thank you so much. You’ve inspired me to dig deeper into this situation.
I’ve had 2 local clinics turn me down. But I may contact hypurrcat again and see if I can get answers from them.(I think they required some money down just to have you complete paperwork to submit to see if they would even look at your cat).
I was very put off by that.

I’m so happy to hear you had such a great experience!!

 

[Dyana]

Hi Staci.
I took Ginger to Hypurrcat. I don't remember having to pay a fee to submit paperwork, but it was 7 years ago when they had a separate office in Bedford Hills NY. Back then Carol always answered the phone, and she was very nice (I loved her) and answered all my questions. Now, that Carol retired and they only have an office in NYC, I know they have you send emails, but they have always responded back to me fairly quickly.
The people who work there had to wear like geiger counters on them and were only allowed so much exposure. I remember one lady came in with her cat who had CKD and she brought in her raw food in separate packages and her fluids and all kinds of medicines with a list of instructions. They have or had video cameras in the condos and you can watch Ivy all day. They said they would give Mirtazapine to Ginger if she didn't eat, but eventually she did. I had to work, but had a bunch of friends watching the cameras. As I worried that she wasn't eating, my friends reported to me that they saw her eating. I wonder if they could keep Ivy on a small amount of Gabapentin or something like that for the 3 days.

Here are the notes from Ginger's stay:

A friend recommended Red Bank in Tinton Falls for i131, but I chose Hypurrcat, since it was within driving distance (just over 100 miles).
It was very scary to leave my cat for 3 days, but everyone says the same, and some choose not to take their cat for i131 because of that. I cried the whole way home after leaving her, but the time went by quickly and soon she was home again and cured.
She did go hypothyroid and gets a tasteless pill dissolved in her food. She's 20 now.

 

[Staci & Ivy]

Hi Staci.
I took Ginger to Hypurrcat. I don't remember having to pay a fee to submit paperwork, but it was 7 years ago when they had a separate office in Bedford Hills NY. Back then Carol always answered the phone, and she was very nice (I loved her) and answered all my questions. Now, that Carol retired and they only have an office in NYC, I know they have you send emails, but they have always responded back to me fairly quickly.
The people who work there had to wear like geiger counters on them and were only allowed so much exposure. I remember one lady came in with her cat who had CKD and she brought in her raw food in separate packages and her fluids and all kinds of medicines with a list of instructions. They have or had video cameras in the condos and you can watch Ivy all day. They said they would give Mirtazapine to Ginger if she didn't eat, but eventually she did. I had to work, but had a bunch of friends watching the cameras. As I worried that she wasn't eating, my friends reported to me that they saw her eating. I wonder if they could keep Ivy on a small amount of Gabapentin or something like that for the 3 days.

Here are the notes from Ginger's stay:
View attachment 70850

A friend recommended Red Bank in Tinton Falls for i131, but I chose Hypurrcat, since it was within driving distance (just over 100 miles).
It was very scary to leave my cat for 3 days, but everyone says the same, and some choose not to take their cat for i131 because of that. I cried the whole way home after leaving her, but the time went by quickly and soon she was home again and cured.
She did go hypothyroid and gets a tasteless pill dissolved in her food. She's 20 now.

Hi Dayna, What a wonderful report. Thank you so much. I’m so glad Ginger is doing so well.

We are about 2 hours from NYC.
Was Ginger diabetic also? I’m not sure how that would work in terms of giving insulin etc.

I will have to revisit their process again to see if there’s a way of possibly making it work out.
Ivy is so complicated with all her conditions, my worry of her not eating without me coaxing her and especially her temperament. (I always sedate her to go to the vet)

Thank you so much for that information and encouragement!

 

[Dyana]

No, Ginger is not diabetic. My last kitty was diabetic for 9 years, but didn't have hyperthyriodism.

It was a 2 hour drive each way for me too.
They said they had given i131 to a number of cats that were 20 and older.
I hope you can work something out.