Need printable material on protocol for hyperT treatment

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Hi everyone, long time no see!

I need some help in locating on the internet some printable material on the proper treatment of hyperT in cats...in respect to starting doses of methimazole. First a little history on what's going on here.

Freon was diagnosed with hyperT about 2 years ago, back when I was seeing Dr. D. They decided to use transdermal cream, said that that is all they ever use on hyperT cats. I received Freon's meds a few days later, and started him on the prescribed amount. I cannot tell you the amount of methimazole per ml in what I was given, it's not on the label, and this particular vet wasn't willing to share numbers with their clients.

Anyhow, after 3 weeks of treatment, I returned to have Freon's T4 tested, and it had dropped too low. Normal ref range for this test at that clinic is 1-4, and Freon's was then 0.8. The vet wanted me to reduce his dose by 1/2, I thought differently and further reduced it to just 1/4. We retested Freon 3 weeks later and found that his T4 had dropped even further, to a mere 0.2! At this point the vet basically declared Freon "cured" and we no longer treated him.

I know, ridiculous, but they just didn't want to bother finding an alternative treatment for Freon because they were all hung up on using transdermal cream!

Ok, now fast forward to about a month ago. Speedy became sick and needed to be hospitalized for constipation and dehydration. I took her in to see our "new" vet at a different clinic, Dr. E. Speedy was manually "cleaned out" and given an enema, plus she remained there overnight on IV fluids. Later that evening my vet called me at home and asked for permission to run some blood work on Speedy. She explained to me that she suspected that Speedy may have hyperT. Sure enough, her T4 was borderline high. Dr. E released Speedy from the hospital the next day, and wanted me to return in a couple weeks, when Speedy was acting like her old self, to run a senior blood panel and retest her T4. We did that, and it's confirmed that Speedy has hyperT, 5.8 (1-4).

I took Freon in too at that time, because he's still not being treated for his hyperT, and we're seeing weight loss, etc, etc. Freon's T4 was off the test range! Because Freon is an absolute horror to pill, my vet and I decided to use methimazole in liquid form. He'll take liquid without a fight, so we're happy with this option.

Now, here's the problem. My vet wants me to give Speedy 2.5 mg bid, and Freon should be getting 5 mg bid! The methimazole liquid is 10 mg/ml. That means Speedy would be getting a total of 5 mgs per day, and Freon 10 mgs per day! I'm a member of the hyperT yahoo group, and have posted there about this starting dose. Thankfully, they've helped me work out the math and I have taken it upon myself to start both cats out on a 1.25 mg dose bid.

The hyperT group told me that the dose my vet prescribed is "old school" dosing.......based on the cat's T4 numbers. When I received the medicine Friday (hubby went and picked it up) and I saw the doses, I tried to call my vet, but could only relay messages through a vet tech to her because she was tied up with a horse emergency. However, the vet tech did tell the vet what I said about thinking that her starting doses were on the high side, and when the tech called me back, she confirmed that those doses (2.5 mg bid and 5.0 mg bid) was what Dr. E wanted my cats on.

I'll be taking both Freon and Speedy back in in 3 weeks to have their T4 levels checked, and with them both on 1.25 mg bid, I'm hoping that their T4 tests show marked improvements. Speedy is already acting much better, much more like her old self! What I'm looking for, and hope that some of you can point me in the right direction, is printed literature on the internet at what the latest thoughts are on starting doses of methimazole in the treatment of hyperT cats. I know some of you have access to vet journals and such online.....I have difficulty finding that sort of thing. I want to provide printed material to my vet on this subject, so that hopefully she'll take the time to update her own knowledge on this. They're very good vets, and I feel that even though they may think "old school" on this, they'd certainly take the time to read through anything I may be able to provide them.

Thanks in advance!
Debra
 
I do not think that you will find anything really useful. i just looked at my Plumb's vet drug handbook (use by vet- I have fifth edition) and it gives three different doses based on different studies:
- Initially 2.5 mg once daily. Retest in 2 weeks.
- If no renal problems, 2.5 mg twice daily if very high T4. Reset 1-2 weeks
- 5 mg twice to three times daily and reset in 2-3 weeks

My Bailey had a T4 of 5.8 and I started on the transdermal of 2.5 mg twice a day. It was increased to one or two times to 12.5 mg a day divided Am and PM where he was at 1.8, where the vet wanted him.
My Lightning was 5.1 and I started o oral 2.5 mg one per day andhis T4 is 1.8.
 
Hello, I hope your cats do well! I've had FOUR cats with hyperT and did not know about the forum until now, thank you. Our current hyperT kitty, Annabelle, just became diabetic and we're working with her now. If I find out anything, I'll let you know. Denise
 
An update on Freon

Sorry that this is all after the fact, but I just wanted to share this with you all.

Monday evening Freon started hiding from us, up underneath hubby's dresser, so I knew something had to be going on with him. When we went to bed I got Freon out from under there and put him up on our bed. Oddly, he had a fairly large fat pad hanging from his tummy......but he shouldn't even have one, he's lost a lot of weight with his thyroid being so badly out of whack! I was petting him, and I reached out to touch his "fat pad" and he turned and bit me! He didn't break my skin, it was just a warning nip, but Freon never ever bites! I immediately grabbed him and flipped him onto his back, to investigate this fat pad.

Oh, it wasn't good.....one of his breasts (one of the two that are between his hind legs) was terribly swollen, and very sore. What little I could feel of it (he kept squirming) did not feel like an abcess or infection. Needless to say, I slept very little Monday night.

Tuesday morning as soon as I got home, I called my vet. They told me to bring him in immediately, so I did. He had a fever of 104.8...he was definitely a very sick kitty! Dr. Kim wouldn't guess whether this was an abcess or cancer, she just hospitalized him immediately, put him on IV fluids and antibiotics, and ran a senior panel to check his blood. I went home just praying for him. I've lost way too many furry family members to cancer, my head said it was, my heart was crying.

Finally, late last night Dr. Julie called me with the news....it was one of the horrible abcesses that she has seen in quite a while. There was a very tiny puncture wound...most likely caused by Radar or Bruiser. Radar adores Freon, and they can't resist a good wrestling match from time to time. Anyhow, they sedated Freon and opened the abcess. It was firmly full of pus, blood, and blood clots! Once they cleaned it out well, they inserted a drain and sutured the incision.

The bad part was after all this was done, and Freon woke up from the sedation, he decided that he no longer needed to be on IVs. He kept chewing his line in half! They finally had to put an e-collar on him to keep him from his line! LOL! This morning, thankfully, his fever had returned to normal, and he was hungry. They monitored him all day today, and let hubby take him home late this afternoon. He's on antibiotics now, plus we'll have to keep him separated from my other kitties until his incision heals.

Hubby put him in a medium size dog crate when he got home, with water and a litter box with shredded paper. When I got home, Freon had spilled all of his water (which was in a "spill proof" bowl), had flipped his litter box upside down, and had throw the shredded paper all over the crate! My boy threw a hissy fit!

I now have a large dog airline crate set up for him for nights and when we're both at work. When we're home I have the bathroom set up for him to stay in. He always likes to sleep in the bathroom, so he's comfortable there and it gives him a chance to walk a bit and stretch his legs a little.

I have to take Freon back to the vet Tuesday to see if the drain can be removed, and then it'll be another week or more before he can resume normal life, but I thank the Gods above that this was "just" an abcess.

Oh, you may like to know that when I took Freon in Monday I told her of my decision to start both Freon and Speedy on that 1.25 mg dose of med for their hyperT. We had quite a talk about why I chose that dose, and she then went to her computer and went to VIN. She couldn't find what she was wanting there, so she then went to Plumb's online.....and guess what???

Plumb's lists several choices in dosing for hyperT, and the very first one listed states "1.25 mg bid and retest in 2 to 3 weeks. If T4 value remains above normal, increase dosage to 2.5 mg bid, and retest in 2 to 3 weeks." Yay! They've now added this in the lastest version!!!

So, while she wasn't entirely happy that I took it upon myself (with the advice of the feline hyperT yahoo group) to reduce both of their dosages, she has agreed that we can continue with this dose and retest in 3 weeks to see where we go from there.

Thank you all!
Debra
 
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