please help! my diabetic/hypert has elavated liver values

[Sara and Buttercup]

i'm going to just paste what i wrote to the hypert group to save time. thanks for any input. going to vet in morning so hoping for some advice by then. thanks.

My diabetic (in remission) hyperT cat has been on tapazole for about a
month and a half. She gets 2.5 mg of transdermal once a day at vet's
suggestion. her t4 last week was 4.6 though it had been down to 3.6 two
weeks after starting. so two weeks after starting with a value over
normal it went down to 3.6. then one month later on same dose it went
back up to 4.6. this last test last week her liver values were up higher
than I have seen them.

Normally they are normal or the alp is just up a couple of points. last
week her alp was 115 (normal range 10-70 and her alt was 114 normal range
5-65. those were the only ones he tested. the vet says this is fairly mild elevation and not to get too
freaked out. he thinks it is due to the hyper t. I am worried that it
might be due to the tapazole also since she had untreated hypert for
several months (not real high values but t4 slightly over normal) and her
liver was normal. either way, whether due to the tap or the hypert i am
worried. he wants to increase her tapazole thinking that i guess the
liver will come down when the t4 comes down.

also, the sample was left over the weekend before being sent out. could
that matter as far as the results. her kidney levels were normal. she
just got those two test for the liver, not a complete panel. i'm going
in tomorrow to vet agtain. they are not that great. they are not up on
things and terrible and diabgnosing illnesses and have really bad
instincts. so my questions are:

1. what do you think about those liver values? what do you think is
causing that?
2. how high can the liver values go before it becomes a worry or worse.
when is it medically unsafe. when is it considered liver failure? what can
i do to reverse it.
3. are there any liver supplements i can try such as sam e or anything
else like that?
4. should i go to tapapzole pills? the vet didn't suggest cleaning the
ears before each dose and i havne't been doing that. there is a waxy
build up on her ears so could that be interfering with the absorbtion?
how often should i clean the ears between doses and with what?
5. should i ask for a full liver panel tomorrow. any other blood work?
6. has anyone with a hypert cat in this group had cats with problems with
their liver and what did you do?
7. should i increase the tapazole which i think the vet is going to
suggest? if so, should i give it twice a day instead of once? they said
what i have is formulated for once a day but i don't htink they kinow what
they are taliing about. they have treated only 2 or 3 cats there with
transdermal tapazole.
8. any other advice.
thanks. i'm really worried about the liver. she's having diarrhea too and
i want to give her the metronidazole but i'm afraid with her liver being
so taxed already it could hurt her. what do you think? she has had off
and on diarrhea for over a year ususally it responds to diet change and
metro.
please help me! thank you.

 

[Sheila & Beau GA & Jeddie GA]

Sara, has she ever had pancreatitis? Liver values can increase with that due to the inflammation spreading to the liver from the pancreas. When Beau was first having p-titis (about 8 years ago) the test was expensive, took a week and had false positives (or false negatives, can't remember) so not totally reliable. It's better now. Anyway, after the initial couple of test and since we were getting regular blood work at the same time, we tracked his flare ups by liver values. So that is something to consider.

I would not switch to the pill form of tap. It is harder on their system than the gel - from what I understand. As for the T4 being higher now, doses do need to settle and be adjusted. It takes several months for things to settle down and even then it can change. But is there any possibility that the gel is getting "weak" as in old and losing potency? Is it a new batch? That stuff is compounded per your script maybe the first batch was stronger by some tiny amount?

I have heard several folks here give SamE and milk thistle for liver support. It's called Denamarin, I think. There is a post from me down a ways where it is mentioned:

http://felinediabetes.com/FDMB/viewtopic.php?f=3&t=9469

I hope you can get things sorted out and her numbers get better.

 

[Sara and Buttercup]

thank y ou for the advice! i will ask about pancreatitis. if I bring it up i'd bet you he will say that it couldn't be that but i will try. also, thanks for the advice about the liver supplements. will also bring that up.

 

[Hope + (((Baby)))GA]

Sara, Hope's ALT and AST just kept going up. Wasn't the pancreas but several ultrasounds, over months, kept showing weird things going on in her abdomen. This was over 3 years ago. Her gallbladder also was showing some sludge. She was put on Marin and Denosyl....I do them individually....Marin with food and Denosyl on empty. They slowly started to come down, took a long, long time but adding the Ursodiol for the gallbladder really helped. She is now in the normal range and other than the meds for her RCM she is looking real good in the belly area. I would not agree to an exploratory or needle biopsy. Figured if it is cancer we would see changes for the worse in her ab and to this day we still don't know why but Hope is doing great.

 

[Jess & Earl]

Hi Sara

This is a late response but here's my $0.02 anyway ...

1. what do you think about those liver values? what do you think is
causing that?

The elevations are mild. Cats with serious liver disease have an ALT in the thousands. Cats with methimazole-induced liver toxicity are typically *sick* (they feel sick) and their ALT skyrockets. (The ALT is the most important value here.) Cats with wildly uncontrolled hyperthyroidism, such as your kitty, will have elevated liver enzymes among other side effects.

2. how high can the liver values go before it becomes a worry or worse.
when is it medically unsafe. when is it considered liver failure? what can
i do to reverse it.

See above I'd worry if she was starting to feel sick, if she was bright yellow (jaundiced), if her belly filled with fluid. That is liver failure and that is very, very serious.

3. are there any liver supplements i can try such as sam e or anything
else like that?

You could give Denamarin. It's best if pilled whole, so it can be difficult to administer. You could give Marin, instead, which only has milk thistle (not sam-e) as that can be crumbled into food.

4. should i go to tapapzole pills? the vet didn't suggest cleaning the
ears before each dose and i havne't been doing that. there is a waxy
build up on her ears so could that be interfering with the absorbtion?
how often should i clean the ears between doses and with what?

I would go to pills. You need to bring the T4 down ASAP. No one is sure how much tapazole is absorbed and it can differ between cats. Oral methimazole is more likely to cause GI effects such as vomiting but the risk for other methimazole effects like hepatotoxicity, blood disorders, etc., are the same for transdermal and oral.

If you go to oral, you might want to start at a lower dose as the dose she was getting transdermally might not have been real (i.e. she was getting 2.5mg but really absorbing 1.25mg).

5. should i ask for a full liver panel tomorrow. any other blood work?

I assume she had a CBC as well? When you retest the blood chemistry again, ask for an extended panel that includes GGT. This is a marker for certain types of liver/gall bladder problems (cholestasis).

thanks. i'm really worried about the liver. she's having diarrhea too and
i want to give her the metronidazole but i'm afraid with her liver being
so taxed already it could hurt her. what do you think? she has had off
and on diarrhea for over a year ususally it responds to diet change and
metro.

Metronidazole may have a soothing effect so if it works for her, I'd use it. Also, GI problems can cause mild elevations in liver enzymes themselves as teh pancreas, intestine, and liver share a common pathway and inflammation can spread between them.

FWIW, I have a dog with chronic liver disease so I don't take liver disease lightly and I do know a heck of a lot about it. My late cat also suffered with cholangiohepatitis secondary to his severe chronic pancreatitis and IBD. I'll be the first one to tell you to do a workup if the ALT stays up and/or increases after her hyperthyroidism is controlled. Right now she has an uncontrolled endocrine disease (hyperT) which is wreaking havoc and that needs to come under control as rapidly as safely possible. If her kidneys are ok, you should consider radio I131.

Jess