Preparing to argue with vet - need ammunition

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spgreenfield

Member Since 2012
I posted back a couple months about a new foster that came into my care. Her fur condition improved as did her weight - she is now close to what her weight seems like it should be. SOME of the muscle wasting has been stopped and even reversed (muscle is appearing along spine) but she is still drinking far too much and testing fine on BG. She has not had a urine test - which I'm thinking should be my next step - but unfortunately her thyroid tested a *TAD* high and now vet is running with her being hyperthyroid and I don't agree. Got labs which I will post below - and would covet ANY advice from seasoned owners! Foster was obviously on high grain kibble when she came to me - I switched her extremely quickly to high quality no grain canned which allowed for her to eat a normal amount but still lose weight. The heavy drinking and urinating is still a concern though - and not sure if it's going to fade away as she is on better food that's not kicking her sugar levels....I'm just not experienced in this area.....but willing to go to bat for my foster rather than poison her with unnecessary Rx!

Pam

Here's the labs:

Total Protein: 7.7 (6.3-8.6)
Albumin 3.3 (3.2-4.7)
Globulin 4.4 (2.6-5.1)
A/G Ratio 0.8 (0.6-1.6)
AST 32 (13-47)
ALT 47 (45-217)
SDH <1 (1.0-10.0) L
ALK Phos 74 (11-95)
GGT <1 (1-3) L
Tot Bilirubin 0.1 (0.0-0.4)
Glucose 89 (60-133)
BUN 31 (16-35)
Creatinine 1.8 (0.8-2.1)
BUN/Creat ratio 17.2 (4.0-33.0)
Phos 5.4 (2.7-6.5)
CA 10.5 (8.0-11.4)
MG 2.30 (1.80-2.70)
NA 154 (148-156)
K 4.7 (3.6-5.5)
NA/K ratio 33 (29-42)
CL 117 (113-123)
Total CO2 17 (13-20)
Anion Gap 25 (15-23) H (apparently a diabetic signal - at least that's
what I found online)
Osmolality (calc) 324 (310-325)
Cholesterol 189 (69-225)
Triglicerides 103 (25-133)
Amylase 1102 (639-1364)
Lipase 16 (6-62)
CK 403 (153-572)
Hemolysis Slight
Icterus none
Lipemia none

WBC 11.6 (5.5-19.5)
Neu # 6.2 (2.3-10.7)
Lym # 4.1 (1.2-6.8)
Mono # 0.4 (0.0-0.4)
EOS # 0.9 (0.0-2.2)
Baso # 0.0 (0.0-0.1)
Neu % 54 (25-77)
Lm % 35 (14-61)
Mono % 4 (0-6)
Eos % 7 (0-23)
Baso % 0 (0-1)
RBC 9.8 (6.9-10.1)
HGB 13.8 (8.0-15.0)
HCT 41 (31-48)
MCV 42 (40-52)
MCH 14 (13-17)
MCHC 34 (32-35)
RDW 24.4 (13.2-17.5)
PLT 330 (200-700) H
MPV 20 (9-24)

Total T4 4.51 (0.80-4.3) H

In my opinion and experience this tT4 is NOT high enough to alone signal
hyperthyroid. Would appreciate other opinions...
 
I forgot to add her symptoms:

Drinking too much
Urinating frequently
Occasional cough (definitely NOT fur balls - she is brushed frequently and if you pinch her fur and pull - only 1-2 hairs come out)
Hearing issues (seems partially deaf)
Vision issues (may be due to hearing - not being able to locate sound/movement)
Always hungry
Muscle wasting
Bad breath (with not much tarter on her teeth....)

She is 6+ years old and weighs 9.6#. Came to me weighing 10.8# back in 11/2012 Was confined to a cage and very timid. Has become very social and is beginning to make friends with my 2 yr old cat. Very loving!

Pam
 
Could be the thyroid. The test result from the IDEXX lab includes:

Comments:
1. Interpretive ranges:
<0.8 Subnormal
0.8 to 4.7 Normal
2.3 to 4.7 Grey zone in old or symptomatic cats
>4.7 Consistent with hyperthyroidism
Cats with subnormal T4 values are almost exclusively euthyroid sick or
overtreated for their hyperthyroidism. Older cats with consistent
clinical signs and T4 values in the grey zone may have early
hyperthyroidism or a concurrent nonthyroidal
illness. Hyperthyroidism
may be confirmed in these cats by adding on a free T4 or by performing
a T3 suppression test. Following treatment with methimazole, T4 values
will generally fall within the lower end of the reference range
(0.8 2.3).
 
I think this might be an informative article for you: http://www.fabcats.org/owners/hyperthyroidism/info.html.

Based on all of the other labs, I really don't see how it could be diabetes. The glucose level is something only many of us can dream of!
Yes, the anion gap is high, but the thyroid issues can create an acidic kitty too (the excess urination). There are no signs of kidney or liver disease either.

In my humble opinion, I think your vet is correct, and it appears kitty might be in the early stages with the possibility of dealing with it through medication alone.

DZ and Sarah
 
In order to truly determine hyperT - two tests are needed. From your labs, I see only one.

Test 1: T4
Test 2: Free T4

I am surprised that your vet did not suggest test 2, when suspected hyper T. There is an extra charge for test 2 as it is NOT part of the standard blood panel which you had done.

I would want to see both tests, and while Test 1 was slightly elevated it is possible that your cat has hyper T.

There are typically two ways to treat hyper T.

1) Methimazole (tapazole- brand name) 5 mg pills - with a scrip, you can purchase from 1800petmed.com cheaper than the vet will sell
2) radio-iodine treatment I131 - which is done only by authorized vet practices - here is info from the place Maui had it done - http://www.gsvs.org/services/radioiodine.html

If you start with the pills, make sure to start on a very low dose, such as 1.25 (or a quarter of a pill) BID. I say this, because Maui was started at 5 mg BID and her white blood count dropped to almost 0 and she almost died from starting on too high a dose.

Not all cats are eligible for I131 and it should be thoroughly researched before deciding to move forward with it. And yes, it is pricey. Whereas the pills are not, but still need close monitoring.
 
I agree with the others. I should add that my kitty Bookmark(GA) who I adopted when he was 9 years old was drinking and urinating a lot with normal bloodwork. About 2 years later his bloodwork finally showed CKD. I would do the other thyroid test. If that is normal you may want to consider an ultrasound.
 
Note that pills will require repeated bloodwork at regular intervals and those costs can add up over time vs the I-131 treatment. You may want to estimate lifespan costs of each when comparing.

Also, I-131 treatment may unmask renal disease which hyper-T slightly compensates by pushing fluid through kidneys faster. If it turns out to be hyperthyroidism and you do I-131, be vigilent for signs of renal disease. I lost a senior kitty missing it.
 
Thanks for all your replies and suggestions. Unfortunately I am all too familiar with the disease of Hyperthyroidism in cats - but not diabetes....was hoping that someone would say that she could have a recovering pancreas or something magic like that!!! HyperT in such a young cat is very VERY sad. I have contacted the rescue that I foster for and asked about getting more tests to get a definitive answer on her thyroid levels. If anyone is reading this - a great lab for a full thyroid panel is Hemopet out in California - cheap compared to what the local vet would charge - but still costly. May have to go that route - just not sure. For now, she's fine. Just peeing a little too much so I'll watch her weight and see what additional tests they'll allow me to get for her.

Pam
 
If you think this could be diabetes - then you need to get a meter and test her BG. You can go to walmart and pick up relion brand, which is an inexpensive meter and strips and start testing.

The only way to know if this could be diabetes, is by testing the blood glucose. The glucose from the blood test you provided is well within normal range., which is why we are thinking it could be hyper T and while yes, it sucks when it happens to a young cat (Maui was young when it happened to her), it also is a good thing, because the cat will more likely be able to handle I131 treatment and the quarantine that goes along with it, then an older cat.

Not sure what you are looking for us to say, without having any home BG testing data to look at.
 
Well - I DO have a meter and have tested her a few times and it's coming up within normal range. The one thing I haven't had done is a urine test to see if ANY sugar is an issue since from what I understand although it's not accurate on levels it shows the presence of sugar being shed by the kidneys.

Think it's probably thyroid issues and we're just going to sit tight for a bit and see where she goes. It's been only 2+ months since I got her under my care - and some things just CAN'T change overnight. This may be one of them. Or it could escalate and get worse. Who knows?

Thanks for all the suggestions and thoughts!

Pam
 
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