Radioiodine therapy I-131 for Hyperthyroidism

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mislissa777

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Hi,
I was wondering if anyone who has a diabetic cat has had the I-131 treatment done. My vet would really like me to consider it because my Trina kitty for over a year now has had a side effect/allergy to the tapazole meds that treat her thyroid disease. She has been on antihistamine to help control her scratching & damaging her face but with a recent increase in the tapazole dosage I had to put an e-collar on her as well. But from all the research I've been reading it seems there can be pros & cons to the I-131 therapy. Some people have had not so good issues occur afterwards & some have had great experiences with no issues. But it's a huge concern of mine wondering if the iodine therapy could make her diabetes worse or cause other issues possibly harming the kidneys. I wish there was another medicine that she could take to treat hyper-T but there is not. So it's either stay on antihistamine, tapazole & e-collar or try the I-131 radioactive therapy. Thank you!! Missy & Trina
 
I have had two kitties treated at RadioCat. They both did great but were not diabetic.
The treatment does not cause kidney problems. However, hyperthyroidism can mask kidney deficiency and it only becomes evident after the the treatment. Id Trina has good kidney function on the tapazole then she should be fine after the radioactive iodine treatment.
Sometimes the radioactive treatment does not work and sometimes it "works" too well and supplementary thyroid meds are required but are very rare.
I have had tow diabetic kitties with hyperthyroidism. Bailey was not in good enough general health and not eating well so I decided against the radioactive treatment. I said goody to him about six months after he was diagnosed with the hyperthyroidism.
My Lightning was diagnosed with hyperthyroidism and diabetics about five months ago and he is doing good with only 2.5 mg of tapazole a day.
 
I have not had a diabetic recieve I-131 treatment.

I had an 19 year old senior who recieved it after an increase in the methimazole (Tapazole) caused constant diarrhea. Unfortunately, I didn't monitor for renal issues and she became very debilitated before I discovered her walking on her hocks. She also had some heart issues as a result of the long term hyper-T.

Moral of the story: if you do this, you need to check for renal issues and dehydration vigilantly, maybe via bloodwork weekly, especially for an older cat.
 
One of my diabetics had i131 last December and it was the best thing we could have done. He became very ill on the oral tapazole - vomiting, inappetant and facial itching. We switched to transdermal but the itching continued and applying it was a nuisance for me. We never got his T-4 into the normal range but since increasing the dose made him feel worse, I decided to go ahead with i131 anyway.

At his 90-day post i131 checkup, the T-4 was a little low and kidney values were up slightly. After 6 months both T-4 and kidney numbers were within the normal range. There was no effect on his diabetes. It was important to me to use a facility with 24-hour staffing and being able to see him on a webcam was a nice feature. I sent along a syringe with B-12 to mark his insulin dose so there wouldn't be any mistakes.

My only regret is that I wasted months worrying about possible kidney issues while he was miserable. If your vet and Trina's bloodwork/ overall health indicate that she's a good candidate, I'd go for it. Hyper-T is really hard on the body and the medication can have some pretty bad side effects, as you're experiencing.

Deborah
 
Fortunately, the experts (Dr. Mark Peterson and Dr. Michael Broome) in feline HT are starting to push much harder for NOT letting renal issues dictate whether a cat goes in for I-131 or not.

The bottom line is that HT is very hard on the kidneys and the idea to let them 'run hot'...ie....not getting the HT under control for fear of worsening renal issues....just perpetuates the damage to the entire body - including the kidneys.

If any of my cats end up HT, they will get I-131 - regardless of their kidney function at the time. IF their kidneys worsen post-treatment, I will deal with it as it comes but I am not going to let them 'run hot' for fear that treating HT optimally will unmask poor renal function.
 
Thank you everyone so much for your feedback! I called 2 places in my area (Pittsburgh) that do I-131. Radiocat is one, which I"m not crazy about using because they are not there 24/7. The other place is AVETS, which has just recently started doing the I-131 a few months ago. They have only done about 5 cats so far & have not treated any diabetics with 131. They said the cost would be $1000 for the I-131 BUT since she's diabetic it would be a "few thousand" more because they would go in the room more often than the usual 2 times a day because they would want to check her glucose. So they would then classify her as a hospitalized patient which would make the cost go up substantially. Which completey baffles me why they would charge a few thousand more dollars just to do a glucose check!!!! And why can't they do the glucose check while they're in the room to feed her on one of the routine visits to check on her. I'm a little upset about that but I do like that they are a 24/7 ER hospital & would have her on camera so they could see her from their ICU. Radiocat (fee is $1200) said they do not charge extra for diabetics, they do not check the glucose while she's there. So I"m torn right now about what to do. I wish we had a facility locally that is staffed 24/7 & would charge the average fee. I may have my vet call & discuss things with AVETS because I can't justify spending that much more money for them to do glucose checks. Uugh.
 
Part of the issue is the risk to the staff. Their exposure time must be limited for their safety. And any equiment used (meters, lancets, test strips, etc) must be stashed until it is no longer contaminated, which puts it out of commission and/or takes space.

I'd ask them to itemize just what they would be charging for because a "few thousand" does seem exorbitant.

If you can stand the drive, MedVet in Columbus, Ohio does it, too. They did my Emmy. No video visits, but they have a lot of staff and an oncology unit, so are very experienced with radiation management.
 
Here's an idea:
Ask them if you could volunteer (legally, its considered a "gratuitous employee") to handle liability issues, and see if that would enable you to gear up in leaded apron, etc., so you could go in an test the glucose.
You'd have to wear a radiation meter to monitor your dosage.
You might have to help with some other stuff there.
 
In order to work with the "radioactive" patients you would require special training. The NRC and specific requirements for radioactive work. It would be a huge liability for the place to allow you to enter.
The few thousands more might be based on their standard hospitalization fee but seems a little high. I looked at aa local place that does the iodine treatment and they say:
Cats are kept in an isolation area here at SouthPaws, and cannot be visited, petted or held by their owners. We can provide food and water, and clean their litter boxes, but we cannot hold them either. Because of these isolation requirements, cats with serious non-thyroidal illnesses (heart failure, diabetes, chronic renal failure, etc.) are NOT good candidates for I-131 therapy.
 
The facility that we used, also an emergency hospital, wouldn't test glucose either because the techs have to minimize their exposure. Wendall was well regulated and I decided a couple of days running a little higher was worth my peace of mind so I just reduced his dose, and told the vet so they wouldn't need to worry. I did pack a meter, strips, etc. just in case but they never used them. I also provided syringes, food, and detailed instructions about his shot and feeding schedule and that syringe with B-12 was taped to the paper. He was the first diabetic they treated with i131 and there was no additional charge for giving him insulin. Maybe if you're willing to skip the testing it will keep the cost down.
 
I can't thank everyone enough for sharing your thoughts & feedback with me! I think I will ask about having them not check the glucose while she's there. She has been well regulated on 2 units 1x day for many years. I am also going to look into the Ohio clinic. Got alot to think about!! Thanks again for all of your help!
 
Larry and Kitties said:
......We can provide food and water, and clean their litter boxes, but we cannot hold them either...
Click to expand...

Aha! litterboxes - what about using Glucotest in the litter? It might give a clue about what was going on, although not perfect.

I like the idea of the reduced insulin dose too. Although it will take a while for the I-131 to finish working, there may be some slight reduction in metabolism while at the clinic, so reducing the dose provides a safety margin for that.
 
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