Very large doses, hyperthyroidism, any advice?

Hi,

This forum has been very helpful for our cat, Sally. Thank you so much. We switched her over to Lantus and, after gradually increasing her dose, got fantastic numbers from January through September. Now she seems to be getting too high again.

For the last year and a half, her blood work was showing elevated T4 levels, but she only recently went above the 4.0 threshold. Other numbers OK. Vet prescribed methimazole and she's been on 1.25 mg BID for a bit over a week. We thought that getting the T4 levels down might help with the BG.

So far, and I know it hasn't been long, we haven't seen any real improvement (this morning was good, but that happens occasionally). The huge insulin doses kind of worry us. Any advice? Just keep monitoring and increasing by small amounts if we don't see improvement?

Vet will do additional blood work in a couple of weeks to see how the hyperthyroidism is responding to treatment.

Food: 1oz fancy feast pate, 3oz raw chicken-based homemade food following the recipe I've seen posted here. Weight dropped a bit this summer, so she's now getting 3/4 oz more than previously.

Thanks again!

 

Has she been tested for Acro and IAA? Did your vet run a full thyroid panel and did he feel any nodules on the thyroid?

 

No, I don't think they are all that familiar with anything beyond standard treatment and diagnoses. We are their first patients that used anything other than pzi.

My understanding was that there was no real difference in treatment whether or not she has acro or iaa. Is that incorrect?

 

That’s not true. I’m not an expert in this but there’s a medication many are using with success for ACRO cats. I’m going to tag a few members that might be able to help you. @Wendy&Neko

 

Thanks! We'll try to get her tested.

 

I posted to check out Cabergoline but it’s not showing up.

 

Hello again. Here is your last post here for connectivity. https://felinediabetes.com/FDMB/threads/new-poster-a-few-weeks-on-lantus.239659/
At that time, I suggested getting tests done for acromegaly (IGF-1 test) and IAA (insulin auto antibodies). Blood work is sent to Michigan State University. Good to hear you are thinking of it. We find that if cats on low carb food go over 6 units per shot, chances are one or the other of those conditions is present. If you do get Sally tested for those secondary endocrine condition, please post back with the results and we can talk about next steps.

Hyperthyroidism will also make it harder to regulate your cat, but not to the point of being over 6 units.

Neko was the first cat at her vet on Lantus, then first on Levemir. First that the vet knew about with acromegaly and IAA, first to get treatment done. We learned a lot together. Once Neko got her acromegaly diagnosis, the vet realized another of her hard to regulate kitties was acro. Sally is actually looking pretty good for the size of dose she's on.

 

Thanks again for the response. When I last checked in, I didn't see any studies showing that there were reasonable, successful treatments for acromegaly or IAA. My thought process was, that if how we managed her diabetes wouldn't change based on the results of the tests, then there probably wasn't any value in getting the diagnosis. Perhaps the situation has changed now, as I see that there have been some positive (and some negative) results on treatment with cabergoline. Are there any other non-surgical treatments? We're already following best practices, as I understand them, regarding feeding, measurements, insulin doses, etc. I've read through the relevant sub-forum and didn't see anything else popping out.

Regardless, we'll have the vet submit the bloodwork and, if the IGF-1 test comes back positive, consider getting a prescription for cabergoline (or other options presented). For IAA, is there any new treatment?

 

I second the idea that you should have your kitty tested for IAA and Acromegaly. Cabergoline is a medication that can be very helpful with symptoms and a few cats have gone OTJ on Cabergoline. It also looks like you have been holding your doses for way too long in some instances. You had some really nice blues recently though! Nice!

 

There is also Stereotactic Radiation Therapy which is a reasonable option if it is financially feasible.

 

Case 2 in this article (2020) Updates in Feline Diabetes Mellitus and Hypersomatrotropism describes various types of treatments for acromegaly (hypersomatrotropism), and the pros and cons of each. The first step is knowing what you are dealing with. IAA has no treatment, it resolves over around a year. But it does change your dosing strategy. My Neko had both IAA and acromegaly and we went for SRT with her. At the time, it was the only treatment available and I was happy I did it. It didn't completely solve her acromegaly, but greatly improved her QOL and I had longer with her.

 

Thanks again for the info. If we can get her bg under control again it will be fantastic. I will update the board with the findings and, if relevant, what we decide to do for treatment.

 

The Cabergoline is what got my cats BG under control and at greatly reduced doses.

 

Another vote for the IAA and acro tests, we went OTJ with the cabergoline and no obvious signs of acro progression. It's almost like I have a kitten running around again, zoomies all night!

 

Thanks again for the great advice - I hope everyone is doing well. I just posted a follow-up thread here:

https://felinediabetes.com/FDMB/thr...ith-high-igf-1-want-to-try-medication.255910/