Hyper t thoughts?

One of my sort of foster cats (he came as a foster, but the rescue is closing so it is up in the air what we will do with him) was diagnosed with hyper-t last week. Background - he was picked up as a young cat in the middle of December but a vet check showed him to be 11/12yo, with possible hyper-t and a bad mouth. He had bloods done a fortnight or so later to check his thyroid levels and he was bang on the end of the scale (55), so the vet said it was too early to treat. About a month later he had his dental, his liver values were about 100 higher than the top end of normal, but everything else was fine - he had to have all his teeth removed. His follow up check showed his mouth was still bad, and a month after his dental he had more bloods to see if the raised liver was down to his teeth or not. His bloods weren't too bad then, his thyroid was still bang on top end of normal though. 4 months after his dental, he went for a check up (he had been having monthly weigh ins, which showed him to be able to gain weight, but not maintain it), and his mouth was full of severe ulcers - there was hardly any signs, the only thing I can think of is a slight increase in drooling when being fussed, so he had 7 days of ab's, which didn't clear it, so another 7 days. he was then checked again, and while they were better, they were still there. The vet didn't really want him on a third consecutive dose of ab's, and despite having such a bad mouth, it doesn't stop him eating, so we just monitor that now (vet feels it is calici, but we have removed all his teeth, tried him on the recommended food and had a few lots of ab's this year, and very little Metacam). He went for a check up last week, as it was 6 months since his last bloods, I felt he had tipped over into hyper-t, the vet wasn't convinced but conceded when she listened to his heart - his weight is only noticeable cos he does get weighed every month, if he hadn't, it would have been up, his fur is still quite nice (although I Feel its a bit dull), his appetite has only really increased since being on the meds (although the neighbour tells me she has found him pinching her cats biscuits, so maybe that is why!!), he doesn't drink in the house (loves puddles though!!) - and his only real symptoms were warm paws/ears, unable to maintain his weight and a bit restless - his results came back at 76, so he really is only just hyper-t (although the vet said his mouth could be suppressing his thyroid). The vet felt that a months worth of meds would work and he could have an operation to remove the gland, my vets do these quite a lot for the RSPCA, so are experienced. At first I was happy with this, but am now having some doubts - despite how severe his mouth is (he will let you check the bad side for a very short time, but not the good side, so we dont know the true extent), it has never affected his appetite, but now i am wondering if that is the hyper-t is the reason why he has been able to eat despite his mouth, and if we put him through the surgery, would it then mean that his mouth bothers him more? IF so, it is regular a/bs and Metacam, which isn't good, and what bothers me more is if he becomes resistant to that, as if he can't eat, he has no quality of life, and I would hate to put him through the pain and stress of the op, for him to suffer with his mouth and not have a lot of time. But the other option is to keep him on the meds, and adjust if he does struggle, but he is a nightmare to pill and I believe there are long term issues with them being on meds.

Apologies for the essay, but I really dont know what to do for the best, and while I will discuss this with the vet when we go back for his check up after a month of meds, I really wanted some clear thoughts in my mind first - although maybe I am panicking prematurely and we will have a better idea at the end of the months worth of meds. Has anyone dealt with hyper-t and severe mouth ulcers?

I haven't dealt with mouth ulcers before, but I just wanted to make sure you understand that not treating the hyperthyroidism will likely result in damage to his organs, especially his heart, liver and kidneys. Hyperthyroidism will usually cause an increase in blood pressure and overtax the organs. You mentioned that the kitty already has audible changes in his heart, so I would definitely suggest trying medication to see if you can get the thyroid levels under control. The nice thing about medication is that it can be stopped if the side effects are too bad to warrent continuing. Medication can serve as a trial run before the operation to ensure that the surgery is worth the risk.

He is on medication, I picked up an oldie from teh streets with untreated hyper-t earlier in the year, so I am well aware of the seriousness of not treating. He has had a reaction this week though, and is currently off his food and being sick, so have stopped his medication for a few days, and will then try just pilling him once a day rather than twice - am hoping that as his levels were only just over, that nearly 2 weeks of meds have reduced them a lot and that is why he is reacting to them, as his body doesn't need the same level. i am in the scenario that I was dreading though, as I can only hide his ab's and painkiller in cat milk, and he is barely touching that (which is really unusual), and only nibbling on biscuits and ham at the moment, so if it is his mouth, I am struggling.

You might want to talk with the doctor about transdermal methimazole. It is usually rubbed on the ears, alternating between each ear for each dose. It would require being able to clean his ears before giving the next dose, but that might be easier than pilling him. I didn't see that he was off his food in the original post--that could indicate side effects from the medication. Sometimes the transdermal will work when the pills do not, since it is not absorbed via the gastrointestinal tract. What painkiller and antibiotic is he getting? Perhaps they come in alternate forms as well?

I dont know how easy it is to get transdermal meds in the UK, and not sure if that would be easier for us, with how he reacts to having suncream rubbed on his ears. He wasn't off his food in the first post, and a couple of days of no meds and he is fine - I think it is more likely to be the dose of the meds than the actual meds, as my last hyper-t cat reacted after the first tablet, it took Sam nearly 2 weeks and his values weren't too high, so maybe they have come down very quickly. I will try him on 1 tablet a day tomorrow and if no better, will then speak to the vet, although I Really wouldnt want to change him to the other medication. The meds for his mouth are Antirobe and Metacam, but as I can't open his mouth, they are both put in food. He does very rarely need them though.

Liquid medications might be another option. I forgot that they don't call them compounding pharmacies in the UK--they are referred to as Special Units: http://en.allexperts.com/q/Pharmacy-...ompounding.htm It might be an option to look into. Methimazole really works best when given twice per day, but once is probably better than not at all. What dose did you start with? Starting with the lowest dose you can (I know the pills are tiny) would probably be best.

Thanks, I will look into that. He was on 2 x 2.5mg Felimazole, but hopefully his reaction this week just means he only needs 1 a day as he isn't that hyper.