CRF cat so don't treat hyperthyroidism immediately?

Many of you here will have taken care of/are taking care of, cats with CRF. As we all know, hyperthyroidism makes the kidneys function better for while.

Have any of you, with advice from your vet, taken the route of not treating the hyperthyroidism while it's in the early stages because treating it would cause more problems with CRF?

I know that not treating it long-term would cause problems with the heart, etc. but with a cat who has been in CRF for years, would you believe it is best to continue treating that and just keep an eye on weight and re-test for thyroid levels frequently?

My experience of a cat with an over-active thyroid was that he lost weight at a frightening rate - and his T4 levels were borderline.  The free T4 was clearly hyperthyroid.

OrientalSlave said:

My experience of a cat with an over-active thyroid was that he lost weight at a frightening rate - and his T4 levels were borderline.  The free T4 was clearly hyperthyroid.

Click to expand...

That's my concern.  Sam has lost a little weight, but she's also more lively so she is enjoying her life more now - after dental surgery a few months ago, and now having been diagnosed (through T4 levels) to be in the early stages of hyperthyroidism. I've decided to go with the vet's advice and hold off on treatment, but I'll be taking her in for a weight check every week. 

She's had three extra years and I know I will lose her to CRF eventually. I just want her life to be the best I can make it, and I'm not going to drag things out.

This is very interesting.  Is the treatment for hyperthyroidism in cats similar to that of humans?  (PTU, Radioactive iodine therapy, thyroidectomy)?  I can't imagine she'd be a candidate for surgery with her CRF unless they do kitty hemodialysis.  :/

I wonder, if she is not showing overt signs of hyperthyroidism, and her current quality of life is good, why mess with it?  I know that in humans, hyperthyroidism often causes high blood pressure, and chronic hypertension "resets" the optimal pressure at which the kidneys work best.. so if she's had hyperthyroidism for a long time, treating it will lower her cardiac output, BP, and renal blood flow, which is not so great for the kidneys.

I think it might depend on how severe the hyperthyroidism (and the sequelae: how hard the heart is working, how much weight she's losing, coat quality, irritability/anxiety, etc), and how severe the CRF is. If the hyperthyroidism is mild, then treating it maybe won't cause such a great drop in system functions. Then again, if it's mild enough, and she's happy, why treat it?  Quite a conundrum.

I like your dedication to quality of life.  Good luck with your kitty!  

At a certain point you have to choose the lesser of two evils. And I would think this is one of those times. What will impact her quality of life more, leaving the thyroid condition untreated or treating it and potentially making the kidneys worse. That's kind of no win all the way around but not treating the thyroid is probably the lesser of the two evils. That's a tough decision but I would probably do the same thing you are doing, for now.

Not sure about that one.... I lost my kitty Gracie to a horrible death due to untreated/mishandled thyroid that developed into congestive heart failure (she came to me as a senior, and the previous owners didn't give her the meds as they should). It was the most painful death a kitty could go through, and an ammount of suffering I wouldn't recommend gambling with - I take managing thyroid very seriosuly because of what I experienced with her.....
With that said, do you have a long term plan? I mean, it will get worst - then what?
One thought to discuss with your vet, is the new Hills y/d diet.
I am not a proponet of Hills, and I know soon some will pop in here with links to a blog by a Dr. commenting on why NOT feed the diet. I get it - I am a raw feeder, and I get why that is said.... However, in your situation, when medication might not be an option, it might be a good route to go.
It does work in keeping the numbers leveled - they do have in canned and dry, and the canned IMHO is the way to go, especially considering her kidneys.
That way, you would have the best of both worlds.
Now, the thing with the diet, is that it only works when you feed nothing at all but the diet - no treats, nothing, nothing nothing. So all she is going to eat is that one canned food..... and I am just not sure how long can a kitty go on eating just one flavor of canned for.... But might be worth a try :dk:

The other option would be radioactive iodine treatment, which cures thyroid problems in almost all cats.......
Just something to consider :dk:

I heard back from the shelter vet that she approves no thyroid treatment at this time, and she mentioned that's what the Seattle hyperthyroid center recommends , so that's what we will do. Sam has blood tests frequently to check her kidney levels, and she became anemic two years ago, so we test every three months for the two problems. In December and March, her tests showed high normal levels that indicated possible incipient hyperthyroidism. When I realized she had dropped a few ounces, I took her right in for a senior screen and free T4. I even had to argue with the vet's office who wanted to do another senior screen because it would be cheaper for me (I often cover my foster's vet expenses as a donation as well as taking my own cats there) but I was convinced about the need for a free T4 check right away and I'm glad I insisted. It's at the lowest level of hyperthyroid so I feel we are on the right track for now.

Sam is extremely special to me and I watch for any signs of any problems - if she is a little less interested in eating, if she is less sociable, etc. I know cats can show big changes in their bodies in the tiniest ways.

Having said that, it was obvious to anyone that she was coming down with a URI on Tuesday evening. It's not bad, just a snotty nose and some snuffly breathing, but it had me on red alert right away. She's on antibiotics and by this morning she seemed a little better.  Sam is a very strong cat.
 

Simka said:

Many of you here will have taken care of/are taking care of, cats with CRF. As we all know, hyperthyroidism makes the kidneys function better for while.

Have any of you, with advice from your vet, taken the route of not treating the hyperthyroidism while it's in the early stages because treating it would cause more problems with CRF?

I know that not treating it long-term would cause problems with the heart, etc. but with a cat who has been in CRF for years, would you believe it is best to continue treating that and just keep an eye on weight and re-test for thyroid levels frequently?

Click to expand...

Actually my first cat had ARF, but her symptoms were the same. At age 10 she became hyperthyroid. The vet was able to diagnose it with his stephoscope (it causes an unusual heart rhythm) but of course he also checked her T4 levels. Emily got the I-131 treatment (radioiodine) and it worked purrfectly as expected. But two years later she had to be euthanized because of the kidney failure.

I talked to my last regular vet about this. She said HT masks RF, so it is possible Emily's kidneys started failing when she was HT and we just never noticed until it was too late. But she assured me HT does not cause RF. Both problems cause weight loss and lack of appetite, so a vet needs to do a blood test on both kidney and thyroid function if those are the cat's only symptoms. How many blood tests the cat needs, I have no idea, but I would not think they must be frequent unless you prefer daily medication to iodine for the HT.

Simka said:

I heard back from the shelter vet that she approves no thyroid treatment at this time, and she mentioned that's what the Seattle hyperthyroid center recommends , so that's what we will do. Sam has blood tests frequently to check her kidney levels, and she became anemic two years ago, so we test every three months for the two problems. In December and March, her tests showed high normal levels that indicated possible incipient hyperthyroidism. When I realized she had dropped a few ounces, I took her right in for a senior screen and free T4. I even had to argue with the vet's office who wanted to do another senior screen because it would be cheaper for me (I often cover my foster's vet expenses as a donation as well as taking my own cats there) but I was convinced about the need for a free T4 check right away and I'm glad I insisted. It's at the lowest level of hyperthyroid so I feel we are on the right track for now.

Sam is extremely special to me and I watch for any signs of any problems - if she is a little less interested in eating, if she is less sociable, etc. I know cats can show big changes in their bodies in the tiniest ways.

Having said that, it was obvious to anyone that she was coming down with a URI on Tuesday evening. It's not bad, just a snotty nose and some snuffly breathing, but it had me on red alert right away. She's on antibiotics and by this morning she seemed a little better.  Sam is a very strong cat.

 

Click to expand...

have you asked why you can't manage her thyroid? I understand about methimazole, but I am curious why you couldn't pursue other options such as diet (not a treatment) or iodine? :dk:

Emily was the first of two cats I lost to kidney failure. Wilbur had normal T4 levels, but they were climbing up. His dermatologist (he had lots of allergies)  was concerend if we did nothing, he would become HT. But more extensive testing - a urinalysis, an ultrasound, and another senior blood panel - revealed he had a bacterial liver infection (I forget the name) and CRF and was still not HT. So I know the feeling about being at the HT borderline even though Wilbur did not get to that point.

Carolina said:

have you asked why you can't manage her thyroid? I understand about methimazole, but I am curious why you couldn't pursue other options such as diet (not a treatment) or iodine?

Click to expand...

No-one has told me I can't manage her hyperthyroidism, they have recommended we don't for the same valid reasons I thought of myself. It was a relief when both my vets and the shelter vet agreed with my thoughts. Leaving her slightly hyperthyroid is helping her kidneys, a much more life-threatening disorder. Her weight loss has been slight, a few ounces, and will be monitored very closely. I've had several cats with hyperthyroidism and they have all been treated with either iodine or methimazole.

Sam would not be accepted for radioactive iodine treatment because she is in CRF, and has been for three years at least (she may have arrived at the shelter in failure, we don't know since they don't automatically blood test cats who come to them) plus she is on Epogen treatment for anemia which began nearly two years ago. They wouldn't accept her.

Her time is short, I know that and my vets would agree.  We are all amazed she has survived many crises with anemia and viruses, and we will continue to fight to give her as long a good quality life as possible. I asked to foster Sam on a Wednesday in August nearly three years ago because she was slated for euthanasia very soon as she was losing 1/2 pound a week. They had  her on a kidney disease diet which she would not eat and fluids every other day. I didn't aim to save her, I thought that would be impossible, I simply wanted her to have a better few days than she would at the shelter. I gave her my  bedroom to herself, any food she wanted to eat, and fluids twice a day. I cancelled the euthanasia appointment that Friday because she ate up a storm almost immediately. She simply needed to be in a quiet space of her own with food that appealed to her.

She is extremely selective about what she will eat and has always refused healthy foods (such as Wellness) or treatment food to the point of losing weight if I try. I don't like not treating an illness but I believe from what I have heard that it is in her best interest at this time.