Hyperthyroid and kidney problems...advice please?

ravynwriter

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My Athena just turned sixteen. We recently noticed she was losing weight, though she was still eating well and acting normally. We took her into the vet today where it was determined she'd lost just under two pounds in about eight months (from the time of her last old kitty wellness visit). They took a blood test and determined that she is hyperthyroid. Kicker is, she's also showing signs of kidney disease (vet felt abnormalities on her kidneys during palpation, and her kidney levels are slightly elevated).

Now we're trying to decide what to do, and I would greatly appreciate as many thoughts on this as possible. I want to do what is going to be the easiest on her, offering the least risk of suffering.

Option one: we do nothing. She continues to lose weight, and is at risk for heart disease, blindness, etc. The moment she shows us she's suffering and no longer having a good quality of life, we let her go. Pros: less stress on her, 'hopefully' less suffering. Cons: we're leaving a medical condition untreated that could cause her quite a lot of discomfort and could cause her to have sudden heart failure or go blind.

Option two: we treat the thyroid with medication. This has a risk of putting her into kidney failure quite quickly. Pros: though she's got a good quality of life now, this could improve it. Cons: more trips to the vet for blood draws and monitoring, which stresses her out. Giving of medication which adds a bit more stress to her day. Risk of catastrophic sudden kidney failure which is painful and frought with suffering. 

Option three: we give her radioactive iodine. Pros: this is very effective in hyperthyroid cats and 95% of them are 'cured' of their problem. Cons: it's extremely expensive. She'd have to spend up to two or three weeks quarantined in the hospital due to the radiation, which would be very stressful. We wouldn't even be able to visit. There is a risk it will do nothing. There is a risk it will also put her into kidney failure.

Thoughts and ideas anyone? 
 

jenny82

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Hi,

I'm sorry to hear about Athena.  My cat Mia was diagnosed with hyperthyroidism about a year ago, and we decided to do the radioactive iodine treatment.  It worked perfectly.  She was in great health until she developed IBD about a month ago (unrelated).  She only had to be quarantined in the hospital for 3 days, do you know why they're saying 2-3 weeks?  Maybe it varies by state.  We were told not to get too close to her for the first few weeks.

What are Athena's kidney values (BUN and creatinine)?
 
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ravynwriter

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I'm not sure, the vet called with the results and all she said was that her kidney levels were elevated and the rest of what I posted here. She definitely said if we did the radiation that Athena would have to stay for at least two weeks in quarantine without visitation. It might be a state law, as you said?

I've been reading some about some owners who have had good results with just feeding their kitties a prescription diet. I'm intending to call her tomorrow and talk to her about that; I can ask her what the BUN and creatinine levels are. 
 

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I'm not sure a thyroid prescription diet is a good if she has kidney issues. I know the urinary diet isn't, but think the thyroid diet might not be as well. Or were you referring to kidney prescription diet?

I definitely would treat the hyperthyroidism. Personally, if it was my 16 year old, I wouldn't want to have them go somewhere either for a few days much less weeks. I didn't even want to do it for my 13-year-old. They both got treated with methimazole.

My Sara is hyper-t and also has early kidney disease. Treating the hyper-t unmasked it, but she had other symptoms that hinted at the fact she had it (namely, dilute urine). She's currently on k/d for at least more than 50% of her diet. She's doing pretty good, even has gained a lot of weight!! She was at 4lb 4oz at one point this year, and on her last exam of 2015, she was 7lbs even.
 
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ravynwriter

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I was referring to the thyroid diet. I've been reading up about it on various places though and I'm liking the idea of it less and less. Right now, I think we're going to treat the thyroid with medication and just keep an eye on her. So long as she's got a good quality of life we'll keep doing it.

Thank you everyone!
 

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Good luck with her treatment. I'm sure you'll get into a routine with her pills and it will help her.
 

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I was referring to the thyroid diet. I've been reading up about it on various places though and I'm liking the idea of it less and less. Right now, I think we're going to treat the thyroid with medication and just keep an eye on her. So long as she's got a good quality of life we'll keep doing it.

Thank you everyone!
The thing about the thyroid diet, vs something like the kidney diet, since it's actually taking the place of a medication, you would have to feed her that, and only that. So it would definitely be more difficult. With the hyper-t meds, I'm able to use pill pockets with Sara, and she just thinks she is getting treats twice a day! Oftentimes - not always, but often - she actually reminds me that it's time if I don't do it soon enough for her tastes.

I think one of the hard things we always have to determine when it comes to these chronic conditions is what our goal is. Is it to treat, or make comfortable. Sometimes the two go hand-in-hand, other times not. With hyper-t, after seeing the transformation with Sara, it did for sure with her. She's so happy now. Ultimately, it means that the kidney disease will probably get worse, faster. But without meds, the hyper-t would probably cause even worse problems. So 6 of one, half a dozen of the other. Pick your poison, if you will. At least I know that she's comfortable right now, and she eats, and she's gaining weight! That last part has been a pleasant side effect of her eating the k/d in addition to all the other food.
 
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ravynwriter

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Yeah, at her age, my goal is to make her as comfortable as possible, and have a good quality of life as much as possible for as long as possible. The moment her quality of life goes down then I think it's time to let her go with dignity. 

Trying the medicine will make her feel better I think, and we'll keep a close eye on her kidneys. So long as I feel she's happy and comfortable we'll keep on keeping on.
 

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I just read about the kitty who has hyperthyroidism.  I, too, have a cat that was recently diagnosed with this.  While the I131 therapy is a cure it is super stressful for a cat to be without their guardian(s) for two weeks in isolation.  Versus giving her/him tapazole orally there is the generic form methimazole (sp?) that comes from a compounding pharmacy.  They make it into a gel that is transdermal.  You put it on the hairless parts of their ears.  It works and it's one less pharmaceutical thing going thru their ALWAYS SENSITIVE tummies.

Good luck to your little fur baby
 

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Having been through caring for a cat with both conditions, I wish you all the best in caring for Athena. It can be a bit of a roller coaster at times.

16 is a tricky age. Amber was diagnosed with hyperthyroid at 13. Faced with that scenario again, I would 100% do the radioiodine, no question. She lived to be 17 even without it, and had 3 years of easy Pill Pocket dosing of methimazole pills (then it got harder when she stopped eating those, then we had to start treating issues related to kidney disease).  After that many years I spent possibly as much in other items as I would have for one radioiodine treatment.  At age 16, though, there could be fewer years to get the full value of the radioiodine treatment so to speak, but that is only if we count in dollars.

You may not want to rule it out just yet.  Maybe she won't eat Pill Pockets.  If so, maybe the pilling will be too stressful (although there is the compounded topical gel option). Maybe she won't do well on methimazole even if pilling is easy or even with the topical (some cats have poor reaction to it).  The methimazole treatment for hyperthyoid often uncovers/makes worse the kidney disease issues.  All these are possible outcomes and are essentially solved by springing for the radioiodine treatment.  This is where the radioiodine has a value that goes beyond just a dollar cost comparison.

Typically cats are started on methimazole first anyway before doing the radioiodine.  So you'll have a chance to see how much see improves just with that treatment and whether it might be worth considering the radioiodine based on her response.

The quarantine these days should be only 3 days at many centers that do the treatment, but I suppose it may still vary.

Leaving the hyperthyroid untreated is generally bound to lead to heart complications.  Not to mention she would continue to lose weight despite eating more than normal, etc.  I wouldn't consider that an option.  Also I personally wouldn't consider the Hill's Prescription food option as I don't find it convincing.

So try the methimazole and see.  If she takes well to the med, the worst part of that dosing is probably going to have thyroid levels rechecked every so often.  The drug itself is not expensive if she can take regular oral pills (it's generic and cheap at regular human pharmacies).  And know that you can still decide to do radioiodine anytime as long as she isn't unwell from other issues. And double check on quarantine times at multiple places within reasonable distance to you, because they should not be anything close to two weeks these days.  Even several years ago when I was checking for Amber, the quarantine was about 6-7 days.
 

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Having been through caring for a cat with both conditions, I wish you all the best in caring for Athena. It can be a bit of a roller coaster at times.

16 is a tricky age. Amber was diagnosed with hyperthyroid at 13. Faced with that scenario again, I would 100% do the radioiodine, no question. She lived to be 17 even without it, and had 3 years of easy Pill Pocket dosing of methimazole pills (then it got harder when she stopped eating those, then we had to start treating issues related to kidney disease).  After that many years I spent possibly as much in other items as I would have for one radioiodine treatment.  At age 16, though, there could be fewer years to get the full value of the radioiodine treatment so to speak, but that is only if we count in dollars.


You may not want to rule it out just yet.  Maybe she won't eat Pill Pockets.  If so, maybe the pilling will be too stressful (although there is the compounded topical gel option). Maybe she won't do well on methimazole even if pilling is easy or even with the topical (some cats have poor reaction to it).  The methimazole treatment for hyperthyoid often uncovers/makes worse the kidney disease issues.  All these are possible outcomes and are essentially solved by springing for the radioiodine treatment.  This is where the radioiodine has a value that goes beyond just a dollar cost comparison.

Typically cats are started on methimazole first anyway before doing the radioiodine.  So you'll have a chance to see how much see improves just with that treatment and whether it might be worth considering the radioiodine based on her response.

The quarantine these days should be only 3 days at many centers that do the treatment, but I suppose it may still vary.

Leaving the hyperthyroid untreated is generally bound to lead to heart complications.  Not to mention she would continue to lose weight despite eating more than normal, etc.  I wouldn't consider that an option.  Also I personally wouldn't consider the Hill's Prescription food option as I don't find it convincing.

So try the methimazole and see.  If she takes well to the med, the worst part of that dosing is probably going to have thyroid levels rechecked every so often.  The drug itself is not expensive if she can take regular oral pills (it's generic and cheap at regular human pharmacies).  And know that you can still decide to do radioiodine anytime as long as she isn't unwell from other issues. And double check on quarantine times at multiple places within reasonable distance to you, because they should not be anything close to two weeks these days.  Even several years ago when I was checking for Amber, the quarantine was about 6-7 days.
Just as a note, it's not the methimazole that unmasks the kidney disease, it's treating the hyperthyroidism in general. Getting i131 will unmask it just as much as treating with Methamazole. The two diseases so often seem to go hand in hand, as it has for two of my cats now. Sara showed signs of early kidney disease though even before being treated for the hyper-t.

In the case of i131 causing hypothyroidism, or not completely curing the hyper-t, it could still require medication. It's a great option, but good to know all the potential outcomes beforehand. Although, my understanding is that treating hypo-t is a much lesser burden on the body than treating hyper-t.
 
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2bcat

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Just as a note, it's not the methimazole that unmasks the kidney disease, it's treating the hyperthyroidism in general. Getting i131 will unmask it just as much as treating with Methamazole. The two diseases so often seem to go hand in hand, as it has for two of my cats now. Sara showed signs of early kidney disease though even before being treated for the hyper-t.
Thanks.  Foggy memory, I guess, perhaps mixed with a little wishful hindsight in my personal case. ;-) (As in, 3 years later when I got to all the kidney stuff, I wished I had done the I-131.)  What it would be, then (in most ideal cases at least), is one less balancing act as you struggle with balancing all the kidney issues.  Throwing a necessity for methimazole in there is just one more item when CKD often throws up many other barriers to the kitty feeling well.

My understanding is that it's pretty rare these days that the treatment causes hypo or that it is not enough in one treatment to fully cure the hyper-t.  But it is always good to know what the less than ideal possible outcomes are, to be sure.
 

donutte

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But it is always good to know what the less than ideal possible outcomes are, to be sure.
Especially considering the cost - absolutely.

Actually, if not for the kidney disease (ironically enough), I'd be more inclined to consider the i131. But in my case I was aware of it probably being there at the time she was diagnosed with hyper-t. Plus, she just thinks she's getting treats. I have moments where it's not as easy to get her to take it (like this morning), but most of the time she is fine taking it.
 
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ravynwriter

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I appreciate all the input, very much.

Bit of an update. I ended up going with the gel treatment that goes on the inside of the ears. She's been getting that twice a day now for at least the last week or so and is tolerating it very well. She's always been pretty good about taking pills, compared to some cats I've had anyway, but the gel is pretty much no stress for her which I like.

So far we haven't seen much if any change, but I know that it can take a while. She, at least, doesn't seem to have lost any MORE weight that we can tell, and in all other respects she's acting perfectly normally. Gonna try and weigh her this weekend and see if she's managing to put anything on.

We have another appointment in four weeks to recheck her kidney values and make sure she's doing well in that regard.
 

donutte

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I can't remember how long it took for Sara to respond to the hyper-t treatment. I want to say she probably showed signs of improvement within a couple of weeks though. It was very subtle at first, but over time became very noticeable. She gained weight, her coat filled out, she got SO friendly! She was always rather aloof before that.

I'm guessing they'll be doing another blood test after a month, then another at three months?
 
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ravynwriter

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 I'm guessing they'll be doing another blood test after a month, then another at three months?
That is the plan, contingent upon how the kidneys seem to be doing, of course.
 

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My Athena just turned sixteen. We recently noticed she was losing weight, though she was still eating well and acting normally. We took her into the vet today where it was determined she'd lost just under two pounds in about eight months (from the time of her last old kitty wellness visit). They took a blood test and determined that she is hyperthyroid. Kicker is, she's also showing signs of kidney disease (vet felt abnormalities on her kidneys during palpation, and her kidney levels are slightly elevated).

Now we're trying to decide what to do, and I would greatly appreciate as many thoughts on this as possible. I want to do what is going to be the easiest on her, offering the least risk of suffering.

Option one: we do nothing. She continues to lose weight, and is at risk for heart disease, blindness, etc. The moment she shows us she's suffering and no longer having a good quality of life, we let her go. Pros: less stress on her, 'hopefully' less suffering. Cons: we're leaving a medical condition untreated that could cause her quite a lot of discomfort and could cause her to have sudden heart failure or go blind.

Option two: we treat the thyroid with medication. This has a risk of putting her into kidney failure quite quickly. Pros: though she's got a good quality of life now, this could improve it. Cons: more trips to the vet for blood draws and monitoring, which stresses her out. Giving of medication which adds a bit more stress to her day. Risk of catastrophic sudden kidney failure which is painful and frought with suffering. 

Option three: we give her radioactive iodine. Pros: this is very effective in hyperthyroid cats and 95% of them are 'cured' of their problem. Cons: it's extremely expensive. She'd have to spend up to two or three weeks quarantined in the hospital due to the radiation, which would be very stressful. We wouldn't even be able to visit. There is a risk it will do nothing. There is a risk it will also put her into kidney failure.

Thoughts and ideas anyone? 
Gosh without reading through this thread other then the first original post I want to comment, as we are in the same boat.

My senior cat Simone, exact age is unknown but at least 14 and likely older, did the same thing, was eating plenty but losing weight.

Doing nothing shouldn't be an option since she will have big trouble if her hyperthyroidism isn't brought under control, every thing is having to work so much harder and faster to keep up, incl;uding her heart, so her life would be very short if nothing is done.

At her age I would opt out of the iodine. Just not necessary to put her through at her age.

Long story short, she also has CKD and hyperthyroidism, and is now on the transdermal (topical ear cream) med for thyroid, 2 months after she started that we had her blood rechecked and kidney values were the same, nothing worse at all.

I would definitely suggest this for your cat! She's gained all the weight back and is doing so good now :)
 
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ravynwriter

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So, it's not her thyroid. :(

It's been just over a month since we started Athena on the thyroid meds. Everything stayed more or less the same, except that now we were putting the the gel in her ear twice a day. She didn't look like she was losing more weight but didn't look like she was gaining any. Her appetite has been fine, she's alert and active (as much as she ever was), still uses the litter box fine, no diarrhea, no over urination, no sign she's painful in any way or with any activity.

We took her back in on Saturday to be weighed and have a follow up blood test done. The tech took her in back and when she came back out she said 'she's about three pounds. Is that about normal?'

I about fainted. She was eight pounds in July and six pounds a month ago. I told them that and the tech got all wide-eyed and decided to re-weigh her with a different scale (the same one she'd been weighed with the first time, in the same room). Turns out she wasn't three pounds, but at just over five pounds. Not as bad, but it did mean she'd lost over half a pound in the month she'd been on the thyroid meds.

So we went home and the doctor called the the blood test results that evening. He said that her thyroid levels had been on the high end of normal (which I hadn't known, the other vet hadn't said that, just that they were 'high')  and they were now on the low end of normal, but given her continued weight loss it wasn't her thyroid that was causing it. Her kidney levels were still where they were before, so thank goodness the thyroid treatment didn't do anything there (also thank goodness I didn't kill her thyroid, given that it wasn't the problem). 

Now he's pretty sure she has some form of lymphoma, or possibly an intestinal cancer. The thing is her stools have still been fine suggesting more the lymphoma than the intestinal cancer.

He had a few suggestions as far as what we can do to try and put weight on her and keep her comfortable, so we're going to do those. He doesn't want to give her steroids because that could cause all sorts of problems with her heart and kidneys and won't do anything but delay any lymphoma for a little bit (my wife's 15 year old Freyja just died of lymphoma last year- at most the steroids bought her a couple weeks). I think at this point we're just going to try and put weight on her, and keep her comfortable and happy as long as we can, so long as she is enjoying life.
 

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Oh no, I'm so sorry to hear this! :(

Is she eating ok? Possibly try kitten food? 1) Cats usually love that stuff and 2) it's higher in calories. If your goal isn't to treat but to comfort, that is a good thing to try.
 
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ravynwriter

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She's eating fine. In fact, her appetite has never been better. She tries to steal the food right off our plates if she can sneak in without us noticing. 

We'll try the kitten food. We're also giving her nutrical as a bit of a supplement and feeding her extra, high value meals throughout the day in small doses. If nothing else, she's going to feel spoiled for the rest of the time she's with us.
 
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