Major Problems with Hyperthyroid Cat - Not Sure What to Do

My 9.5 year old cat just started having noticable problems around Christmas.  He had always vomited like once a week or so his entire life (usually immediately after eating so I just thought he would sometimes eat too fast and make himself vomit), but this escalated to several times a day, and I could see noticable weight loss around his back/hip bone.

I took him to the vet on January 9 and spend like $700 on tests.  Once he got to the vet, he was hyperventilating so much that he was literally panting/open mouth breathing and they had to put him on oxygen the entire 2 hours I was there.  They did a chest/lung X-Ray which came back with nothing out of the ordinary, and also did a CBC blood test, also that had nothing outside of normal levels.  They finally did a T4/Thyroid test that came back at 180, which is apparently 3 times the maximum normal level.  They prescribed him 5 mg of Tapazole twice a day. 

He has been taking the meds without a problem (he apparently LOVES pill pockets), and showed an immediate improvement after even one dose (calmed right now, has not vomited since).  After 3 weeks, I took him in for a follow up T4 test to see how his levels were, and they came back at normal (at 20), so they refilled the prescription and said he was fine to stay on it for 6 months before he needs an additional blood test.

On Friday, I noticed that he had an uncontrollable nose bleed.  It was obviously driving him crazy because he kept making sniffling motions (that sprayed the blood every where), but I assume that is probably just a natural reaction, because having something dripping in your nose is irritating?  Anyway, after the bleeding didn't stop for a couple of hours, I took him back to the vet.  His temperature and heart rate were both very high, and his blood pressure was on the high side of normal.  They did another CBC which showed his red blood cell/platelet count at half of normal levels.  The vet told me that it's highly unlikely that would be caused by blood loss from a nose bleed (because nose bleeds are almost always superficial - look bloodier than they really are) and that she believes by far the highest likelihood is that the RBC decrease is caused by a negative reaction to the Tapazole.  She advised me to stop the Tapazole for a week and then have his red blood cell count checked again.

Does it make sense that Tapazole would cause his RBC to crater so much between February 5 and February 26, when he was already on it since January 9, or is it just something where the side effects can cause a while to show up?  Also, he has been acting very detached/hiding since coming back from the vet.  He avoids all contact, sleeps as far away from me as possible and sometimes will barely look at me.  He apparently managed to scratch his inner ear, causing a large bruise over almost the entire ear (and I assume the bruising like that is a side effect of poor clotting/low red blood cell count).  He is both eating and drinking like twice the normal amount, however.

What options do I really have if it turns out he can't take Tapazole/turns out the drug was causing the issues for dealing with his hyper thyroid?  I don't see the Science Diet thyroid food as a reasonable option.  I have another cat, and any attempt to seperate them for feeding or feed them during specific time windows has always failed.  He always never eats enough and then is upset the rest of the day.  I measure their portions, but they generally eat them over a 6-8 hour period.  I think locking him away for several hours at a time to make sure he only eats the thyroid food would be an unreasonable loss of quality of life for both cats.

There is a clinic about 5 km from here that does offer Radioactive Iodine.  However, it is $2000, and while I could dump that on a credit card or something, it would be a huge expenditure that I can barely afford.  If I end up considering that, what type of tests should I have the vet run first to make sure that some of his issues are not related to another underlying health condition?  If I am going to kill my finances to get the iodine surgery done, I want to at least make sure he doesn't have some type of cancer or kidney problem too.

Hello there! I'm guessing you are not located in the United States, because a T4 of 180 would probably be a dead cat going by the range I am used to!

I know there are some cats that don't tolerate the hyper-t meds. Is Tapazole the same thing as methimazole? Ah yes, Google tells me it is. I honestly don't remember what the big problem they can have is, but I thought it was something related to the liver, not the RBC.

Do you happen to have the blood test results with the ranges on them? I know you are mentioning that you want to rule out other things. Kidney disease can be unmasked when hyper-t is treated, although he's a bit young for that (it's not impossible though).

Yes, Tapazole and Methimazole are the same thing. 

Based on the scale they use, apparently 10 - 60 are normal thyroid levels, and his was at 180.  I didn't get a copy of the blood test results, but with all 3 CBCs, they told me that every thing was within the "normal range" - with the exception of red blood cell count on the test on Friday.

Methimazole causes blood issues among others (says on the manufacturer's label)

This from Wikipedia:

Other known side effects include:

• skin rash
• itching
• abnormal hair loss
• upset stomach
• vomiting
• loss of taste
• abnormal sensations (tingling, prickling, burning, tightness, and pulling)
• swelling
• joint and muscle pain
• drowsiness
• dizziness
• decreased white blood cells
• decreased platelet count (thrombocytopenia)
• Aplasia cutis congenita (prenatal exposure)

Click to expand...

Which is why I'm at a cross-roads myself with my own cat who has liver and kidney issues with anemia AND hyper-t. What to do.

Now, the cat seems to be having some type of urinary or constipation issues.  He has literally been in and out of the litter box every 30 minutes or less all night, producing small amounts of urine or diarrhea at most.  He seems to be sore in his hind area (if you lift his tail or touch his bag legs), he calls out in pain.  However, his bladder appears to be completely empty (if you palpitate the area under his hind legs - you can't feel a full bladder), so I don't think he's actually blocked.

I wonder if this type of reaction is a side effect of either the low blood counts, coming off the Methimazole, or of his thyroid levels skyrocketing back up.  He already has a follow up appointment on Friday (and I have to take him in Friday regardless because they need the full week to see the blood work impact of stopping the medication), and I really don't want to have to take him in for another appointment before Friday unless it's absolutely necessary (both for cost reasons and the fact that it stresses him to the max).  Does any one have any experience with how cats react to coming off thyroid medication?

As someone who has an autoimmune disorder that means my platelet count is always 1/3-1/2 normal, the low platelets probably caused the nosebleed. The stress from all the vet visits could potentially be causing the diarrhea. Did you look for a picture guide on finding the bladder? I know they can be hard to find in cats. Both the urinary problems and diarrhea could be caused by dehydration. If he's on dry food, maybe switch to wet so he gets more water (hopefully that wouldn't stress him out). Hyperthyroid cats usually want to eat constantly, so that doesn't surprise me. (Luna's recent T4 was borderline high so I learned a lot about hyperthyroidism from my vet. She hasn't been put on meds yet, so I can't help much there).

He may be hiding because he is in pain. Cats don't like you to know when they're hurt, it's a small-predator instinct. Try to watch him closely because if he's blocked, that quickly becomes very very bad. I wouldn't worry TOO much if he's still urinating. Also, if he's going more often, he will produce less each time, but that could still be dangerous.

As for thyroid science diet, I personally (and many other members from what I've seen) think Science Diet in general is mostly bull, so I wouldn't go that route even if the other cat wouldn't eat it.

Keep us updated! I hope things get better quickly and go well overall. Kitty is in my thoughts and prayers.

I have both cats on a mix of wet and dry food.  They share 1-2 cans of wet food a day, plus supplemental dry food.  Yesterday and Sunday, he was eating like a horse - like eating 3x his normal amount.  He only barely skimmed at his food so far today.

I know how to find the bladder because years ago when I had a cat in for a suspected blockage (that wasn't really one), the vet showed me how to find it.  You can barely even feel his bladder, so it appears to be empty.

He also now appears to have an upper respiratory tract infection too, because he has started blowing snot bubbles out of his nose.  I suspect that is something else that could be stress induced from all the vet visits/medication/uncontrolled thyroid too.

My inclination is to bite the bullet and get the radioactive iodine done - at least if they can get his health stabilized to make sure it isn't caused by some other underlying issues.

tiberria said:

 
Now, the cat seems to be having some type of urinary or constipation issues.  He has literally been in and out of the litter box every 30 minutes or less all night, producing small amounts of urine or diarrhea at most.  He seems to be sore in his hind area (if you lift his tail or touch his bag legs), he calls out in pain.  However, his bladder appears to be completely empty (if you palpitate the area under his hind legs - you can't feel a full bladder), so I don't think he's actually blocked.

I wonder if this type of reaction is a side effect of either the low blood counts, coming off the Methimazole, or of his thyroid levels skyrocketing back up.  He already has a follow up appointment on Friday (and I have to take him in Friday regardless because they need the full week to see the blood work impact of stopping the medication), and I really don't want to have to take him in for another appointment before Friday unless it's absolutely necessary (both for cost reasons and the fact that it stresses him to the max).  Does any one have any experience with how cats react to coming off thyroid medication?

Click to expand...

If the Methimazole is still in his system - which probably it is - all sorts of havoc could be going on. I would give him some slippery elm slurry - to ease his GI tract. What are you feeding him? Is he dehydrated?

I took him back to the vet this morning, because his nose started to bleed again.  They said that he was almost entirely blocked, but they were able to drain his bladder by sticking a catheter in.  They gave me the option of either treating him with anti inflammatory drugs and seeing if that clears things up in 2-3 days so he can urinate normally or of going for the (very expensive) route of 48 hours of hospitalization and on a catheter.  His penis is also apparently extremely inflamed (they think from excessively licking it), and he definitely has an upper respiratory infection (although his lungs sound normal).  They ran a urine test which shows evidence of a bladder infection, but his urine pH is normal.  His CBC showed that his platelets had returned to normal, but his red blood cell count had dropped from the normal range to 17, and that if they were to drop much lower (to ~10) he would need a blood infusion.  His kidney, liver function, etc is apparently still normal.

The vet said that it's possible that all of this could be related to a Methimazole reaction (nose bleed, bleeding in the bladder, etc.) but that in 25 years she has never seen a Methimazole reaction that severe, so she is skeptical.  She is also skeptical that the blockage issue is related to a typical male cat blockage, both because it came on in such quick progression with other side effects, and because it is very unusual for a 9.5 year old cat with no history of blockages to suddenly get one.  She did say that the other thing that could cause this type of onset of symptoms (assuming it isn't a drug reaction) is some type of malignant cancer progression (which of course can't be definitely confirmed without CTs, etc.)

He is now home with an Elizabethan collar on to prevent penis licking, they gave him a 20 mg injection of Onsior, and he has to take 1 of those tablets a day for the next 2 days, and he also has to take a Baytril tablet a day for the next few days.   The advice is to carefully observe his litter box activities and see if the anti inflammatory clears things up.  If not, obviously I would have to make a decision.

I don't think I would go for a multiple day hospitalization, because of how unlikely that this is a simple basic blockage.  I also don't think there is much value in spending over $1000 in getting CT scans run to diagnose a cancer, when the end result would be it wouldn't like be reasonably treatable any way.  If he doesn't improve in the few days/blocks back up again, euthanasia may be the most reasonable option.  The fact that the vet is very skeptical that a drug reaction would be this severe and the fact that his condition has continued to get worse the longer he has been off the drug makes me strongly suspect an outside serious illness.  Plus, even once this condition stabilizes, I would need to figure out a way to treat his hyperthyroidism without medication being a real option.  While I could find a way to afford radioactive iodine, it obviously doesn't make any sense with his health this unstable.

Does any one else have any opinions/experience with this stuff? 

He's also having difficulty breathing, or is at least making sniffly noises with all breaths, but I assume that's just the upper respiratory congestion/nose bleed.

Poor kitty. What kind of food are you feeding him? I know you said wet/dry - what brands? Whatever they are - switch pronto to something healthier and no kibble. The other thing is about the Hyper-T alternatives to Methimazole - there are some remedies out there like Gold's (can't vouch personally) that have had good reviews, they do not ship internationally, so if you're outside the US - that could be a problem. There's homeopathy and acupuncture which are probably less costly than regular vets in the long-run and have a way of supporting the cat's own immune system and organs which are all effected once Hyper-T sets in - even if blood panels are ok - heart rate increases, hormones start getting out of whack - basically the thyroid regulates almost every single process in the body. So once it goes into high gear, wear and tear is one of the outcomes. You want to support a cat like this nutrtionally, emotionally, physically and every other which way - reducing stress at every turn. Check out Rescue Remedy - one drop on his paw or in the water bowl could chill him out a bit. Again - the food is a major factor - you want to really look at that and make some changes.

Hope he's feeling better and you too, take care of yourself. This is very stressful, I know.

Miss Bliss

Final update on this - yesterday, about 4 hours after I made the mid-day vet trip, he started noticably going downhill.  His nose bleeding intensified and then a couple hours later progressed to out right constant panting/open mouth breathing.  He was also crying out in pain whenever touched and seemed to be completely dispondant/unable to to even lie down/sleep/get comfortable.  I called the vet and they had him come in right away.

They determined that he had already completely reblocked in less than 6 hours, that he would need to be put on oxygen to survive more than a couple of hours, as well as require blood tranfusions to survive through the night.  His penis had also swollen to the point that even if they were able to unblock him, he would likely need several days of hospitalization to regain normal bladder function.  They did another chest x-ray and it was inconclusive.  They would also need to use some type of endoscope to see what was going on with his nasal passages.  It did not respond at all to anti biotics or anti inflammatories (kept getting worse), leading them to strongly suspect some type of growth.

Given the multiple different significant health conditions, they advised me that even if they went the route of hospitalization for several days/weeks, the prognosis was likely to be poor in any case, and any reasonable cause that was determined would likely turn up one or several untreatable conditions any way.  Given the situation, and the clear suffering, I made the decision to put him down.

Has any one had experience with that type of rapid unexplained deterioration in a cat's health?  I don't understand it.  He started having health issues in December, the symptoms of which were (in retrospect) classic hyper thyroid symptoms.  Once that diagnosis was made and he was started on Methimazole, the symptoms quickly dissipated and his personality completely changed.  He was always a super vocal cat and high energy, but he became quiet and starting sleeping as much as my other 9 year old cat (who was always been extremely lazy).  The treatment seemed to be going fine - his thyroid levels quickly dropped to normal within 3 weeks, and there were no real significant signs of issues until the sudden nose bleeding a couple of weeks later.  That was last Friday, and by Tuesday evening, he had to be put down.

Would a Methimazole reaction cause something of this severity - especially after causing no negative side effects for 5+ weeks of initial treatment?  I have to wonder if taking him off the medication somehow aggravated/escalated a pre-existing health issue.  Or, is it likely that whatever it was was some type of rapidly spreading cancer/illness that caused his body/organs to basically start shutting down?  The entire situation really bothers me, although obviously spending thousands on CTs/Xrays just to get an answer wouldn't have likely resulted in a different end result.

First, I' so sorry about your cat. My cat Scooter did not do well on the hyper-thyroid medication at all and refused to eat and seemed quite ill. I took him off of it but it all happened within a week.

Before that, I had a cat about the same age that suddenly collapsed and was gone before 6 hours later. I wondered if it was a stroke. Her death is what prompted me to get him a senior blood panel. He's 14 and I won't be putting him back on the thyroid medicine. The only other choice is the surgery to kill the thyroid with the RAD treatment.

I am so sorry for your cat's suffering and your loss.

A quick google search for nosebleeds and Methimazole brought up About 24,900 results (0.70 seconds). I would think there are many complications this particular drug will induce, but people are confused due to an already ill animal and chalking whatever *else* comes up in terms of dis-ease as part of the *aging process* or perhaps part and parcel of the hyper-t itself and not from the drug. Vets of course will never speak about such things in a frank manner because it is their bread and butter - i.e. livlihood to prescribe, cut, irradiate and sell toxic foodstuffs to unsuspecting animal owners.

In this case, it's my feeling that a combination of  parameters caused this downward spiral. Methimazole didn't help a probable underlying pre-existing condition - this coupled with basic toxins. The ingredients in food/water/medications can combine into a very bad combo - plus there is the drug dosage that can also be overwhelming to an already compromised animal. I am so very sorry to hear about your cat suffering. Please do that search on the nosebleed/Methimazole connection. May he rest in peace.

Tried to edit this - was asking others about alternatives both to removal of the thyroid, medication and iodine treatments - primarily due to a compromised animal's system. How to manage symptoms in a hyper-t cat who cannot undergo these procedures due to age, underlying illnesses etc?

Very sorry about your having to put your cat down. I had a cat that developed hyperthyroid and went the $2000 radio-iodine route. She was 12 years old and all the tests they did before the procedure seemed to show she was healthy except for the thyroid. The T4 dropped back to normal after the procedure and never went up again. So it WORKS....However a year later she still seemed to be skin and bones and was not putting weight back on. Back to the vet again for $$$ tests which now said she had IBD and mega colon. For various reasons with this cat I could not treat her any further and decided to put her down. It was rough....I have several other cats and you have to look at each one individually to make that decsion and it's always hard.