Hyperthyroid + many other issues

Hello, I am fairly new to the site, but I am wondering if anyone might have some suggestions that might help my poor kitty.  Spritle is a neutered male domestic shorthair, almost 14 years old (best guess as he was found about 12 years ago).  He was diagnosed around 5 years ago with hyperthyroid disease and has been treated successfully with Methimazole. A little over a year ago he had dental work done and they removed an upper canine tooth.  About 3 months later, he had an episode of Anisocoria  (one pupil was larger than the other). He also suffered some vestibular symptoms around this time. Was treated with antirobe for the vestibular symptoms and all resolved in about 5 days.

About 3 months later he had noticeable swelling in the front of his throat, halitosis, and lethargy, back to the vet, who recommended an ultrasound. The ultrasound showed an enlarged thyroid, but they believe it is just thyroid tissue and not malignant. They also did an abdominal ultrasound which showed some thickening of the colon.  We had also recently increased his Methimazole which we found had dropped his T4 levels too low. I was told to decrease the Methimazole back to his original dose and he got better.

About 6 weeks ago, he was diagnosed with an anal gland abscess and treated with antibiotic and Prednisolone.  After weaning him off of the Prednisolone, he started having issues with diarrhea. We tried the Fortiflora and it seemed to work for a week or so, but then his diarrhea was getting worse again. The vet put him back on the Prednisolone and he now has developed diabetes we think due to the steroid. Vet has me weaning him off of the Prednisolone and started him on Atopica.  The problem with the Atopica is it is a liquid that he does not like. 

We are also now back up to the increased dosage of the Methimazole as his T4 levels have more than doubled.

I know my vet is trying everything she can to make Spritle comfortable, but I am just looking for any possible suggestions.  I was wondering if anyone has ever found the Atopica in a pill form for cats?  Also has anyone ever had any success after a cat has been diagnosed with steroid induced diabetes of their kitty not needing insulin shots anymore?  I know my kitty is a bit of a medical mystery at this point as he never seems to present with the same symptom twice.  

Thank you to anyone who takes the time to read this very long post, but I was trying to include as much pertinent information as I can.  I am sure I have left some out as well.

Any suggestions are greatly appreciated.

So sorry for all the problems your baby is having. There is a pill form of Atopica. We have given it to our Zuzu in the past. It was much easier on her than the liquid. It is a gelcap. The vet said to keep them in the freezer but I can't remember why. I think it was less likely to give her stomach upset if it was cold. Hope your boy is feeling better soon.

Thank you. I am going to try putting it into empty capsules myself, but if that doesn't work then at least I know I can ask for the gel caps next time. Unfortunately, I really think this could be the end of the road for my little guy as it doesn't seem to be working yet and we are running out of options

I guess I'm confused, what is the Atopica treating? Forti Flora is a really poor probiotic. It's a good topper to help cats eat, but other than that it's basically useless. You want to go with a humane grade probiotic, here's a good list of them. I use nexabiotic as do a lot of others. 

http://www.rawfeedingforibdcats.org/probiotics-for-cats---why-and-which-ones.html

As you probably know medication for hyperthyroidism doesn't actually treat the thyroid tumor, it just treats the symptoms, so long term that tumor is just going to keep growing and growing and at some point cause other medical issues (which may be part of what you're dealing with now). Is there any reason you never went with i-131? My cat was treated with it back in March and is now fully cured. 

It's okay, Missmimz, you are not the only one who is confused with all of this.  I am so confused I had to make a spreadsheet to keep track of everything.  The vet replaced the Prednisolone with the Atopica saying that it would do the same thing to control the diarrhea that the Prednisolone was doing without causing the side effect of the diabetes.  (They either think that it is IBS or some type of cancer that is causing the gastro issues.) 

As for the Thyroid, we opted to not do the i-131 as he is not a cat that would do well away from home or being secluded (I have another cat in the house) for the time frame they require. 

I will look into the other options for the Forti Flora and see what I can find.  I really appreciate your thoughts on the issues.

adnerb4 said:

 
It's okay, Missmimz, you are not the only one who is confused with all of this.  I am so confused I had to make a spreadsheet to keep track of everything.  The vet replaced the Prednisolone with the Atopica saying that it would do the same thing to control the diarrhea that the Prednisolone was doing without causing the side effect of the diabetes.  (They either think that it is IBS or some type of cancer that is causing the gastro issues.) 

As for the Thyroid, we opted to not do the i-131 as he is not a cat that would do well away from home or being secluded (I have another cat in the house) for the time frame they require. 

I will look into the other options for the Forti Flora and see what I can find.  I really appreciate your thoughts on the issues.

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I realize it's probably not an option for you now but cats don't have to be secluded from other cats once they return home (I have 9 other cats and it wasn't an issue). In fact all that was required was that I keep all the litter waste in a bucket in my garage for 2 weeks after the procedure and then dump after 3 months. My Fluff is very sensitive and it was tough for him to be away for 5 days, but I'd do it all over again in a heartbeat. 

Def look into probiotics, specifically Nexabiotics, which is excellent for diarrhea. I know your kitty doesn't have IBD but the raw feeding for IBD site is full of really great info about digestive issues and nutrition and is worth reading. Here's the link for Nexabiotics. It's totally safe for cats, and the dosing info is on the site I linked you earlier. I think if you can move away from steroids it would help him a lot. But of course consult your vet.