Cat has had no appetite in weeks, newly diagnosed with hyperthyroidism

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elliebean

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Hi everyone, I found this forum some weeks ago while dealing with my cat's health issues, and thought I'd ask you lovely people for advice. This is gonna be a really long post of what me and my cat have been dealing with since July, and I apologize for the length!

My baby boy is 12 years old. I was out of town for a couple of months this summer, so my mom watched my cats, and my boy's appetite steadily declined over the course several weeks. My mom took him to the vet on 7/30 and 8/30, where he got steroid and antibiotic shots both times (and simple bloodwork at the first appointment). She said the vet said it may just be allergies or asthma and stress. I came home and got him some Freshpet food that he ate well for a day, but the next day he kept regurgitating it and then wouldn't touch it anymore. I couldn't get him to eat any wet foods, and when I would give him treats I noticed he seemed to have trouble keeping food in his mouth. He vomited multiple times a day, food or water or just dry heaving. I would wake up every morning to him vomiting on an empty stomach. I called the vet on the weekend and he recommended I syringe feed him some wet food mixed with pedialyte until his appointment Monday.

At this 3rd appointment (9/11), I mentioned his issues dropping food and that he has some tartar/gingivitis, which the vet (a different vet) confirmed. He gave me an oral antibiotic and an endosorb suspension for his tummy troubles, but didn't do any more testing and sent us home. He weighed 6.6 lbs. I gave my cat these meds and kept syringe feeding what little I could without him vomiting. After 2 days I called the vet office again and they told me to come in and buy some Hills A/D food. After 3 more days of syringe feedings, vomiting, and no appetite, I walked in to the vet clinic with him (9/16). He weighed 6.25 lbs. The vet (a 3rd vet) did a very short exam, said my cat's intestines felt ropey/irritated, maybe it's IBD, and sent us home with 3 more oral meds: a long course of prednisolone, cisapride for digestion, and an appetite stimulant called elura. He got another dexamethasone shot as well.

For the first couple days after this, there was no vomiting, but there was a lot of stress from being given 4 oral meds twice a day plus an appetite stimulant that never worked. At this point my cat started having diarrhea, but when I syringe fed him he'd actually lick some from the syringe himself. Every now and then I'd see him eating a few bites of kibble on his own. After a couple days, he went back to vomiting and would often vomit his meds or food. He seemed nauseated often.

He had a follow-up appointment on 9/25, where I became pretty confused. When we went to the exam room, the vet assistant started asking me about my cat's hyperthyroidism. What hyperthyroidism? She said it was in his chart that he was diagnosed on 7/30. I said nobody ever mentioned it to me or my mom, and I don't think they had even tested for it then. Eventually the vet comes and does his exam, they take more blood for testing and it is confirmed that my cat has hyperthyroidism (his TT4 was 14.5µg/dL). This vet, who is the first vet my cat saw at his first 2 appointments, asks me if I've been using the "click pen" on my cat's ears. I had no idea what he was talking about. He explained it's the hyperthyroid medication. I said no, because no one ever mentioned if my cat had hyperthyroidism! The vet gave me a prescription for methimazole in gel form to put on my cat's ear twice a day. This time he had gained one ounce of weight. I'm still feeling the confusion about his chart and his diagnosis, but after talking to the manager of the clinic she was nice enough to reimburse me for the meds I was told to discontinue.

Anyway, now it's been almost 4 weeks since I first syringe fed my cat. He still vomits clear liquid/foam every morning. Until this morning, he hadn't vomited food in over a week and he doesn't seem to be very nauseated anymore after feedings, and his diarrhea is gone. He seems to feel better since coming off the other meds and starting the gel. He acts more like himself, though he's not back to being as active. I feed him a can of the Hills A/D each day with him sometimes licking some from the syringe himself, but he won't touch it if it's in a dish. Some days he'll nibble at dry food but some days he won't. Any cat foods I try to give him he'll sniff and move away from. But the other day I did give him some chicken and he happily ate it, so I don't know what to do! Maybe he would have an appetite for something else? It's worth mentioning that all this time he has still been drinking well.

The 3 vets we've seen at this clinic never seemed to take my concern about his eating seriously enough, even though since June my cat has lost 5.5 lbs, since he is still alert and active. But he's only even alive because I have been hand feeding him for a month. I unfortunately don't have many vet options living in a small town; the vet we've been seeing is actually a bit of a drive to another city, because the small clinic where I live isn't great either.

I'm going to the store today to maybe buy him some chicken to boil or some new cat foods to try, but does anyone have any advice for me? Has anyone gone through something similar where their cat eventually got their appetite back? I would gladly syringe feed my cat for as long as it takes, even though it breaks my heart. But as good as he is with the syringe, I know it's still stressful for him. I just feel anxious and stressed that there is a problem I can't solve. I suppose that's why I'm posting here, even though he has a follow-up appointment on the 11th for new bloodwork. Really sorry for the long read, and thank you to anyone who reads through it.
 

pearl99

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My kitty Gracie had hyperthyroidism. She also lost weight and vomited. She had kidney disease too. I am so sorry this has been so hard!!

Oh my. How awful you weren't informed. After starting the methimazole and after any dose change there must be another blood test in 2-3 weeks for thyroid levels to see if it is the appropriate dose. He won't get all the way better and appetite return until the dosage is correct (if that's the only thing going on here.) Nausea and vomiting could be from the methimazole dose still being too low.
What dose is he on? There are also liquid and pills by mouth besides the ear ointment. The pills worked best for Gracie. The liquid compounded at a pharmacy was expensive. It's what works for both you and him.

Have they scheduled a recheck? They must do followup labs and labs periodically to check thyroid levels.
There is a forum with tons of information to go to and to post questions, Tanya's feline hyperthtyroid forum- Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Hyperthyroidism. Lots of detailed info there, I used them extensively to educate myself.

Did they test for feline kidney disease, do you know? Do you have a copy of the lab work?
Any food he will eat is good. What have you tried besides Hill's?

Keep us posted! Others know more than me, hopefully they will post, too.
 

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Hi. I am not sure I have much to offer but will make a few observations/comments anyway.

First off, as you probably already know, his weight loss was likely caused by both the vomiting and hyperthyroidism. Secondly, there are cats who will have more uncommon side effects from hyper-T such as lack of appetite, diarrhea, and even vomiting - in addition to weight loss. Thirdly, it sounds as if there have been a lot of meds thrown his way, and perhaps many food changes - all of which can lead to the stomach problems too. I am leaning toward thinking that getting him off all the excess meds and allowing the methimazole to start working might go a long way to getting him back on track.

It is possible that he correlates some of the food he has been eating with feeling unwell, and that can put off a cat from wanting to eat. The chicken was something new that he couldn't connect with feeling bad, so it was a nice change for him. You can feed him some chicken, but it can't be much of his overall diet since it is not nutritionally complete. But perhaps it will help get him over the edge about not wanting to eat on his own. For now, I would continue to give him the A/D food, and you can test feeding some of it from a tongue depressor or a spoon to see if he might be willing to eat a bit of it that way to help lead him to eating more on his own over time. You can even add some chicken to the A/D to see if that might encourage him to eat it on his own as well. If you are using a different type of dish/plate/etc. for the chicken, you might try using that same type for the A/D as another tactic to get him to try eating on his own.

It might be wise to stick to A/D and chicken until he seems better settled before you start trying too many other foods, especially if you can get him to start eating some of the A/D without it being syringed to him all the time.

Also, avoid letting him go too long without food - the vomiting in the morning might be from not having enough food at night to 'hold him over'. There are cats who will throw up liquid/foam/bile if stomach juices are allowed to build up in their stomachs without food to absorb them. My cat did this for a while until I ensured she was eating some food late at night. As soon as I did that, the clear liquid vomit in the early morning stopped.

Sorry for the long response!
 
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elliebean

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pearl99 pearl99 Thank you so much. The delayed diagnosis and all the extra stress and weeks of incorrect treatment definitely have had me feeling down. Yes, he has a follow-up appointment to check his thyroid levels next Wednesday. I was given a Wedgewood methimazole 2.5mg/.05ml (1.5ml twist pen) with directions to give him 2 twists twice a day. I won't know how well it's helping his thyroid until next week I guess, but he does seem more like himself aside from the appetite issue. I have some of his lab results but they aren't in a format I can share unfortunately, I was given them through the office's PetDesk app which doesn't seem to have any export function. I'm not sure which all values are most important when it comes to kidneys but his CREA was 0.6 mg/dL and BUN was 19 mg/dL. I will post an update here when I get new results.

FeebysOwner FeebysOwner Thank you, I've been really worried that maybe his lack of appetite is caused by something else we don't know about since cats I've known with hyper-T have had increased appetites. My sister's cat passed a couple years ago from hyper-T plus kidney disease and he was always yelling for food. I had never heard of lack of appetite also being a symptom! Before my cat became ill, my cats were on a feeding schedule because my boy would overeat and had gained some extra weight. Feels a bit ironic now.

Now he has access to kibble 24/7, but I'll see him eating a few bites maybe once every couple days. I'm not sure if he eats it when I'm asleep. Every day when I give his sister her wet food I offer it to him to see if he's interested, but he walks away. He was never crazy about it before, he preferred their kibble, but he'd usually eat at least half. My mom said when his appetite started getting bad he would still eat fancy feast broth packets, but he isn't interested in those anymore either. He hasn't yet taken A/D from a spoon or any kind of dish, but I'll keep offering. Usually I'll have to give him a ml or two from the syringe before he'll start licking it (from the syringe) on his own.

As for his vomiting issue, yeah for a while I was feeding him the A/D pretty late (sometimes 12 or 1am) but I'd still wake up at 5 or 6 to him vomiting clear liquid. I will say that this is something he has done on and off (not often) over the years, so it hasn't started with the hyper-T, but now it happens daily. I suppose I could get up in the middle of the night to feed him, if it makes him feel better and helps get him over this hump I'm willing to try it. Very thankful at the moment to work from home.

At first on the A/D food I was only able to give him 10-15ml at a time and could tell he was always nauseated, but I've slowly increased it and now give him 30-35ml at a time and he runs off and scratches his post or drinks some water. So I'm hopeful that he will keep improving... it's just heartbreaking that he doesn't want to eat on his own.

Thank you both so much for replying <3
 

IndyJones

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Not every cat follows the rules, it was the seinor vet who sugested we check Kabuto's t4 when he was diagnosed with heart disease. The heart disease and weight loss where his only symptoms really. His diet always changed with the seasons.
 

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E elliebean , glad he has a followup. Loss of appetite can be a side effect of methimazole too so will see what his thyroid level is.
Also hyper-T can mask kidney disease, with increased heart rate that goes with hyper-T rushing blood through the kidneys too fast, that's why I asked about that. Gracie had underlying kidney disease discovered after hyper-T treatment.
Keep us posted on how things are going!
 

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Sorry to hear about your experience with your vet(s). I would expect any time an older cat presents as your cat did, that a full geriatric blood panel and urinalysis would be in order. The creatinine and BUN values you stated are with normal range but should your cat have kidney issues it is not uncommon for them to have a constant low grade nausea, that could be the reason for the low appetite and food avoidance. There are meds that will help with nausea no matter what the cause, did the vet say anything about dehydration, when you go back I would ask about the hydration level of you cat, just because a cat is drinking water does not necessarily mean that their hydration is adequate and if they are dehydrated that can make them feel unwell.
 
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elliebean

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Thank you everyone! I'll definitely ask the vet about his hydration. Unfortunately today I woke up and he'd scratched a spot by his ear raw, I assume from the methimazole gel. :/ He's got a small bald spot. I'm not sure if I should try cleaning his ears between doses until Wednesday or if I should immediately stop it and see if I can move up his appointment.
 

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The gel should be applied to the inside of the ear pinna and you should alternate from left to right daily, the gel has a tendency to build up a film after several days so you should also be wiping the ears every few times where you apply to gel to prevent the build up, If this is not the protocol you are following maybe there is a build up that is irritating to your cat and therefore he is scratching.
 
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elliebean

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The gel should be applied to the inside of the ear pinna and you should alternate from left to right daily, the gel has a tendency to build up a film after several days so you should also be wiping the ears every few times where you apply to gel to prevent the build up, If this is not the protocol you are following maybe there is a build up that is irritating to your cat and therefore he is scratching.
Yes I've been alternating ears with each dose (he's on 2x a day at the moment) and with each application I clean the new ear beforehand. What I meant was cleaning the ear between doses as well (ie clean an ear some hours after application). This is the first time he's scratched. He was moving around a bit when I applied it to the ear (the one he was scratching) last night, could putting the gel too far down the ear have caused irritation? Sorry, I'm new to all this. :(
 

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Thank you everyone! I'll definitely ask the vet about his hydration. Unfortunately today I woke up and he'd scratched a spot by his ear raw, I assume from the methimazole gel. :/ He's got a small bald spot. I'm not sure if I should try cleaning his ears between doses until Wednesday or if I should immediately stop it and see if I can move up his appointment.
Scratching their face is a side effect and needs a call to the vet, especially if scratched raw.
Here's a link...under "is there monitoring..." is the statement, and what my vet told me when Gracie was on it.
Methimazole | VCA Animal Hospital | VCA Animal Hospitals
 

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Hi. Are you able to give your cat pills. An oral dose of the Methimazole would be much more accurate a dose. What other medications is your cat on?
Can you get a referral to a specialist? Might be time for one.
I am sorry to say, I don’t have allot of faith in the vet hospital you have been taking him to. That is a huge screw up.
I would ask for your records and get a referral if you can. If you can’t, I would ask for the pill version of Methimazole snd after giving twice a day for at least 2 weeks, have the thyroid rechecked.
 
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elliebean

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Hi everyone, we had an appointment today so I thought I'd post an update. Around Saturday his appetite started improving a bit and he started eating kibble on his own again several times a day (in small amounts), for the first time in a month. So I was feeling pretty hopeful, even though it wasn't much. But at the vet he weighed in at 5lbs 11oz, 10oz more lost in 2 weeks, despite all the feedings. I just feel crushed right now. I asked the vet if he was going to do more bloodwork but he said no, based on my cat's lack of improvement on the gel, we were given pills instead (told to give a 5mg pill twice daily) and instructed to come back in a month. A month seems like a long time, so I'll see if he improves or not in the next couple weeks and make an appointment. And I guess I will keep trying to find things he will eat and syringe feed him in the meantime. I'm finding it hard to feel hopeful right now. :( Wish I had a better update, but I'll keep trying what I can for him. I'll include a photo of my baby boy from before his health issues. Thanks everyone

20210823_100820_001.jpg
 

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Your vet should have rechecked his T4 level regardless. There could be something else going on besides hyperthyroidism that is exacerbating his weight issues. Anyone ever suggested a B-12 test to see if he is absorbing nutrients appropriately?

What was the transdermal dosage? You probably said, but I didn't find it. All I know is that unless he was receiving an equivalent transdermal dosage amount, 5mg dosage twice a day orally is a huge amount.

If you don't choose to get another T-4 test done now before you start this new dosing, I would NOT go longer than 2 weeks before the next test.
 
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elliebean

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Your vet should have rechecked his T4 level regardless. There could be something else going on besides hyperthyroidism that is exacerbating his weight issues. Anyone ever suggested a B-12 test to see if he is absorbing nutrients appropriately?

What was the transdermal dosage? You probably said, but I didn't find it. All I know is that unless he was receiving an equivalent transdermal dosage amount, 5mg dosage twice a day orally is a huge amount.

If you don't choose to get another T-4 test done now before you start this new dosing, I would NOT go longer than 2 weeks before the next test.
The gel was 0.5ml twice a day, I'm not sure what an equivalent pill dosage would be. None of the vets I've seen there ever mentioned B-12. I always ask what I can do about his weight loss and they never have anything very helpful to say. Today I asked and the vet seems confident the pills should turn him around quickly, but he also said that about the gel. I do feel pretty frustrated about this vet/hospital, but I feel like I don't have many options. I already take him to a hospital in a different city because the only one where I live is small and I haven't had great experiences there either. I'm just overwhelmed
 

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The gel was 0.5ml twice a day, I'm not sure what an equivalent pill dosage would be.
The ml does not denote the strength. For transdermal, from what I know, there is a range mostly anywhere from 1 mg to 15 mg per 0.5 ml. Does your prescription not include the mg? Where did you get the transdermal version? I would call and ask for a translation so that you can compare apples to apples. It may be the equivalent, but it's better to know one way or the other.

I'm sorry if I am making you feel worse about all of this, I don't mean to.
 
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elliebean

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The ml does not denote the strength. For transdermal, from what I know, there is a range mostly anywhere from 1 mg to 15 mg per 0.5 ml. Does your prescription not include the mg? Where did you get the transdermal version? I would call and ask for a translation so that you can compare apples to apples. It may be the equivalent, but it's better to know one way or the other.

I'm sorry if I am making you feel worse about all of this, I don't mean to.
Sorry, you're right, I looked at the pen (it's from Wedgewood) and it's 2.5mg per 0.5ml, so 2.5mg twice a day. And my feelings aren't your fault at all, no worries, I'm just concerned if my vet's not giving proper treatment/directions. I was going to make an appointment sooner than they told me to today anyway, as I don't think it's appropriate to wait 6 weeks since he started meds without re-testing. They had already made me wait too long for the T4 test
 

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So, despite the thought that transdermal isn't as effective as oral, your vet has essentially doubled the dosage for the oral version, IMO, not good. Again, strictly speaking from what I would do, is that I would NOT give double the dosage. What pill form did you get and in what mg?
 
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elliebean

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So, despite the thought that transdermal isn't as effective as oral, your vet has essentially doubled the dosage for the oral version, IMO, not good. Again, strictly speaking from what I would do, is that I would NOT give double the dosage. What pill form did you get and in what mg?
They are 5mg each, with instructions to give one every 12 hours with food. I'll call the vet office tomorrow and ask about the high dosage
 
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