Liver shunt, newly diagnosed with hyperthyroidism, medication concerns

[StaySpooky]

Hello. I'm new here but have lurked off and on quite a bit. I'll try to keep this as brief as I can.

My cat is a 6 year old female, she was around 8 months old when we found her sick and injured on the street, nursed her back to health, got her spayed and almost lost her to the anesthesia, and it was then that we realized she has liver shunt. We keep it in check with lactulose and a low protein diet, she still has some bad days here and there but overall she lives a pretty happy normal life. Along the way things like rabies shot (caused tremors and lethargy for a week), Cerenia injection (again lethargy and refused to eat for 3 days), sedation for ultrasound duo to blood in urine (rough week of blindness, muscle weakness, poor appetite, etc..)

So last week she was vomiting more than usual, I took her to the vet they did bloodwork and the cerenia injection and sent us home, got a call the next day and said that she is hyperthyorid. Her T4 is 4.7 and her free T is 3.4 (or 43.8 depending on the formula you use). He wants to start her on the methimazole that you rub on the inner ear. 1.25 once a day. I know this is about as low of a dose as you can get but this medicine is metabolized in the liver and I'm beyond terrified that this is almost certainly going to cause some sort of negative reaction in her. Pretty much everything does and this drug seems to be rather notorious for such things. First thing she does when she has a reaction is usually to stop eating and then its a waiting game. He said she isn't really a candidate for the iodine i-131 treatment because they would want to sedate her for scans and stuff. Her t4. is 4.7 which is at the absolute limit of high normal,I'm wondering if its worth the risk of the medicine at this stage or if I should try to slow it down with diet for a little while. It takes her twice as long to get any sort of medicine out of her system because her liver doesn't function properly, I'm worried the daily meds will stack up because she won't burn them off and end up causing her to go hypothyroid and not have enough wiggle room to turn her around if we realize we made a big mistake. I just want to give her the best life I can but its really confusing on what to do here.

Has anyone had any experiences with the transdermal methimazole in cats with liver shunts, or liver disease?

Thank you for you time

 

[Furballsmom]

Hello
My angel Poppycat already had a compromised liver (his numbers never really decreased like they should have after his bout with triaditus ) ... when he was diagnosed with hyperthyroidism, so as far as I was concerned the med was completely out of the question. He also was the type of cat who had severe separation anxiety, hated the vet even when we were there with him etc so the treatment was also out.

We got the vet prescription Hills Y/D kibble. He wouldn't eat their canned so we also got Weruva. For all of their various varieties, the company maintains as low a level of iodine as the AAFCO allows, whereas almost every other brand I talked to has much higher levels. The only other company at the time, about a year and a half ago that had as low a level of iodine was Feline Natural.

It worked for the time he had left and although I will never know for certain, I think it was his liver that finally gave out that last weekend, but he was still up on the top of the refrigerator two weeks before he died

 

[StaySpooky]

Hello
My angel Poppycat already had a compromised liver (his numbers never really decreased like they should have after his bout with triaditus ) ... when he was diagnosed with hyperthyroidism, so as far as I was concerned the med was completely out of the question. He also was the type of cat who had severe separation anxiety, hated the vet even when we were there with him etc so the treatment was also out.

We got the vet prescription Hills Y/D kibble. He wouldn't eat their canned so we also got Weruva. For all of their various varieties, the company maintains as low a level of iodine as the AAFCO allows, whereas almost every other brand I talked to has much higher levels. The only other company at the time, about a year and a half ago that had as low a level of iodine was Feline Natural.

It worked for the time he had left and although I will never know for certain, I think it was his liver that finally gave out that last weekend, but he was still up on the top of the refrigerator two weeks before he died

Thank you for replying. I feel like I'm sort of stuck between two worlds between the hyperthyroid and liver shunt, I can't seem to find anyone else out there who has had to deal with the situation. I will look into the food brands you mentioned. I have the transdermal methimazole getting shipped to me, but I'm still not sure if I'll risk it.

Do you mind me asking how long your cat lived hyperthyroid after the initial diagnosis? I'm seeing 2 years on average with medical treatment and about 5 years with the radiation iodine treatment.

This has been extremely stressful, and expensive as well. I absolutely love my girl and love animals in general but I'm thinking I'm retiring from being a pet parent after this one. Thank you again.

 

[iPappy]

Hi!
I have a hyper-thyroid cat (no liver disease AFAIK) who is on oral methimazole. She seems to handle it very well.
Have you asked your vet about a liver protecting supplement, like Denamarin? I've worked with a lot of cats and dogs over the years that are on medications like phenobarbitol, keppra, etc. (for seizures) that are metabolized by the liver, and in many cases they are also given this with their medications to help protect the liver. I don't believe this requires a prescription.

 

[Furballsmom]

you mind me asking how long your cat lived hyperthyroid after the initial diagnosis

He made it another year, but it wasn't the hyperthyroidism that caused his system to crash on that last weekend. He had a lot going on, leftover from the triaditus with his liver and his pancreas.

 

[StaySpooky]

Hi!
I have a hyper-thyroid cat (no liver disease AFAIK) who is on oral methimazole. She seems to handle it very well.
Have you asked your vet about a liver protecting supplement, like Denamarin? I've worked with a lot of cats and dogs over the years that are on medications like phenobarbitol, keppra, etc. (for seizures) that are metabolized by the liver, and in many cases they are also given this with their medications to help protect the liver. I don't believe this requires a prescription.

I'm taking notes on these tips. I have never heard of , nor been offered Denamarin, it sounds like it is definitely worth trying. I'm sorry that your cat has hyperthyroidism, but I am glad to hear that she is tolerating the methimazole well. Thanks for the Denamarin tip.

 

[StaySpooky]

He made it another year, but it wasn't the hyperthyroidism that caused his system to crash on that last weekend. He had a lot going on, leftover from the triaditus with his liver and his pancreas.

Poor guy, that is a lot going on. It's amazing what they can go through and keep on moving. Thank you again for the info, it is greatly appreciated.

 

[Furballsmom]

You're very welcome. I always love and appreciate the opportunity to talk about him. He made it to 17.5 years old

 

[iPappy]

I'm taking notes on these tips. I have never heard of , nor been offered Denamarin, it sounds like it is definitely worth trying. I'm sorry that your cat has hyperthyroidism, but I am glad to hear that she is tolerating the methimazole well. Thanks for the Denamarin tip.

You are very welcome. One of mine took a different brand of a product just like denamarin for years, and his liver enzymes stayed normal for years. I hope it's helpful for your cat if you decide to give it a try.