what would you do

[John]

Hi Sammy..how did you give your two tablets at the time

[Amber]

Hi John, I know this is an old thread and you seem to be doing really well with the tablets but just thought I would add my piece aswell.

Hyperthyroidism (over active thyroid gland) is probably the most common disease in older cats. It is caused by an increase in the thyroid hormones produced by the thyroid gland (thyroxine). Thyroxine plays an important role in controlling the body's metabolic rate and so the general activity level, so cats with hyperthyroidism tend to burn up energy too rapidly and typically suffer weight loss despite having an increased appetite and increased food intake.

Thyroxine has an effect on almost all organs in the body and so the disease can sometimes cause secondary problems with the heart, kidneys, and high blood pressure which can effect several organs in the body.

To reach a diagnosis of hyperthyroidism, a thorough physical health check and blood tests are required. On examination, one or both enlarged thyroid glands can often be felt as a small hard mass in the neck (about the size of a baked bean). However in some cats the thyroid gland cannot be felt due to overactive tissue being present in an unusual site.
A blood test looking at thyroxine (T4) concentration is normally all that is needed to diagnose hyperthyroidism, as the levels are normally elevated.

There are three ways to treat hyperthyroidism, medical management (tablets), surgery (thyroidectomy) or radioactive iodine therapy (this is used least often out of all treatments).

Medical: Anti-thyroid drugs are available in tablet form and these act by reducing the production and release of thyroxine from the thyroid gland. They do not provide a cure for the condition, but they do allow either short-term or long-term control of hyperthyroidism. Methimazole (trade name Felimazole) is given at a starting dose of 2.5 mg twice daily. Thyroid hormone concentrations usually fall to within the reference range within 3 weeks. For long term management the dose of Felimazole is then adjusted according to response. To maintain control of hyperthyroidism, Felimazole needs to be given daily for the rest of the cat's life. Felimazole is the only licensed treatment for feline hyperthyroidism.
For most cats methimazole (or a related drug, carbimazole) is a safe and effective treatment for hyperthyroidism. Side effects are uncommon and if they do occur they are usually mild and reversible. Poor appetite, vomiting and lethargy are the most likely side effects and often resolve after the first few weeks of treatment and/or by temporarily reducing the dose of treatment and administering the tablets with food. More serious problems, including reduced white blood cell counts, reduced platelet counts (which help the blood to clot), liver disorders, or skin irritation are rare, but if they do occur then an alternative treatment must be used.
Anti-thyroid drug treatment has the advantage of being readily available and economical, but it is not curative. Life long treatment, usually involving twice daily oral dosage, will be required and for some owners, and some cats, this may be difficult to achieve. Routine blood tests should be checked periodically during treatment to monitor the effectiveness of therapy, to monitor kidney function and to look for potential side effects.

Thyroidectomy: Surgical removal of the affected thyroid tissue (thyroidectomy) can produce a permanent cure and is a common treatment for many hyperthyroid cats. In general this is a very successful procedure and is likely to produce a long-term cure or permanent cure in most cats. However, even after successful surgery, occasionally signs of hyperthyroidism develop again at a later time if previously unaffected thyroid tissue becomes diseased.
To reduce anaesthetic and surgical complications, where possible it is always recommended that hyperthyroid patients are initially stabilised with anti-thyroid drugs for three to four weeks before surgery. Any associated heart disease must also be treated where necessary. Good success and avoidance of post-operative complications depend on good surgical skills, and experience is necessary to achieve good results. The major risk associated with surgery itself is inadvertent damage to the parathyroid glands – these are small glands that lie close to, or within, the thyroid glands themselves, and have a crucial role in maintaining stable blood calcium levels. Damage to these glands can result in a life-threatening fall in blood calcium concentrations (hypocalcaemia). This is most likely to occur when both thyroid glands are removed at the same time, since this can result in damage to both parathyroid glands. To minimise the risk of this complication in those cats that require removal of both thyroid glands it may be appropriate to perform the procedure in two stages, removing the most affected gland first and allowing six to eight weeks for recovery of parathyroid hormone production before removing the second thyroid gland.
Some vets recommend that cats remain hospitalised for a few days after surgery so that blood calcium concentrations can be monitored and any treatment given, if required. Clinical signs of low blood calcium include muscle twitches and weakness, which can progress rapidly to convulsive seizures. Treatment is with supplemental calcium by injection and then by mouth. Additional treatment with vitamin D3 is also needed to allow the calcium given by mouth to be used effectively. Once stable, continued treatment can be given at home, but in most cats the damage to the parathyroid glands is only temporary and treatment may only be needed for a few days or weeks.

Radioactice Iodine Therapy: Radioactive iodine (I 131) can also be used to provide a safe and effective cure for hyperthyroidism. Like surgical thyroidectomy, it has the advantage of being curative in most cases with no ongoing treatment required.
Radioactive iodine is administered as an injection given under the skin – the iodine is then taken up by the active (abnormal) thyroid tissue, but not by any other body tissues, resulting in a selective local accumulation of radioactive material in the abnormal tissues. The radiation destroys the affected abnormal thyroid tissue, but does not damage the surrounding tissues or the parathyroid glands.
The advantages of radioactive iodine are that it is curative, has no serious side-effects, does not require an anaesthetic and is effective in treating all affected thyroid tissue at one time, regardless of the location of the tissue. However, it does involve the handling and injection of a radioactive substance. This carries no significant risk for the patient, but precautionary protective measures are required for people who come into close contact with the cat. For this reason, the treatment can only be carried out in certain specially licensed facilities and a treated cat has to remain hospitalised until the radiation level has fallen to within acceptable limits. This usually means that the cat must be hospitalised for between three and six weeks (depending on the facility) following treatment. Most treated cats have normal thyroid hormone concentrations restored within three weeks of the treatment, although in some it can take longer.
A single injection of radioactive iodine is curative in around 95 per cent of all hyperthyroid cases, and in the few cats where hyperthyroidism persists the treatment can be repeated. Occasionally a permanent reduction in thyroid hormone levels (hypothyroidism) occurs following radioactive iodine treatment, and if this is accompanied by clinical signs (lethargy, obesity, poor haircoat) then thyroid hormone supplementation may be required (in the form of tablets).
The licensed facilities currently available in the UK are at the Animal Health Trust near Newmarket, the university veterinary schools at Bristol and Glasgow, and at the Barton Veterinary Hospital in Canterbury.

Sorry to waffle - I do go on when I get started

Good luck with whatever you decide in the end John

[sammy]

Thanks for posting that Amber, very interesting.

The first cat that I had with this did have the surgery, but unfortunately after a year or so, the condition returned, so she was then put back on the tablets. It was a bit of a struggle with her, so we mostly mixed them with her food.

The second cat we had with it, we decided against surgery as she was that bit older (16) - I suppose we were also mindful of what happened with the first cat! She was an absolute star for taking her tablets and would literally open her mouth for me to put the tablet in! She was always an intelligent cat and I think she'd worked out that the less struggle she put up, the quicker it would be over with. She was well maintained on them for four years, when we lost her to cancer, age 20

Hope that answers your question John!

[John]

Thank you Amber..that definatly answers any questions I had....