Hyperthyroid Kitty: What to do?
June 2, 2015 9:04 AM   Subscribe

My 12-year-old cat Gordon (obligatory photos: 1, 2) was diagnosed hyperthyroid this weekend. I had suspected this was the case, as he'd been exhibiting symptoms. So now I need to decide what to do for his treatment.

I can either give him methimazole twice a day for the rest of his life, or he can get radioiodine treatment. The vet thinks that either would work for him, and suggested I mull it over for a day.

The radioiodine treatment seems appealing to me because I sometimes have to travel for work and would prefer not to have to pay someone to pill my cat (or give him transdermal methimazole) twice a day while I'm gone. (Also, El Gordo is not the easiest cat to wrangle...and he really hates pills.)

But the price! I don't doubt that the care is good and the treatment is worth the cost, and I'm not sure if it's pricier because I'm in NYC, but holy cow. I called the clinic where my friends took their cat for treatment many years ago and the price had doubled since they'd been there. I have a call in to another clinic (just for price comparison) and am waiting to hear back from them.

I guess I'm trying to decide what to do. Mefites with hyperthyroid cats: What treatment did you opt for, and would you recommend it? (Or I guess more specifically, would you recommend it for a single, non-wealthy person who also has to travel for work sometimes?)
posted by cowboy_sally to Pets & Animals (23 answers total)
My cat was diagnosed hyperthyroid about six months ago. We do the twice-daily meds with a liquid, compounded at a pharmacy with sardine flavor. The cat hates it and I miss doses several times a week because I can't catch her before I'm late for work. I think it's infinitely preferable to pills or the transdermal stuff, however. It costs about $22 a month.

We're going to look into the surgery. At the time the cat was diagnosed, they told us it would cost about $2k. The cat is 12 years old and otherwise healthy, so we think it might be worth it

I look forward to more responses to this question, as I was thinking about burning one to ask about the surgery anyway!
posted by liet at 9:26 AM on June 2, 2015

Did your vet talk to you about surgery?

My cat Patches was diagnosed just a month ago. The vet did not mention anything other than medication, but google taught me about the other choices! I think this website has a good discussion of the treatment options.

Fortunately, Patches will take a tablet if is buried in a Pill Pocket. This has not worked with other cats we've had, but since it does work for Patches, that's probably the treatment that we will stick with.

The thing about medication, though, is that it is not a cure. And as you pointed out, if you travel a lot, it's a pain to have someone else pill your cat.

But what about surgery? I do live in NYC, but I have not priced this. Maybe it's not any less expensive than the radioiodine treatment, but it might be worth asking about.
posted by merejane at 9:34 AM on June 2, 2015

We did the radioiodine for our kitty and it was totally worth the money (around $1500 in Massachusetts), as it is a cure. A decision-making factor for us is that he was also diabetic and there was no way we were going to pill him on top of his daily insulin shots and blood tests. Though even without the diabetes, I think we still would have chosen the radioiodine route so that we'd have a cure and since the side effects of the pill can be pretty miserable for kitty.

Check how long kitty would need to stay at the radioiodine vet, because that may affect your decision as well. It varies by state (because of the radioactivity) and the dosage your kitty would need. Ours only needed to stay one night, but had it been much more than that, I think we would have maybe considered trying the pill first.

Also, be ready to deal with the radioactive urine for six months! No, really. Like you have to collect up the pee clumps in a sealed container and throw them out after six months (or however long they tell you... I might be misremembering the six months). You can't trash the pee while it's still radioactive (and the trash company will be able to detect it!).

Good luck to you and Gordon Kitty!
posted by dayintoday at 9:40 AM on June 2, 2015 [1 favorite]

My Tigger got the surgery, it was way cheaper than the radioiodine treatment, and it helped him a whole lot. Ask your vet whether that is a good option in this case.
posted by Too-Ticky at 9:46 AM on June 2, 2015

Our kitty Cleo needed this treatment. She was difficult to pill and my partner (who had to medicate her when I was out of town) was uncomfortable pilling Cleo. Our vet gave us a transdermal prescription which entailed donning gloves and smearing a paste on the inside of Cleo's ears. Sometimes it seemed that the paste irritated her ears.

After a few months of doing this, we decided to go with the radio-iodide treatment. Cleo didn't like being at the vet and she liked being shut out of the bedroom at night even less (you can only have 1 hr of contact with the cat for a period of time). I didn't like dealing with the cat box. However, it was less than 6 months of that and now Cleo is fine and happy.

Good luck!
posted by elmay at 9:47 AM on June 2, 2015

My girlfriend's cat gets methimazole 2x daily in pill pockets and usually isn't a little shit about it, but some days, man. It's not too bad, though, because he's on a diet anyway so he gets fed 2x daily as part of his routine and he knows he has to eat his pill pockets before the food bowl gets set down.
posted by komara at 10:04 AM on June 2, 2015

We do methimazole in a topical gel, once a day. My cat is 15 and is so clingy that I could not see putting him through either surgery or quarantine when he can be managed with minimal fuss with the gel. If he were younger or had a personality more amenable to quarantine I'd have gone a different route, but I don't regret this one for this cat.
posted by Stacey at 10:05 AM on June 2, 2015 [1 favorite]

Both of my late cats developed hyperthyroid.

1) Victoria decided to be difficult about it--she vomited up the pills and had a major allergic reaction to the gel. Oy. So we trekked one hundred miles (she made her displeasure manifest) to Cornell University, where they did the radioactive iodine treatment. It cost $1200, including nine days of hospitalization (about which she also made her displeasure manifest). As there are no small kids or elderly folks at home, isolating her was not an issue; however, as dayintoday said, I had radioactive waste hanging out in my garage for several months. (If you live in an apartment, this might be a Thing.) I also had to wash my hands every time I touched her, which led to a sudden increase in my expenditure on hand lotion.

Vicki's hyperthyroidism was entirely cured by the treatment, but some cats go the opposite direction and develop hypothyroid as a result. So be aware that you may not be liberated from pills/gels.

2) Disraeli, whose opinions of pills was low, had the gel once per day. He was reasonably patient about it, aside from shooting me stern looks afterwards. The gel does gunk up, though; you will either need to clean the cat's ears periodically or have the vet do it (I went the latter route, as Dizzy's tolerance proved to have limits).

If you travel and don't have a professional sitter who is comfortable administering meds, radioactive iodine may be easiest. If your cat can tolerate the gel, though, that will be cheaper in the short run (although the price will eventually add up).
posted by thomas j wise at 10:39 AM on June 2, 2015

At first we gave Missy methimazole pills twice daily, but she developed a really nasty allergic reaction, breaking out in ugly lesions. (It's rare, but documented.) On our vet's advice, we briefly considered switching her to a zero-iodine diet for the rest of her life, but we realized that the prescription food would be obscenely expensive and require great inconvenience. We paid for the radioiodine treatment, and it was a total success.
posted by Faint of Butt at 10:43 AM on June 2, 2015

My mom did Radioiodine treatment for her cat Sam when he was much older than your Gordon. She vehemently states that it was totally worth it, not just for his comfort and happiness of not having to be pilled/gooped for every day for the rest of his life, but also for her, because she never had to experience the anxiety of "Will I get home in time for his dose? Can I leave for an impromptu weekend away ever again? Can I find a catsitter who will dose him if I leave?"

In the DC area, this surgery cost about $2200. If you're being quoted higher prices, look into further away places and consider that the cost of short travel might still be less than NYC prices. But also, run numbers on the cost of the daily maintenance: if you're paying $40/month for a prescription, and let's say you need to pay someone to pill the cat twice a day while you're traveling for ~5 days per month at $20/visit (so, $40/day x 5 days = $200/month) and on nights you want to work late or go out, another five visits per month ($20/visit x 5 extra visits = $100), so now you're looking at $340/month. In less than a year, you'll have paid out the cost of the surgery.

Sam had treatment at age 16 and lived another very happy four years. The only inconvenience was the one-time vet bill and two weeks of wearing hazmat gloves while scooping the litterbox.
posted by juniperesque at 10:56 AM on June 2, 2015 [1 favorite]

Aw, he's a cutie! My then 16/17 year old was diagnosed a couple of years ago and we couldn't go surgical or radio routes because of his age.

He's already a finicky eater so the diet was out, so I have to do tablets - luckily only one a day so far. It is a pain even though he has got used to it quite quickly - but I would much rather have been disciplined about waste for six months and have it done with forever.

(Though he is doing better than a friend's cat who somehow requires the pills THREE times a day!)
posted by symphonicknot at 10:57 AM on June 2, 2015

One of our cats was diagnosed hyperthyroid at age 17 (appx). We decided to give her pills, thinking she'd wouldn't be around long enough for the radioiodine treatment to be cost-effective. She lived another 8 more years. Fortunately she was easy to pill.

Another cat was diagnosed at age 10. We did the radioiodine treatment and she is now a healthy, cranky 20-year-old.

The 10-year-old's littermate was diagnosed about a year later. He had radioiodine treatment, but it turned out the hyperthyroid was also masking kidney disease, which led to his death less than a year later.

I'd go for the radioiodine treatment. Good luck to you both.
posted by mogget at 11:28 AM on June 2, 2015

Everything juniperesque said. Our vet was ambivalent about treatment vs meds when our kitty was 14. At the time, she told us the treatment was about $800 but we never looked into it because of her age. We just did meds.

Well, we could NOT pill her (and I have pilled many cats), so we had to do liquid which is more expensive and a hassle because I had to get it from the compounding pharmacy. Gel is even MORE expensive. Quarterly and then semi-annual blood tests to titrate the dose. So many vet visits. Meds twice a day. Having to board her when we went on vacation instead of just getting a cat sitter. Higher and higher dosages as she aged.

She lived to almost 20. I wish we would have done the radioiodine treatment.
posted by peep at 11:29 AM on June 2, 2015

Our senior citizen kitty was diagnosed with HyperT and we started him off on the meds. Unfortunately, they didn't work out for him and, in fact, made him really ill. He lost further weight at an alarming speed and was extremely lethargic/depressed.

I joined the Yahoo group for cats with HyperT and, apparently, it isn't uncommon for cats to have bad reactions (if memory serves) because the vets tend to want to start kitties on really high doses. There is a different protocol that the Yahoo group recommends (based on a university vet hospital in Texas if I am recalling correctly): the idea is to start with the lowest dose possible to help kitty's body adjust. So we did that and it helped get him feeling better (and eating) again, that is until we had to bring the dose so high (to bring down his ever-increasing thyroid) that he began reacting negatively as when it all started.

After a year of hell taking him back and forth to the vet on a nearly weekly basis, we had enough of the meds and went for the radioactive treatment (covered in part by pet insurance). I SO wish we had done it earlier, bc our cat was miserable on the meds and the vets kept insisting that the meds weren't the problem (though they had to backtrack a bit when I had him start over again, but on a low dose, and he improved).

Anyway...this is all to say that if you can swing it, do the RI Tx and hook up with the folks on the Yahoo group who have seen and heard it all:


P.S. What a cute kitty!
posted by Halo in reverse at 11:30 AM on June 2, 2015

When my cat Pookie had hyperthyroid about 6 years ago, we had to do 3 months of ear goo before we could do the iodine treatment because he was unpillable and at the time the vet wanted to make sure that the hyperthyroid wasn't masking a heart condition. He was only about 8 years old, and the cost of the medication ($50 per month) made the iodine (~$1000) a real bargain when considered over time.
posted by monopas at 11:34 AM on June 2, 2015

My family had a hyperthyroid cat for years. We got her medication (I guess it would have been the methimazole) in liquid form, tuna flavored, and squirted it on her food at meals (as per vet's recommendation). She seemed to like it, so she'd lick it off before eating, but with other cats you have to squirt it in their mouths. Because our cat had no problems with it, it wasn't really an issue to have other people look after her.

I've read other peoples' experiences, and it sounds like YMMV. Some cats spit out pills, some don't. I've been clawed trying to squirt stuff in a cat's mouth, but the cat I have now doesn't seem to mind it in the least. It really depends on the cat. Is there any reason you can't try out methimazole, to see how easy it is to give to your cat, before taking the expensive plunge on the radioiodine treatment?
posted by teponaztli at 11:49 AM on June 2, 2015

We crushed methimazole tablets with the back of a spoon and mixed them with a spoonful of wet cat food, then fed the cat the rest of her wet cat food after that first bit was gone. (Didn't mix it with the whole serving in case she didn't want it all.) She did well for five years. When we went out of town, if we didn't take the cat with us, we had to pay the cat sitter (a tech from the local vet's office) an extra $6 per dose to give her the medication.
posted by artistic verisimilitude at 12:05 PM on June 2, 2015 [1 favorite]

Response by poster: Thanks everyone for your answers so far! Your perspectives and experiences are all so helpful.

To answer a few questions:
  • The vet didn't mention a surgical option at all. I will ask her if that's a possibility.
  • I am hesitant to start Gordon on the meds because he's a difficult dude. I'm considering the compounding option, though the vet pointed out that this can be costly. For some reason I guess I'm worried he might not respond well to the meds.
  • I feel driven to make a decision about his care sooner rather than later; I like the radioiodine treatment option as it seems like an immediate solution with (likely) permanent resolution. (Though the radioactive cat litter and gloves and washing hands thing does freak me out a bit.)
  • It's amazing to me how much the cost of the radioiodine treatment varies! For the record, the cost I was quoted in NYC was still north of any price point mentioned in the responses here.
Thanks again, all.
posted by cowboy_sally at 12:20 PM on June 2, 2015

Aw, poor Gordon. Love that belly!

My Minnie is 20 years old and developed the same thyroid condition about a year ago. She's super chill about taking meds, so I've opted to give her the methimazole twice daily. To be honest, I'm not always the best at remembering but she's doing fine anyway. As far as I can tell (I'm not a vet), it's not the end of the world if you miss a dose here and there.

When I'm out of town, I will sometimes buy Pill Pockets for the catsitter to use. That's another option you might consider.
posted by soonertbone at 12:37 PM on June 2, 2015 [2 favorites]

Another vote for radioiodine. Our Meg had it about 18 months ago and it was life changing for her. She's in complete remission and obviously much happier.

But the price!

It's a kick in the pants, isn't it? But I figure she's had at least two more good years (so far) as a result, and that's worth it to us.
posted by bonehead at 1:55 PM on June 2, 2015

My boy Coco had the radioactive iodine treatment in 2011(?). It cured him and was absolutely worth the price IMO (~$1200, in Los Angeles). He had to stay at the treatment center for 3 days, but his cubby had a webcam in it so I could check in on him throughout the day. He was probably a little sad and confused about being away from home, but since the treatment itself is just a shot, I was very happy knowing that he wasn't in pain or distress from the procedure.

My vet did offer surgery as an option, but with the following caveats: Any surgery has inherent risks. Recovery is painful and distressing. Also, the surgery is not always successful; if the surgeon does not completely remove the tumor(s), then the cat's condition will likely reoccur.

I would absolutely opt for the radioactive iodine treatment for any cat I had who is diagnosed with hyperthyroidism.
posted by kitty teeth at 4:08 PM on June 2, 2015

It's not unusual for indoor cats to live 20+ years these days, and Gordon is still pretty young. My Topper was about 14 when he was diagnosed with hyperthyroid. I didn't think I could afford the surgery or radioiodine, so I opted for the twice daily liquid medication. Here we are 6 years later and he's still going strong, and I'm still tied to buying medicine every month and having to administer it every 12 hours. If I had suspected he would live this long, I definitely would have gone for a more permanent treatment!

A side benefit of treating Topper's thyroid problem is that it turned him from an aggressive, unpredictable monster to the sweetest, most friendly cream puff imaginable. Totally worth it, whatever method you decide on!
posted by platinum at 2:21 PM on June 3, 2015

Response by poster: An update: I decided to do the radioiodine, and Gordon just came home today after five days of listening to the oldies station in a lead-lined room. He seems okay! They even gave him a Purrtificate of Merit, which is kind of hilarious. So, we'll see. I think this was the right route for us to take. Thank you to everyone who offered advice!
posted by cowboy_sally at 4:56 PM on June 22, 2015 [1 favorite]

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