Hyperthyroidism
April 7, 2016 9:24 AM   Subscribe

I come to this question via my beloved cat who is 17 years old and who has been diagnosed with hyperthyroidism. Due to her inability to take conventional medication for this, and surgical procedures are not conducted in our geographic location, I am seeking as much information right now on how to at least alleviate symptoms.

IKYNMV and we've spent literally 10's of thousands of dollars on finding solutions to what has been ailing one of the sweetest cats on this planet. It's with a lot of frustration and urgency to find her some relief and how to give her quality of life that I've been putting everything else aside to figure out just how.

I need to understand first - if someone would be so kind to explain to me - what is the PROCESS of t3, t4 being released into the symptoms and why in hyperthyroidism there is no regulation but an influx. Once I have this basic knowledge it would be easier to deal with the symptoms which are many, as you probably know.

My cat has a liver mass, kidney failure as well, Methimazole is metabolized by the liver, we went as far as to get it compounded into a cream but the side-effects were just too severe and it was stopped.

Lab-wise her liver enzymes are elevated, t3-t4/ 6 plus at last count, blood in urine- no infection.

She is a fighter, as I am and I will leave no stone unturned to help her. At this point, 1 - knowing the mechanisms of the valves/glands that release these hormones will be at least half of what will get us through. The other half is figuring out how to put a damper on these processes to stabilize her and then how to actually go about healing the thyroid itself.

We've already done homeopathy, acupuncture, homotoxocology, all blood tests, analyses, ultrasound, herbal treatment (similar to Gold's), Bach remedy, energy healing and prayer.

She is getting sub-q 1x at least 100 cc, digestive enzymes, rescue remedy, gentle infusion for her heart palptitation, best quality food - some raw and some canned. Also tissue salts and Traumeel for pain as needed. Also been giving her some greens for chlorophyll. Vitamins, e, d, c, b.

We are currently in Israel, I feel completely helpless at this point and am putting this out there for the hive mind.
posted by watercarrier to Pets & Animals (18 answers total)
 
I'm so sorry you are all going through this. It's impossibly hard. Can you explain her symptoms? Is she in pain? Is she eating and drinking and behaving normally with the current regimen?
posted by juliplease at 9:31 AM on April 7, 2016 [1 favorite]


She is drinking a lot, peeing a lot, eating somewhat now less, starving for grass which I bring her almost every day to eat as she wants. She is in pain, I can see it. I can feel it too. Her fur is unkempt and greasy, she sleeps most of the day, she has tremors, sort of twitching in her upper body. Her heart is beating very fast, her stools are sometimes light, sometimes dark. No vomiting that I noticed. She has gotten weaker.
posted by watercarrier at 9:38 AM on April 7, 2016


If she is in pain, you should do some soul searching and think about whether you're keeping her alive for her... or for you. Hyperthroidism is common in elderly cats, and she's got cancer too, and you've said she's in pain. It's easy to get so involved in seeking a solution that you forget that perhaps her body is shutting down, and it's time to think about letting her go in a way that is humane and loving.

I've had two cats go through this in their late teens/early 20s. The first cat lived with more pain than she should have because I was so sad to lose her and I couldn't make myself make that decision. She actually had a stroke, and was scared because she didn't know where she was or who I was, and only then did I see that I had to let her go.
posted by answergrape at 9:46 AM on April 7, 2016 [11 favorites]


I am so sorry. I've been there.

I opted for surgery for my kitty (Max, RIP, my tuxedo boy!) because he mightily resisted taking daily pills for his hyperthyroidism.

I understand that surgery is off the table for you because of geographic inaccessibility. But in the years since Max's surgery, I've learned that methimazole, a common hyperthyroidism medication, is now available in the form of an emulsion/transdermal compound that can be administered by rubbing into a cat's ear. It might be worth investigating whether this option would be available to you.
posted by virago at 9:52 AM on April 7, 2016


virag - I wrote above that it was tried and proven to be too much for her to handle

*My cat has a liver mass, kidney failure as well, Methimazole is metabolized by the liver, we went as far as to get it compounded into a cream but the side-effects were just too severe and it was stopped.*

posted by watercarrier at 10:03 AM on April 7, 2016 [1 favorite]


Does the lack of surgical access also preclude access to the radioactive iodine injection treatment? I don't know a lot about it because the lengthy quarantine isolation is something I wasn't going to put my own elderly Hypo guy through, since he doesn't do well with isolation and has responded reasonably well to methimazole.. But if that's something that interests you, maybe poke around and see if that might be an option for you.
posted by Stacey at 10:03 AM on April 7, 2016 [1 favorite]


I meant to say: " ... by rubbing it into a cat's ear."
posted by virago at 10:04 AM on April 7, 2016


I'm sorry -- I read for a living, so you'd think that my reading comprehension would be better than that.
posted by virago at 10:04 AM on April 7, 2016


First off, I'm so sorry for you and yours.

Secondly, I want to again bring up that while you obviously love your cat and want what is best for her, it may be possible that at 17, with liver issues and kidney failure, what is best for your cat may not be more treatment. The most loving thing that you can do for her now may be to lovingly euthanize her, and it's important that you consider that option when thinking of next steps. And I say this as a cat owner, who is personally a survivor of hyperthyroidism, so it's not like I'm throwing up my hands and saying you might as well just right her off.

At this point, 1 - knowing the mechanisms of the valves/glands that release these hormones will be at least half of what will get us through. The other half is figuring out how to put a damper on these processes to stabilize her and then how to actually go about healing the thyroid itself.

The thyroid itself is the gland that is overproducing the thyroid hormone. There are a number of different possible causes for this, including autoimmune disorders, cancer, and "inflammation." The thyroid is tricky that way, because all three of the causes listed are very hard to pin down, and equally hard to treat.

Based on my experience, I don't think that "healing the thyroid" is really an option. I was diagnosed hyperthyroid, spent a couple of years on methimazole to see if my case was acute and could be managed, and when it couldn't, the thyroid had to go. In my case, it was a non-surgical radioactive ablation. I took two pills (one an iodine dye to measure my thyroid's uptake and determine the dose of I-131 I should get, and a second a couple of weeks later with the actual radioactive iodine). Totally painless, zero recovery, and the joy of being on synthroid for the rest of my life.

Therefore, I suggest that you look to see if radioactive ablation is an option for your kitty, with the knowledge that she will likely need another daily pill for the rest of her life. But, I'm going to state again, that the financial cost to you, and the ongoing deterioration of your kitty's quality of life may not be worth it.
posted by sparklemotion at 10:08 AM on April 7, 2016 [2 favorites]


Metafilter hates when I reply so much, so will just say 2 things before they get mad at me, one - non of the surgical procedures are offered here. At all. Nada. There's methimazole and that's it. The other thing, if anyone would like to contact me directly, please metamail me, this way I'll still be cool with MF. Thank you.
posted by watercarrier at 10:20 AM on April 7, 2016


I'm afraid I don't know of any other options, then. If you haven't done a literature search already, you could take a look at some of the veterinary medicine journals to see if there's some new cutting-edge treatment out there or a little-used alternative to methimazole. But otherwise it might be time to think about palliative care and/or letting your cat go. I'm so sorry; that's a hard decision to have to make. But "healing" the thyroid is probably not a realistic goal here, from my understanding based on my cat's hypo and my partner's hyper.
posted by Stacey at 10:25 AM on April 7, 2016


If you will forgive my saying so, it is a blessing to have a diagnosis and (it sounds like?) a prognosis and such a loving and detailed understanding of what is happening to your kitty. This means you have the knowledge, time and some of the wherewithal to make decisions now so that you won't have to do so later under the circumstances of a frightening medical emergency.

It's not reasonable to expect 17-year old feline thyroids to heal. Liver and kidney failure are how cats bodies usually age and die. If she is in pain and if her quality of life is declining, then I agree you need to consider whether to euthanize her mercifully now can save all of you the heartache of having to do it later when she's already in unbearable pain. Don't wait until the last minute if you don't have to. It is so much better to define those final moments together for yourselves and your kitty without panic.

Helping pets age and die is one of the hardest things we have to do. You're doing a good job and she knows she is loved. Again, I'm so, so sorry. I have been there, too.
posted by juliplease at 10:28 AM on April 7, 2016 [4 favorites]


If surgery isn't an option and methiamazole isn't an option, that leaves radioactive iodine. Radioactive iodine ablation is not a surgical procedure. Basically, the iodine is administered as a pill, is taken up by the thyroid, and destroys the thyroid cells. You then supplement with thyroid hormone to get back to normal levels.

Radioactive iodine is a pain in the ass to deal with on a practical level, but on an experiential level it's apparently a lot less unpleasant than being actively hyperthyroid or having thyroid surgery.
posted by pie ninja at 10:34 AM on April 7, 2016


Both of my elder cats developed hyperthyroidism, and one of them was, like yours, allergic to methimazole and ultimately required radioactive iodine treatment, the only other viable medical option. (On preview: as pie ninja says, that's not invasive surgery, but it does require a veterinary hospital that can safely quarantine your cat for at least a week.) If that's off the table, then untreated hyperthyroid is only going to exacerbate your pet's kidney condition--in the case of my female cat, it destroyed one kidney entirely (as in, it withered so badly that it disappeared), even with treatment. There are some prescription foods with reduced or no iodine that your vet may be able to recommend, but I don't know about how available they are in Israel.
posted by thomas j wise at 10:39 AM on April 7, 2016


You say your cat is a fighter, but that is just what all animals (and people) do, it is not an indication that s/he wants more help to live longer.

Do you have your cat on pain meds? As someone highlighted upthread, your cat has hyperthyroidism AND cancer. Cancer itself can (and most often is) an extremely painful condition, and add to that having an overactive thyroid and you have extreme anxiety, stress and pain. This is a pretty bad combination to suffer with. I would start with pain medication and anti-anxiety meds and see if your cat displays less anxiety and pain. If s/he does, then you can consider the cat on hospice care, and you can focus on providing relief from suffering as your cat dies and you can try to make the last few days/weeks as comfortable as possible, with or without euthanasia.

(You cannot heal a thyroid except with meds or other medical treatment. If your vet says that that is not an option, you do not have any other recourse, sorry. Thyroid conditions just get worse over time, not better. And then you have the cancer. And your cat is 17 years old. That is really old for a cat and medical interventions in any case I think are ill advised).

I have been through this, I sympathize. My biggest regret is not offering pain relief for my cat. It was so heart breaking when the mobile vet came to help her slip away, and the vet gave my cat a shot to sedate her first, and she visibly relaxed, all the tension and pain leaving her body, and I had a chance to see my old cat, the way she was before she was so sick, enjoying a few last moments of physical relief. I am crying as I write this.
posted by nanook at 12:20 PM on April 7, 2016 [6 favorites]


First of all, the symptoms you're describing here:

She is drinking a lot, peeing a lot, eating somewhat now less ... her stools are sometimes light, sometimes dark

are not symptoms of hyperthyroidism in cats. They are symptoms of kidney and liver failure. The only symptom you describe that is consistent with hyperthyroidism is a rapid heart beat.

Understanding the pathophysiology of hyperthyroidism is not going to help your cat survive. Medication is required in order to appropriately manage the condition. Your cat is not a candidate for these medications due to her other medical issues. Your cat is in pain. Let me emphasize this: your cat is in pain. Please, please do the good, kind, right thing and let her go.
posted by jesourie at 1:23 PM on April 7, 2016 [6 favorites]


Last year, I had three cats euthanized because they were at the end stages of their respective diseases. One was 18, she had kidney failure; one was 16, he had liver cancer; the third was only seven and he had hyperthyroidism and kidney failure. There were no other options for me at the end of each of their lives for treatment, the only other avenue left for me was to have them humanely euthanized. Your cat is in pain and suffering from multiple diseases, any of which is fatal at her age. There is nothing else to do for her, there is no way to heal her thyroid. Her kidneys are failing, you can't heal those either. The only thing you can do is to end that poor cat's suffering before the kidney failure causes neuropathy and she stops being able to walk. The worst regret is knowing you waited too long and kept her alive and suffering because you couldn't handle losing her.
posted by crankylex at 1:31 PM on April 7, 2016 [2 favorites]


As someone who's been there:
I'm so, so sorry, but it seems like you can now help her best by letting her go.
posted by Too-Ticky at 2:40 PM on April 7, 2016 [1 favorite]


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