Itchmo Forums for Cats & Dogs

Pet Health (not to be substituted for qualified vet advice) => Help With My Sick Pet => Topic started by: rbauer on April 05, 2019, 06:07:18 AM



Title: New Hyperthyroid diagnosis
Post by: rbauer on April 05, 2019, 06:07:18 AM
Dear Itchmo forums,

My 12 year old kitty was just diagnosed with hyperthyroidism on a wellness exam and confirmed with a second more sensitive thyroid test.  It just started.  Wasn’t there last wellness exam.  Only thing changed was a new prescription food that had beet in the ingredient list so I am suspicious that caused it.  The vet wants to put her on felimazole twice a day but I am a little concerned about side effects.  Is it pretty safe?  Also can it be stopped/started easily or tolerate missed doses or does the cat get very dependent on it once you start it and stopping or missing doses becomes dangerous? I read about I131 therapy and am thinking I should start the felimazole now and then maybe in 6 weeks consider the i131 therapy.  Any suggestions or recommendations? Not looking for veterinary advice of course, just maybe some personal experiences?  

Thanks.


Title: Re: New Hyperthyroid diagnosis
Post by: ranger on April 05, 2019, 11:28:47 AM
I'm on my third hyper t cat, one did not do well on the meds and did have the I 131. Second did great on the meds. Third has more issues going on right now.

If your kitty can get the iodine I would do it. There is a great hyper t group on facebook https://www.facebook.com/groups/157328711082932/ highly recommend it.

If you start meds make sure to start on a low dose of 1.25 mg twice a day. Some vets start 2.5 twice a day or higher and there were some deaths from that dose.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 05, 2019, 11:46:47 AM
Very sorry to hear about your kitties Ranger.

The vet prescribed 2.5 twice daily. 

The local university veterinary hospital offers an I131 program.   I have to make an appointment with their internal medicine department first and transfer all her records.

Wondering now if it’s worth even starting the medicine or just going straight to the radiation therapy.   Her value was just slightly above normal.   I don’t know how much damage the disease causes if it sits there for a month or so untreated waiting for an appointment at the university hospital.




Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on April 05, 2019, 06:32:30 PM
Very sorry to hear about your kitties Ranger.

The vet prescribed 2.5 twice daily. 

The local university veterinary hospital offers an I131 program.   I have to make an appointment with their internal medicine department first and transfer all her records.

Wondering now if it’s worth even starting the medicine or just going straight to the radiation therapy.   Her value was just slightly above normal.   I don’t know how much damage the disease causes if it sits there for a month or so untreated waiting for an appointment at the university hospital.




PLEASE do not give 2.5 twice daily.  All of the hyperT forums I've seen say that is too high to start with.  Mandycat should chime in, I think she's associated with the yahoo hyperT group.  Here is my own experience.  Kozy had elevated thyroid level, in the gray area, last September, he's 12 years old and thyroid has been normal prior to this.  We started him on just 1.25 once a day because he had other symptoms such as weight loss.  A month later we had to discontinue the tapazole because he had a reaction to it, with open sores on his face.  We waited for more than a month to re-test to make sure the Tapazole was out of his system and his thyroid level was back to normal.  We re-tested in another month and it was still normal.  I can't explain the one elevated test, but just want to caution you not to do the radiation until your cat is tested a few times to check to see if the original test is valid.  We were ready to schedule the I131 after he reacted to the med, and we would have put him through it for no reason if we hadn't kept testing!

I'm sorry you and the kitty are going thru this!  If she is indeed hyperT, then the iodine is the best treatment for a lot cats, if you can afford it up front.  We would have done this if Kozy had a definite diagnosis, since he was allergic to the med.  The experts don't have a definitive cause for hyperT, but I would really doubt that it was from the new food?

Good luck to you and your kitty!! :-*


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 06, 2019, 04:19:53 AM
I haven’t started the med yet.  Don’t know if I even should until I retest.  Do most kitties tolerate 1.25 mg twice daily just fine or do they all start having side effects to this medicine like no appetite and vomiting or worse?   And is it okay to cut the coated pill in half with a regular pill cutter and hide it in a pill pocket?  Thanks.


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on April 06, 2019, 06:09:50 AM
Yes, you can split the pills with a regular pill cutter and pill pockets are fine to use with the med.  AFIK, 1.25 2/day works well for kitties.  I think the retest should be done no sooner than 3 or 4 weeks after starting, and you might then need to increase the dose at that time but again, go slowly.  I don't know about the side effects, but if the hyperT diagnosis is correct, then you must give the meds or do the I131.

Mandycat has a great deal of info for newly diagnosed here:  http://itchmoforums.com/feline-hyperthyroidism/feline-hyperthyroidism-basics-t14414.0.html

I didn't answer your earlier question about whether waiting for a while on the I131  will cause more problems, sorry!  Unless the cat is extremely far along in the disease, it's not likely to make a difference, IMO.  It is a progressive disease but it occurs over a long time.

Do read Mandy's link, though.  I haven't read it thoroughly in a while and may have missed something.  Hang in there!   :)


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on April 06, 2019, 06:40:24 AM
Also, I think generally speaking that most cats tolerate the pills but if not, a transdermal med is available.  It’s a gel you would apply to the bare spot near her ear.  Catbird and others have used it.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 06, 2019, 11:33:19 AM
Fizzy1, I’m really grateful for all of the help, advice, and links to resources that you and ranger have shared.  Thank you so much.  I keep staring at the medicine bottle but probably should start the 1.25 mg twice daily tomorrow or Monday then for sure - before she loses any more weight.  I’m a little uncomfortable not following the vets instructions exactly, but it seems like it’s better to start slow, and if there’s any problems they will be less severe.  The cat should have some kind of beneficial response based on what everyone’s saying.  After the recheck I can always titrate upward if tolerated.   I don’t think the vet will be upset for not following her instructions, especially if 1.25 does the trick.  I just saw that the pharmaceutical company actually has a coated 1.25 tablet now, but only available in Canada and UK, so that lends some weight to this discussion as well, or why would they even invest in producing that.


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on April 06, 2019, 05:20:55 PM
rbauer,
My thanks to Fizzy for giving you the information I would also have given you.  She is correct that you should only start the Felimazole at 1.25 mg twice a day with doses 12 hours apart,especially if the T4 was only slightly elevated.  Actually, I would like to know the actual T4 result.  There are certainly instances like Fizzy described where a T4 test result can be slightly elevated but the cat is not really hyper-t at all.  To try to confirm the diagnosis, the vet should palpate for an enlarged thyroid nodule, and symptoms are very important, especially weight loss despite a ravenous appetite.  If the other test you had was a Free T4, that is no longer considered to be a reliable confirmation of hyper-t since it is frequently elevated when a cat has other non-thyroidal medical issues.  It is not very likely that the beets in the new food would have caused hyper-t. 

The pills are generally safe, but can cause side effects in some cats.  The most common side effects are GI in nature, so loss of appetite, vomiting, diarrhea may occur.  However, if the dose of the medication is too high and the T4 decreases too much, those same side effects can occur.  So, retesting the T4 3 weeks after starting the pills is recommended so you can see if there is a need to increase or decrease the dose.  Not all cats will have side effects, especially with the low dose.  It is necessary to dose consistently every day to keep the T4 in the ideal range, which is 1.5-2.5 ug/dL or 20-32 nmol/L, depending on which unit of measurement your lab uses.  These values are equivalent - just different units of measurement.  It is always safest to start with the 1.25 mg twice a day and increase if necessary to prevent the T4 from decreasing too much and causing hypo-t which can have an adverse effect on the kidneys if prolonged. 

The I131 treatment is the gold standard for treatment since it is a cure rather than a control.  Some facilities will want a trial of  the Felimazole (methimazole) before doing the treatment to be sure that there is no serious kidney disease because  hyper-t can mask underlying kidney disease which is unmasked when the T4 normalizes on the medication.  If the T4 is borderline, you would also want to know for sure that the kitty is truly hyper-t since doing the I131 treatment on a cat who is not would destroy their thyroid totally. There can be false positives on the test, so borderline results need further confirmation.  The most definitive confirmation is a test called a thyroid scintigraphy scan which allows for visualization of the adenoma (benign tumor) that causes the condition.  It is not widely available, but is very helpful if it is available in your area if a diagnosis is needed sooner rather than later.  If you have a treatment facility in your area that you would be considering, I may be able to give you some feedback on that facility as far as their protocols and availability of such a test if you post that name.  The support groups can also help with that.

There is a learning curve for managing this disease, so I do recommend that you do some reading about the disease and join a support group.  The facebook group is a good one and was actually founded by the same people who are on the Yahoo Hyper-Y Group that I am a member of.  The Yahoo Group can be found at
                 
                    https://groups.yahoo.com/neo/groups/feline-hyperT

I think I gave some links to the websites of Dr. Mark E. Peterson in my link here on Itchmo.  Dr. Peterson is a veterinary endocrinologist who is considered to be the foremost expert on feline hyper-t and is the one who first described it in 1979.  There is lots of important information you can read on his websites.

Although everything may seem to be overwhelming right now, it does get easier once you are familiar with the disease and its treatment.  I had 2 hyper-t kitties.  One was managed with the medication for 5 years until she passed away at age 20 from an unrelated medical issue.  The other had the I131 treatment and it was very successful.  She also passed from an unrelated medical issue. 

I know that this is a long message, but I hope it helps you with your decision and with obtaining further information you may need to treat your kitty.  Keep us updated.


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on April 06, 2019, 05:28:29 PM
rbauer,
To add to my previous post.  I looked back at my thread here on Itchmo, and at that time, the Free T4 was still considered a good confirmation for the hyper-t diagnosis, so you will see that there.  However, that has changed in recent years and it is not considered so reliable now.  Here is an article by Dr. Mark E. Peterson that discusses why an elevated T4 and/or Free T4 are not always diagnostic for hyper-t.  I am not saying that your kitty is not hyper-t, but just making you aware that you need to be cautious when the T4 is borderline high or still within the high end of the reference range.  I don't know your T4 test result, but this information may be helpful if there is any doubt.

                   https://animalendocrine.blogspot.com/2013/08/is-high-serum-t4-or-free-t4-level.html

             


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on April 06, 2019, 06:12:47 PM
Fizzy1, I’m really grateful for all of the help, advice, and links to resources that you and ranger have shared.  Thank you so much.  I keep staring at the medicine bottle but probably should start the 1.25 mg twice daily tomorrow or Monday then for sure - before she loses any more weight.  

You are very welcome.  I know how overwhelming it can seem, but all you need to do is take it a day at a time. 

Yay, Mandycat is here!   :)


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 07, 2019, 05:56:56 AM
Hi Mandycat, thanks for providing all of this great information.  There is so much to learn and I'm really grateful for all the help and support that you and everyone has been providing.  You had asked a few questions in the previous message.  I'll try to fill in as much additional detail as I can.

1) There is a second ongoing illness that's complicating things.  A bloody nose, inability to chew dry food and dropping it at the bowl, along with pain behaviors (hiding, rigid stance, etc after eating dry food) is what brought her into the clinic initially. They noticed a very angry carnassial tooth.  Blood labs were taken and were normal except for the borderline T4 (confirmed with Free T4).  Urinalysis revealed blood and crystals.  A decision was made to place her on Clavamox tablets for 7 days and Buprenex every 12 hours or as needed.  She made it to day 4 okay on Clavamox but got diarrhea early on, which somewhat improved with giving her Benebac.  She's vomited the last couple doses, and has started vomiting meals and lost her appetite.  I'm having to hand feed lunch meats and coax her to eat.  I don't think I can finish out the Clavamox - her tummy is too upset now and maybe I should stop it.  What do you think about stopping it, halving the dose, or asking them to switch her to Metronidazol?  This not eating well is not good.  They won't do the dental and extract the tooth until about 4-5 weeks from now when they want her T4 to be normal.  I don't understand- I feel she needs to get back to eating normally and the sooner that tooth comes out the better.

2) The most visible Hyper T symptom was weight loss. She was 14 lbs in September 2018, but only 12.5 pounds on Tuesday. No real diet changes except adding Royal Canine gastrointestinal energy dry to her other dry food between the September and Tuesday vet visits.  She had good blood labs before but she had been drinking a lot also and frequently scratching at her neck.  She also had frequent 4 am vomits that were somewhat corrected by feeding later in the evening but it still happens occasionally - like this morning.  I've been awake since 4 am with her, she threw up, refused breakfast, etc.

3) The nearby hospitals that do I131 are University of Penn (Penn Vet) which is close to me, or VSEC in Levittown.   I e-mailed the Dr. at the Penn program and was advised to make an appointment with internal medicine first and let them get her records and refer her to the program.   After reading more I have become concerned that if I start the Felimazole it might change her perfect liver values and she'd be disqualified from the I131 program, or it may unmask a kidney problem that would also be disqualifying.

4)  I emailed the vet and asked for all the lab reports and will post them here or send them to you via private message on Monday.

Right now I'm just trying to get as much food into her as I can with frequent hand feedings.  Not sure about continuing clavamox at full dose.  She threw up this morning's dose anyway and there's only two days left to go.   Also not sure about starting 1.25 Felimazole now until she's eating normally again.  If she develops an aversion to pill pockets from vomiting it will be difficult to pill her in the future.  The vet's office is closed until tomorrow.   Gosh things are so complicated.   Any thoughts or advice greatly appreciated.  Thanks.  


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 07, 2019, 07:50:17 AM
Also just bought some high calorie nutritional gel to syringe into her mouth a few times a day until the appetite is back to normal.


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on April 07, 2019, 03:28:26 PM
Rbauer, I hope Mandycat will post some answers for you.  I don’t know what to tell you about the Clavamox.  It’s so hard seeing them with no appetite, and vomiting.  The nutritional gel is a good idea.  When you speak to the vet you might ask about an appetite stimulant.  I don’t like their side effects, like lethargy, but it might help get her over the hump here.  Not trying to give medical advice, but I prefer giving 5mg of Zyrtec for appetite stimulant, instead of the prescription ones.  Zyrtec seems well tolerated by cats and it does have the app. stim. effect, but it’s used off-label and some vets aren’t up to speed on it.



Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on April 07, 2019, 05:50:30 PM
rbauer,
It would help to know the exact T4 test result.  Also, as I said previously, the Free T4 is not now considered a reliable confirmation of hyper-t, especially when there is also a non-thyroidal medical issue.  Obviously this is the case with your kitty, so the Free T4 result may not have confirmed hyper-t.  It appears that the weight loss may be the only hyper-t symptom.  However, could that be due to the dental problem?

Clavamox very often causes diarrhea in cats.  If that were the only problem, I would say finish the course of it.  However, if there is vomiting, your kitty is probably not getting the full benefit of the antibiotic anyway if it is coming back up.  I think I would ask the vet about changing the antibiotic if he thinks she still needs additional medication for the problem.  As for waiting for the T4 to be normal before doing the dental, there could be another reason, like a question about her kidney function status, that is making them want to wait.  Vets don't like doing anesthesia if they think there may be a kidney disease issue.  I would have to also know the BUN and Creatinine test results to determine if that could be an issue.  I agree, however, that, if there is no possibility of underlying kidney disease and the T4 is just very borderline, it would seem to be better to just get the tooth out.  Perhaps the vet would reconsider if he knew that she was not eating which could make her sicker.

Fizzy's suggestion of using Zyrtec (cetirizine), which you can buy over-the-counter as an appetite stimulant is very good.  It is used by many cats on the Yahoo Hyper-t Group when they have appetite issues.  The usual dose is 1/4-1/2 of a 10 mg tablet (2.5 - 5 mg) once a day.  It does not have side effects like the prescription appetite stimulants.  However, if the cat is also nauseous, you may also need an anti-nausea medication for best results.

Do not worry about any liver issues if you decide to start the Felimazole.  That side effect is extremely rare.  In fact, the truth is that frequently cats will have elevated liver enzymes when first diagnosed with hyper-t, but it does not indicate any true liver disease.  It is just a symptom of the disease and the liver enzymes return to normal once the T4 decreases and the hyper-t is controlled after treatment.  So, if your kitty has good liver enzymes now, that is actually something that could indicate that she is NOT hyper-t, or that it is so early in the course of the disease that they have not yet become elevated.  I have never known of a cat who could not have the I131 treatment due to any elevated liver enzymes.  I previously said that hyper-t can mask underlying kidney disease which would be unmasked with treatment as the T4 normalized.  The kidney disease would have to be very severe to disqualify a cat from having the I131 treatment.  Some vets still like the do the methimazole trial to see the results of the kidney values when the T4 is normal, but, unless the kidney values were already very high before starting the medication, it is unlikely that kidney disease severe enough would be unmasked.  The T4 and the Creatinine tests have an inverse relationship.  When the T4 is elevated, the Creatinine is suppressed; when the T4 decreases, the Creatinine increases.  Very often the Creatinine just increases and decreases within a normal range, but can also increase enough to unmask underlying kidney disease in a  hyper-t cat.  Most of the time this underlying CKD is very mild, and has no effect on doing the I131 treatment.

I don't know if UPenn has the ability to do the thyroid scintigraphy scan, but they might since they are affiliated with the university.  I would ask them about that since they may include that in their protocol for doing the treatment and it would definitely confirm the hyper-t diagnosis when the T4 is borderline.  You might want to follow through with submitting her records and have her evaluated for the treatment.  But, even if they don't require a methimazole trial, they would probably want the dental problem resolved before doing the treatment, and your vet won't address the dental problem without giving the medication to decrease the T4.  So, you do have some issues to resolve with that.  

Cats can have problems with acid in their stomachs that cause middle of the night or early morning vomiting due to long stretches of time without food.  If this could be the problem with your kitty, the suggested treatment is to give 1/4 of a 10 mg tablet of famotidine (Pepcid) at bedtime along with a small meal.  Smaller more frequent meals during the day also helps.  This may not be the current problem, but sounds like it could have been the problem in the past.

If I am able to see the lab results, I may be able to be a little more specific in my comments.  I don't want to mislead you, so these comments are pretty general without knowing any numbers.

As you are gathering information about the I131 treatment, ask UPenn if they tailor the dose of I131 to the individual cat.  I didn't find that information on their website.  It is important since you definitely don't want a one-size-fits-all dose given that would result in more possibility that she would become hypo-t after the treatment.  VSEC does appear to tailor the dose according to what I read on their website, but would want to verify that also.  Your choice of facility for the treatment could depend on that answer.
  


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 08, 2019, 05:11:37 AM
Hi Mandycat, thanks again for all your kind help with all of this.  It is greatly appreciated and you are truly Mabel's hero!  Below are the lab results cut and pasted.  I could not figure out how to attach files or images.  Hope this is okay.  I emailed Penn with the questions about tailoring the dose and the scan.  Withheld Clavamox last evening and she is eating almost normally again this morning.  Did not start Felimazole yet.  I'd like to discuss the possibility of maybe not even starting it at all and going straight to I131 if the diagnosis is confirmed by other methods and the facility does not require a tapazole trial.  As far as the tooth is concerned, she has a history of crown and root FORLs and extractions.  I'm hoping that maybe this tooth is not a true "infection" but maybe just hurts when she chews on dry food and the clinicians will give us a pass on addressing it before I131 is offered.  I left a detailed message for her doctor and she will likely call this afternoon.


Laboratory:   Antech - Zoasis East
   Profile:   General Senior Profile
   Test   Results   Range
Superchem


Total Protein   6.5 g/dL   5.2 - 8.8
   Albumin   3.4 g/dL   2.5 - 3.9
   Globulin   3.1 g/dL   2.3 - 5.3
   Albumin/Globulin Rat   1.1   0.35 - 1.5
   AST (SGOT)   22 IU/L   10 - 100
   ALT (SGPT)   42 IU/L   10 - 100
   Alkaline Phosphatase   64 IU/L   6 - 102
   GGTP   1 IU/L   1 - 10
   Total Bilirubin   0.1 mg/dL   0.1 - 0.4
   Urea Nitrogen   23 mg/dL   14 - 36
   Creatinine   1.0 mg/dL   0.6 - 2.4
BUN/Creatinine Ratio   23   4 - 33
Phosphorus   4.2 mg/dL   2.4 - 8.2
GLUCOSE   136 mg/dL   64 - 170
Calcium   9.5 mg/dL   8.2 - 10.8
Magnesium   2.0 mEq/L   1.5 - 2.5
Sodium   155 mEq/L   145 - 158
Potassium   4.3 mEq/L   3.4 - 5.6
Na/K Ratio   36   32 - 41
Chloride   122 mEq/L   104 - 128
Cholesterol   137 mg/dL   75 - 220
Triglycerides   66 mg/dL   25 - 160
Amylase   1022 IU/L   100 - 1200  PrecisionPSL   24 U/L   8 - 26
Acute pancreatitis is unlikely. Chronic pancreatitis is not excluded by a normal PrecisionPSL.
CPK   120 IU/L   56 - 529
Complete Blood Count
WBC   7.4    3.5 - 16.0
RBC   8.8    5.92 - 9.93
Hemoglobin   13.6 g/dL   9.3 - 15.9
HEMATOCRIT   39 %   29 - 48
MCV   44 fL   37 - 61
MCH   15.5 pg   11 - 21
MCHC   35 g/dL   30 - 38
Platelet Count   318    200 - 500
Platelet EST   Adequate
Neutrophils   53 %   35 - 75
Bands   0 %   0 - 3
Lymphocytes   37 %   20 - 45
Monocytes   3 %   1 - 4
Eosinophils   7 %   2 - 12
Basophils   0 %   0 - 1
Absolute Neutrophils   3922    2500 - 8500
Absolute Lymphocytes   2738   1200 - 8000
Absolute Monocytes   222    0 - 600
Absolute Eosinophils   518    0 - 1000
Absolute Basophils   0    0 - 150 T4
T4   3.7    0.8 - 4.0
The Total T4 result is greater than 2.5 mcg/dl and less than or equal to 4.0 mcg/dl. A Free-T4 by equilibrium dialysis may aid the diagnosis of hyperthyroidism in cats with clinical signs of hyperthyroidism. Please contact Customer Service for this additional testing.

Urinalysis-Complete
COLLECTION METHOD
Natural Voiding
COLOR   Yellow
Appearance   Cloudy
Specific Gravity   1.046   1.015 - 1.060
PH   8.0   H   5.5 - 7.0
PROTEIN   2+   H   Negative -
Urine protein:creatinine ratio testing is recommended (if the sediment is inactive) to help determine the clinical significance of proteinuria.
GLUCOSE   Negative   Negative -
Ketone   Negative   Negative -
BILIRUBIN   Negative   Negative -
BLOOD   3+   H   Negative -
WBC   0-1 HPF   0 - 3
RBC   11-20 HPF   H   0 - 3
CASTS   None Seen LPF   Hyaline 0 - 3
Triple Phosphate Cry   4-10 HPF

Free T4 By Equilibri
Free T4 (Dialysis)   53.0 pmol/L   H   10 - 50



Title: Re: New Hyperthyroid diagnosis
Post by: GKit on April 09, 2019, 11:14:31 AM
rbauer, I hope you were able to get some satisfactory answers from your vet call yesterday. I’m glad Mabel is eating normally again.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 09, 2019, 04:04:05 PM
Thank you Gkit.  The vet wants to do some more testing and check a couple more things.  If those are okay she can then get her dental.  I asked for some testing besides the free.and total T4 because I’m not convinced yet she’s really hyper t.


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on April 09, 2019, 08:53:27 PM
rbauer,
Sorry for being late replying.  I was not able to be on-line on Monday to see the labs.  Now that I have seen them, I think that the results are so borderline that you might want to wait to treat at all.  If you read the article I send by Dr. Peterson that discussed whether an elevated T4 and/or Free T4 is always diagnostic for hyper-t, you will see that Mabel's result fall in the category of the T4 being at the upper end of the reference range which is the gray area for a definite diagnosis.  Dr. Peterson's advice in that case is to wait and not treat, but to retest in 2-3 months to see if the T4 has increased above the reference range, palpate for the enlarged thyroid nodule, and observe for additional symptoms of hyper-t.  It will not be  harmful to wait with the results being so borderline.  It would be far more harmful to treat when it is not needed.  Treating with the medication may cause hypo-t, which would make Mabel sick, but can be reversed.  However, even that should be avoided if possible.  In the case of doing the I131 treatment, that would totally destroy her thyroid if she were not really hyper-t and would make her permanently hypo-t and cause other adverse effects.  You definitely want to avoid that.  It is your decision to make about treatment, but, IMO, it would be best to wait and see if the diagnosis becomes clearer before treating.  If she is truly hyper-t, you will see additional symptoms and the vet will also observe additional symptoms that you cannot see like increased heart rate,  heart murmur, elevated BP, and the enlarged thyroid nodule.  And, more important, the T4 will increase above the reference range to help confirm the diagnosis.  The most common symptoms you can observe are weight loss despite a ravenous appetite, increased thirst, increased urination, increased vocalization, poor haircoat, overgrooming.  Also, there are some clues that can be seen in the lab results that I do not see at this time.  I think I mentioned that the liver enzymes, especially the ALT, can be elevated, but not indicate any true liver disease.  It returns to normal when the T4 is controlled.  There can be a decrease in the Creatinine due to the increased metabolism caused by  hyper-t increasing filtration through the kidneys.  Mabel's Creatinine is very good, but I would not really know if it is decreased unless it could be compared to a previous test result.  There are some other clues as well, but I don't see any of them on these lab results.  The urinalysis shows blood in the urine. Since a cystocentesis was not done, which can ususally be the cause of blood due to the vet hitting small blood vessel during the procedure, you might want to ask the vet if any follow-up is needed to find the root cause of this blood.  The other abnormalities on the U/A are most likely due to the presence of the blood, with the exception of the crystals.  Nothing in the U/A is due to hyper-t.

I hope this helps a little.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 11, 2019, 02:21:58 PM
Hi Mandycat, thank you for looking at Mabel’s labs and helping us navigate through  all of this information.  I’m so grateful for your help and really glad that we waited and that no medication was started.  I will just recheck the levels in 2-3 months as you suggested to see if the diagnosis becomes clearer. Mabel’s appetite has fully recovered and her stool is pretty much back to normal.  She still has that bad tooth but is doing okay on wet food only now.  At this point the vet still does not want to do her dental yet despite very good lab work.  Now they want me to get an ultrasound of her belly to follow up on something from 5 years ago.  Back then Mabel had  a minor bout of pancreatitis I think was caused by a drug reaction to high dose gaba pentin. The ultrasound said her intestine had minor  thickening, and lymphoma was suggested because of low b12 status.  She did b12 shots for awhile but I never followed up with biopsy.  She’s been perfectly healthy all this time though, so I don’t think it’s lymphoma and is  more likely just IBS/IBD. They might be linking her weight loss with this other condition perhaps.   Then again, she could have lost weight from dropping food and not eating full servings due to tooth pain. At this point I just would like her to have a dental and get that bad tooth out so that she can enjoy eating again.  I believe that the tooth is an acute situation that needs immediate attention.  I’d be happy to do ultrasounds and what not after the tooth is taken care of, but the vet doesn’t want to do things in that order.  They want to do the ultrasound, test TLI, PLI, cobalamin, and folate and then refer to a specialist if needed.  Mabel just got her appetite back, diarrhea is resolving and she’s happy and playing again.  I would have to fast her and put her through all this. Feeling a little frustrated.  I don’t think she’s very hyper t and there’s nothing really in her labs that says she can’t handle anesthesia for a dental.  Her blood pressure was 140 / 140 / 140.  What do you think if I go get the dental done elsewhere?  And then come back and follow up with the abdominal  workup when she’s pain free? Or are they really right and I should just follow the plan?  I could let them do the abdominal work up on Monday but am just concerned if I would be jumping the gun and chasing another non emergency again (like the hyper t) and delaying the bad tooth.  The only thing that’s absolutely certain right now is there’s a bad tooth and Mabel is in pain.  I don’t know what to do.  What do you think? Im really grateful for all your help Mandycat.  Thanks.  


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 12, 2019, 10:49:49 AM
I emailed with Mabel’s doctor and she was very kind and understanding of my concerns and explained why we need to go in the order that she wants.  I decided to just follow her plan and do the ultrasound, blood work, and b12 on Monday.  Hopefully the dental can follow soon after. In the meantime Mabel is eating canned food okay.


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on April 12, 2019, 12:22:07 PM
Rich, I'm glad you've had your questions answered by your vet.  It's so hard to know what to do!  Please keep us posted on Mabel's tests on Monday.  It's great to hear she's eating the canned food.  Hang in there!  :-*


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on April 12, 2019, 08:52:02 PM
I don't quite understand why your vet wants to do the GI work-up, but I will have to just accept that she knows more about Mabel than I do when it comes to that.  As for the tooth, IMO, it would probably be safe to get it taken care of.  I personally prefer using a veterinary dentist to do all dental work except simple cleanings.  With Mabel's dental history, that is what I would suggest doing.  In any event, I think you need a second opinion on how to handle the dental issue.  I'm not understanding why your vet would just allow Mabel to remain in pain.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 13, 2019, 03:22:12 PM
Hi Mandycat.  Thanks for your reply.  I had been taking Mabel to the University of Pennsylvania dental clinic for many years and they did her extractions and even a root canal on a canine tooth but it was getting a little pricey.  She was getting one FORL after another.  Penn is still an option, and a very good one.   I am not completely on board with this ultrasound idea myself, but I will go through with it.  Mabel gets the poops a lot and I think it’s just chronic IBD but who knows.   I don’t think it will hurt to get the scan and labs and it may give me some peace of mind about what ever went on before with the pancreas and thickened bowel.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 15, 2019, 12:22:38 PM
Mabel had her ultrasound today.  She has active pancreatitis (again) and her intestine has inflammation but it doesn’t look like the kind of inflammation that requires biopsy.  Kidneys have changes consistent with an older age cat and need to be watched.  She got her b12 shot and the other lab results for pancreas and gi should be back in a day or two.  Hoping for a dental in a couple weeks if the medical director feels that all these other things are under control.  Treatment plan is buprenorphine for comfort, Pepcid for early morning vomits, oral b12, royal canine gastrointestinal high energy food, and repeating t4 labs in a few weeks with possible 1.25 mg felimazole.  Any new diarrhea might be treated with metronidazole and we also talked about using it to calm the intestines down.  I feel relieved and am grateful that Mabel is mostly okay.  Also am very grateful for all of the support from everyone here.  Thanks so much.


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on April 15, 2019, 05:00:22 PM
It appears that perhaps the pancreatitis is mild and will resolve pretty quickly.  The lab results will help to verify that.  I hope that she will be able to get the dental done sooner rather than later.  Let us know the results of the GI tests, and also the retest of the T4 when you do that.  Did you ever ask your vet about the urinalysis results?  I do think that the root cause of the blood in the urine needs to be explored since the urine was not collected by cystocentesis.  It could just be due to idiopathic cystitis, which is believed to be caused by stress.  You probably should repeat the urinalysis when you retest for the hyper-t to see if there is still blood in the urine.  You might consider doing a culture & sensitivity along with the U/A to rule out any infection also.  Just suggestions.  Discuss it with your vet. 


Title: Re: New Hyperthyroid diagnosis
Post by: alek0 on April 15, 2019, 05:53:02 PM
No experience with hyperthyroidism, but I would just like to add that vit B supplements do wonders for an older cat. My Mitzie is on oral vit. B complex and vit. B 12 (I use human supplements and just cut them), she was mildly anaemic before we started regular vit B supplementation but this has completely resolved after the supplements. With age the absorption of vit. B from food becomes less efficient, and since it is water soluble no harm done if there is excess.

Also, since we ask the vet for vit. B shots when we have to travel to reduce number of pills that pet sitter needs to give so Mitzie and Max would be less stressed out, there seem to be some new formulation of vit. B injections which doesn't sting. Not sure if that has been available on your side of Pacific for a while, for us is new, but wanted to mention it just in case you don;t know that there are different ones, some which are apparently painful and some which are not.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 16, 2019, 03:16:35 PM
The lab results did not come back yet but they emailed the full ultrasound report.  Mabel’s vet also said that we can definitely repeat the U/A with cytocentesis when we recheck the T4.  Thank you so much for catching that Mandycat.  You’re Mabel’s hero again :)  

Alek0 thank’s for sharing about Mitzie’s vitamin regimen.  I will ask about that too.  I think the plan is for me to use an oral b12 because I had expressed some discomfort with the idea of injecting Mabel. Not sure what we’ll be doing.

There is a vitamin Mabel sometimes uses for runny eyes.  Lysine.  Either powdered on wet food or the Viralys gel brand.  


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 18, 2019, 05:55:52 AM
Mabel’s lab work came back yesterday and her folate and pancreatic function was normal.  Her cobalamin was <150 and the normal range is 200-1500.  She received one B 12 injection on Monday. The plan is to give her one tablet of cobalaquin per day.  The early morning vomits have stopped since initiating 1/4 tablet of Pepcid at bedtime. My only question about it is if it is safe for long term nightly administration.  She seems to be enjoying the Royal Canin gastrointestinal high energy diet and her stools have been normal for several days since initiating it. I soak it in water for 45 minutes before serving it because of her tooth sensitivity.  We’ll recheck all labs and do a cytocentesis urinalysis in about 3 weeks.  Pending those we’ll schedule her dental and make decisions about the thyroid treatment if the levels still looks high.  I’m concerned about the kidney findings on ultrasound now that I’ve seen the report.  Her labs are still good in that regard however, so I’m not sure that we can really do much right now except continue observing them.  Thanks again for everyone’s help and support.


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on April 18, 2019, 06:41:01 AM
Thanks for the update.  I don’t think there is any problem with giving the Pepcid nightly.  It’s good to hear Mabel is eating better.   :)


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 19, 2019, 04:07:37 PM
I might be getting a little ahead of things but if in a few weeks the T4 is still high, and there is a delay getting a dental or into an I131 program, is it reasonable to start Mabel on just 1.25 daily methimazole ?   Also is it a real bitter medicine?  How is the compounded liquid suspension?


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on April 19, 2019, 06:58:37 PM
You are probably getting a little ahead of yourself, but if it seems necessary to start the methimazole, a dose of 1.25 mg would be okay.  Methimazole really needs to be given in doses twice a day, so, if you mean 1.25 mg per day, that would be .625 mg twice a day.  We can discuss that more later, though.  If the T4 is still as low as it is now, I wouldn't consider starting the methimazole unless you observe more hyper-t symptoms, the vet palpates an enlarged thyroid nodule, or we see lab results that are clues to confirming hyper-t.  It is far more harmful to treat than not to treat if you are not confident of the diagnosis. 

If you do start the medication, the methimazole pills are a little bitter, but very small.  The pill is actually a 5 mg tablet that is split into 4 pieces that are 1.25 mg each, so not a very large pill to give.  They can be given wrapped in a product called Pill Pockets, which are like a treat.  Or you can wrap it in a piece of cheese or other soft treat.  You can have it compounded in a transdermal gel form that is applied to the upper, inner hairless part of the ear and absorbed from there. It can be compounded in a liquid form that is flavored (chicken or tuna usually).  It can also be compounded into a treat form.  So, there are many options.  The least expensive option is the pill.  The other options cost a bit more.  For the pills, you can use either the human generic methimazole, which is a 5 mg tablet that you can get from any pharmacy, or you can use the veterinary brand of methimazole called Felimazole.  The Felimazole is usually obtained from the vet or a veterinary pharmacy on-line and is more expensive.  It is a 2.5 mg tablet.  Either tablet must be split with a pill splitter to get the correct dose when that is smaller than the dose the pill comes in.

The Pepcid (famotidine) is safe to give nightly.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 21, 2019, 12:14:53 PM
Hi Mandycat, the medicine and the dosing doesn’t sound too bad now that you explained all the options, and it would probably just be temporary until she gets into the I131 program.  I have run into some new challenges with Mabel this weekend with food however.  I’ve been having difficulty getting her to eat her full rations the past couple days if it’s served in her bowl.  She leaves a lot of food behind and walks away. Today I put fortiflora on the food and that helped a little.  Feeding her directly out of my hand helps even more.  There’s something about eating out of the bowl that she’s not comfortable with at the moment but if I keep refilling my hand with bite size portions she eats out of my hand just fine.  The bowl is ceramic and raised off the floor by four or 5 inches so it really is the ideal set up, but for whatever reason she is avoiding it.  I’m very much aware of her recent weight loss, and the tendency to lose even more, so I might need to keep hand feeding her for now to get the full daily amount of food into her.  She was not like this before starting Pepcid but that might just be a coincidence. 


Title: Re: New Hyperthyroid diagnosis
Post by: GKit on April 21, 2019, 02:04:06 PM
rbauer, is Mabel still on buprenex?

The blood in her last urinalysis coupled with this eating relapse makes me twitchy that she should get checked for a UTI,  assuming all this is not tooth-pain related. There was no bacteria mentioned in the UA results, so it is possible the blood might be a result of the presence of crystals, and her kidney numbers are good, so that makes it a bit unclear what is actually going on. It is possible, in my experience, to see no bacteria in urinalysis (under the microscope) yet test positive when they culture the urine.

Hopefully Mandycat can comment further.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 21, 2019, 03:02:09 PM
Hi Gkit, Mabel is no longer on buprenex.  Do you think she may be in pain?  From past experience with many dentals over many years, I became aware of a pattern that she can only take buprenex for 2-3 days before developing diarrhea from it even when she is well.  Never understood why. it’s not supposed to cause diarrhea.  So she was on it but quickly got off it.  Maybe if I put her back on this eating problem will temporarily improve, but will need to be mindful of her stool quality.  She should be getting a new urinalysis by cytocentesis at the recheck visit. She had crystals last time.


Title: Re: New Hyperthyroid diagnosis
Post by: GKit on April 21, 2019, 06:06:01 PM
I was thinking Mabel’s food setback was painful tooth related, but since it sounds like she has been off the buprenex for some time, and she has been eating well/normally in the meantime, making this less likely. Also, with as many dentals as she’s had, you probably know better than me how a painful tooth presents itself. :-)

Gypsy, my IBD/IBS kitty, has some odd reactions to meds as well. I would not rule out the Pepcid being an issue. It may not be the drug itself, but one of the inactive ingredients in the tablet.  Sometimes switching to another brand can help, but a more definitive test would be to take it out and see if she goes back to eating from her bowl, and then you can decide what to do from there. It is possible to get famotidine compounded as well, if inactive ingredients in the tablet turn out to be the problem.

A urine culture is a step further (and more $$) than a urinalysis, where they culture the urine for about 5-7 days to see if anything grows. They will usually also do a sensitivity test to see what antibiotics would be most effective. Since no bacteria were reported?  in her most recent urinalysis, this is probably why they didn’t add a culture, but if Mabel is still losing weight (hope not!) and vomity when she has her recheck, it might be something to ask the vet about.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 22, 2019, 03:00:22 AM
Hi Gkit, thanks for your message.  I gave Mabel some buprenex before bed last night and she is very playful this morning.  Got me awake an hour early even.  Going to try breakfast as soon as the food softens in water.  The compounded Pepcid was ordered Saturday and should arrive tomorrow.  It’s a soft chew chicken flavor available from vets first choice.  They partner with my vet’s practice and offer a compounded, liquid, melt, or chew of just about any cat medication from what I can tell.  I also emailed the doctor and asked if we could please get a sedated oral exam and any extractions now rather than wait several more weeks until after Mabel’s recheck.  I don’t see any reason to wait. You mentioned that Gypsy IBD/IBS.  Have you found a good combination of foods and medications that keeps everything mostly okay? 


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 22, 2019, 10:23:44 AM
Breakfast did not go too well.  Mabel appears to have developed an aversion to water soaked dry food now. I think she bit into a few that were too hard in the past and she knows they hurt.   I converted the meal into a slurry instead.  Around lunch time I was able to get about 1/3 of a can of RC gastrointestinal high energy canned food into her by hand feeding her mouth sized portions.  I will keep doing this as long as necessary to make sure she gets about 200 kcals/day.  She also got her first dose of cobalaquin today in a pill pocket.   Her Buprenex is .05 mg given every 12 hours. Strength is .5 mg/ml.  This is only half the normal prescribed dose but it seems to help and might not trigger the diarrhea if the dose is kept low.  We’ll see what happens. 


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 22, 2019, 02:47:16 PM
Just had a call with Mabel’s doctor.  They can do a dental on Wednesday but cautioned me that she just went through a lot and there are some low risks for a complication.  The other choice would be to wait another week or two and keep treating her as I have been and maybe adding Mirtazapine transdermal to build her strength and weight back up.  For now I elected to do the dental but have about 24 hours to change my mind.  This is a tough decision.  Not sure whether to get the teeth done immediately now or manage her medically for another week. 


Title: Re: New Hyperthyroid diagnosis
Post by: GKit on April 22, 2019, 07:36:10 PM
I hope Mabel ate dinner for you. After a lot of trial and error I ended up feeding Gypsy homemade raw food. I am pretty sure she is allergic to corn and peas and fish, so this was the best way for me to control all the ingredients in her food. We tried metronidazole, but it was not as effective for us as changing the food and getting rid of all the allergens. We could not do prednisolone because of her frequent urinary tract infections.

Not sure what to tell you about scheduling the dental versus medical management. You had mentioned a while back the vet had detailed her reasons for wanting to wait—are you still comfortable those reasons make sense in light of the latest round of tests and events?  If not, I would consider seeking a second opinion, since another vet seeing all the reports and data would be best able to weigh the risks/reward of a dental versus her new reluctance to eat from her bowl. Maybe I am not understanding the situation correctly? but I’m not comfortable that it seems the vet left this decision to you without more guidance, since Mabel is not eating well.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 23, 2019, 06:34:06 AM
It’s great you found a combination works and that’s all natural.  That’s the best.  

I thought about things overnight and am considering waiting and having the university hospital do the dental instead.  They could see her next week.  The benefits to going to the university are that they have seen her many times over the years, she’s an older cat and they are a 24 hour facility that may be better equipped to deal with a complication than the neighborhood vet hospital, and dental is all that the dental department does.  

The only downside is needing to keep medicating her with buprenex for another week, but so far she is tolerating it and seems comfortable.  She’s laying in all her favorite spots, grooming, and playing, whereas before she was hiding under things all day. Last night and this morning she ate wet food from a stainless steel dish by herself.


Title: Re: New Hyperthyroid diagnosis
Post by: GKit on April 23, 2019, 03:39:53 PM
Yay for eating! -whispers so as not to jinx it


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on April 23, 2019, 05:08:37 PM
I agree with the decision to have the dental done by a veterinary dentist at the university.  Having 24 hour coverage is a definite plus after surgery.  Will be keeping Mabel in my prayers.


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on April 23, 2019, 09:55:20 PM
I've been following this thread but haven't posted since I don't know much about hyperthyroid. I just wanted to say I'm glad Mabel is feeling better today.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 24, 2019, 08:55:44 AM
A big thank you to everyone for all your continued help, support, and encouragement.  Purrs and kisses from Mabel too :). I spoke to Mabel’s doctor yesterday and cancelled the dental at their office. The plan is to take Mabel to the university veterinary hospital dental department next week.  When I called the nurse there even remembered Mabel and was very glad that we were coming in.  I don’t know why we ever stopped going there every year- sometimes twice a year for her periodontal disease and FORLs.  It’s so important to stay on top of their dental care even if you think your kitty is doing fine. Lesson learned the hard way here.

Mabel’s current daily regimen is:

Royal Canin gastrointestinal high energy food
Fortiflora
Cobalequin Oral b12
Prednisolone 2.5 mg M-W-F long term ongoing for itching
Buprenex .05 ml every 12 hours
Pepcid 1/4 tablet at bedtime

Upcoming appointments are for dental, repeating all blood work, repeating urinalysis with sensitivity and culture.  



Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 24, 2019, 03:35:38 PM
Is anyone using a slanted bowl like the small version of this one so that pate style food doesn’t get packed into the walls and/or pushed over the edges of a regular Durapet bowl?

https://www.amazon.com/Ourpets-Company-2400012856-Tilt-Stainless/dp/B010Q45WE8/ref=pd_sim_199_1/138-8437997-6689910?_encoding=UTF8&pd_rd_i=B010Q45WE8&pd_rd_r=044c79ab-66e7-11e9-b80c-09dbc8d3b34b&pd_rd_w=4WIUT&pd_rd_wg=71hN2&pf_rd_p=90485860-83e9-4fd9-b838-b28a9b7fda30&pf_rd_r=ZV98CWN3DFXCY1A9DPD2&psc=1&refRID=ZV98CWN3DFXCY1A9DPD2

Right now if I serve the prescription pate food in a 10 oz paper Dixie bowl, and hold it at an angle while she eats, that works perfectly and she can lick the food in a natural upwards direction and really clean the dish.  Nothing gets stuck anywhere and gravity keeps it in the low section.  Wondering if this tilt bowl might work as well ?

This is another option maybe

https://www.amazon.com/dp/B07G23DV4F/ref=sspa_dk_detail_4?psc=1&pd_rd_i=B07G23DV4F&pd_rd_w=56POA&pf_rd_p=46cdcfa7-b302-4268-b799-8f7d8cb5008b&pd_rd_wg=QlXw4&pf_rd_r=T15VY59AX9NQF9HHP62F&pd_rd_r=dbb9865d-66ea-11e9-b12e-253105b62179





Title: Re: New Hyperthyroid diagnosis
Post by: NedF on April 24, 2019, 04:01:12 PM
I use the first one but only for dry. It does keep the food in the center of the bowl but the bottom is flat and not slanted. The slanty part is just the rim. Petsmart carries these for about 5 bucks.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 27, 2019, 06:34:03 AM
It seems that Mabel is still “learning” how to eat the prescription pate style food.   :).   Before her illness she ate dry food and sometimes a chunky/gravy or sliced wet food, so watching her try to eat pate style food is kind of like watching one if us lean forward and eat a plate of mashed potatoes without utensils.  She’s getting better at it though. After reading way too many online reviews of various dishes and bowls I finally just got her this.  Hoping that it will help with the wasted food caked around the current dish, or spilled over the edges onto the floor, and maybe it will keep her chin cleaner.  

https://www.amazon.com/dp/B06ZZX6QLL/ref=dp_prsubs_2

Another thing I found helpful through trial and error is to not serve more than 1/4 of a 5.8 oz can at a time.  That seems to limit waste and she eats more of it.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 28, 2019, 08:55:40 AM
Very pleased to report that Mabel cleaned the new Cat Guru dish.  :)  I did not have to scrape all of the wet food back into a pile and put it down in front of her again to get her to finish like I was having to do with the old dish.   It seems to work as advertised and reviewers say.  I watched her eat and as she licked the pate up the rippled incline it would form into a small clump that would roll back towards her mouth and she could chomp it.  Whereas with the old dish the pate style food would just keep getting pushed around the plate. 

I also found a new healthy snack for in between meals to help with her weight.  Trader Joe’s Just Chicken white meat chicken.  It’s just white chicken meat that’s cubed for salads.  Fully cooked and no chemicals, preservatives or seasonings of any kind.  It’s bland as can be and she loves it.  Don’t confuse it with another chicken product they have that is sliced- that one is seasoned with pepper and other things and not appropriate for cats.


Title: Re: New Hyperthyroid diagnosis
Post by: alek0 on April 28, 2019, 06:05:13 PM
When it comes to healthy snacks, my cats love steamed chicken. It works better than having it cooked or baked, since the meat remains juicy and tender.

Very simple to do actually. All you need is a cooking pot or pan which has a tight fitting lid. The you need some kind of a metal rack, I use one for cooling cakes. You put the rack in, boil some water in the kettle and fill it in to the level below the rack. Put the plate with some chicken on the rack, cover the pan with the lid and put it on high heat to keep water boiling so that there is plenty of steam. It would be done in about 10-15 mins or so, just uncover and cut through one piece to check, if it changed colour all the way through it i done. Mine go nuts over chicken drumsticks done that way, even those who normally refuse anything chicken.



Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 29, 2019, 03:48:39 PM
Never thought of steaming the chicken for Mabel. It would definitely be moister and tenderer.  What a great idea.  I have a pot with the rack for steaming fish and vegetables that I can use.  Her doctor just gave me the okay to supplement with chicken instead of trying to force more Royal Canin into her - as long as her stools stay good.  

They are also suggesting changing her Pepcid to Prilosec but I don’t think we’ve really given the Pepcid long enough to fully work.  It’s only been about 8 days on Pepcid and vomiting has definitely improved.  No vomit since Thursday.

The other thing they suggested is maybe changing her prednisolone 2.5 mg  Monday, Wednesday, Friday which is just used for itching currently, to a higher dose that is more useful for IBD.  She used to be on higher doses before her itching was under control.  I was thinking to just let her stools be the guide and leave things alone unless she has symptoms again but I don’t know.  Do a lot of people put IBD kitties on higher pred and is it generally a good thing even if kitty is asymptomatic at the moment on diet change and cobalequin only?

Wednesday is dental day 1.  The university will examine her and decide if they will do a procedure on dental day 2.  I hope that they don’t bulk at a slightly elevated T4 and tell me she can’t do anesthesia unless I get it lower.  I will be really disappointed if they say that. I don’t want her living on buprenex every day just to eat.  We need to get those bad teeth out.  Her heart rate and blood pressure are normal.  Labs posted here were pretty good too.  So I hope they still do the dental even if T4 is a little off.



Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on April 29, 2019, 07:04:00 PM
I would not use Prilosec for Mabel.  It is a medication that is in a class of drugs called Proton Pump Inhibitors.  It is used for acid reflux in humans.  However, that whole class of drugs have recently been found to have very serious adverse effects in humans.  It is virtually almost impossible to get off of the drug once one is on it for any length of time due to the acid rebound that happens when it is discontinued.  A study done on cats showed that this hyperacidity does occur in cats as well when it is discontinued.  It also has other adverse side effects.  I would give the Pepcid more time rather than start this medication.  Here is the link to one article about its use in cats.  Scroll down to the side effects.  I don't think Mabel needs vomiting, diarrhea, etc. caused by this medication.   The side effects from long-time use are even worse.  For instance, it causes B12 deficiency and kidney issues in humans, which I would think could also be true for cats.    

            https://www.vetinfo.com/omeprazole-for-cats.html

Here is another article about using Prilosec for cats.  This one says it is used ONLY for stomach ulcers in cats.  Unless your vet is sure Mabel has a stomach ulcer (doubtful), I would stick with the Pepcid, which, IMO, is safer for cats.

             https://www.petconsider.com/can-i-give-my-cat-prilosec-safely/


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on April 30, 2019, 04:28:28 AM
I also would not give Prilosec. My own experience with it was as Mandycat said - very difficult to get off it and it caused digestive problems while I was on it. I also get kidney stones now (not sure if Prilosec is the cause but it seems too coincidental).


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on April 30, 2019, 06:48:42 AM
Thank you Mandycat and NedF.  I will be sure not to give Mabel Prilosec.  I think that we have a combination of feeding routines and pepcid that is working pretty good now.  I’m not too keen on the idea of increasing her steroid either unless the benefits would outweigh the risks.  The diet and supplements might be enough right now.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 01, 2019, 10:44:35 AM
Mabel was seen by both dental and internal medicine today.  She has two or three painful resorptive lesions that were visible during her physical exam.  She is staying overnight and will have her dental procedure done first thing in the morning.  They are also going to do the cytocentesis and culture.  She will have a dental recheck in two weeks and will see internal medicine again during the same visit.  At that time they will take up managing her hyper t and get her into i131 if the diagnosis is confirmed.  The only outstanding condition still to address is the mild IBD and whether I should change her prednisolone from 2.5 mg m w f to every day dosing.  I’m told by her local vet that this will help with a lot of things including appetite and weight gain.  Is it safe though?  I was always under the impression that pred was something to avoid unless you really can’t.  


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on May 01, 2019, 12:06:30 PM
Please be sure to post after Mabel’s dental, we’ll be thinking of her tomorrow!  I don’t know what to tell you about the pred.  Can you wait until she is seen by the internal med doc in two weeks?  They might offer a different opinion.


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on May 01, 2019, 08:43:57 PM
I will be keeping Mabel in my thoughts and prayers tomorrow with wishes of a uncomplicated dental procedure. I'm glad it is being done by the veterinary dentist.  Resorptive lesions are best handled by the experts.  

I am going to be concerned about the hyper-t issue with that T4 being so borderline.  I hope that the vets there are very careful about their evaluation of that condition.  Do you know whether they have the ability to do the thyroid scintigraphy scan?  That would be the most definite way to confirm the hyper-t diagnosis.  There is another test called the T3 Suppression Test that can also be used for that purpose, but it isn't used very often these days and there can be some question of good compliance with the protocol used and that could make the results questionable.  I cannot stress enough how important it is to be absolutely sure that a cat is hyper-t before doing the I131 treatment.  If there is no hyper-t, the cat's thyroid will be totally destroyed by the radiation if the I131 is done.  When a cat is hyper-t, the normal tissue of the thyroid is in a state of dormancy and it is the abnormal cells of the adenoma that are producing the abnormal amounts of thyroid hormone.  Therefore, since the I131 radioisotope is taken up by only the abnormal cells, the normal cells are spared and will recover once the abnormal cells die off.  If the cat is not hyper-t, the normal cells of the thyroid will be able to take up the radiation because they are "awake" and they will all die.  This is will make the cat permanently hypo-t.  

If it is determined that Mabel is definitely hyper-t, the other concern would be that this facility carefully tailors the dose of I131 to the cat's specific needs.  A T4 of just 3.7 would require a very low dose of I131.  Otherwise, a dose too high would result in hypo-t as well, although it would not totally kill all of the thyroid cells.  It would just result in the thyroid not being able to function normally, so a thyroid hormone supplement would be needed to bring the T4 up to a normal range.  So, it is important that you discuss with them how they calculate the dose of I131.  Some facilities still use a one-size fits all dose protocol, which is crazy, but for some reason they have not kept up with the latest research on dosing of I131.  Hopefully a university based facility would not be doing that.  

I do not want to frighten you with this information.  I just want you to be aware.  We give this same guidance on the Yahoo Hyper-t Group so that the members there have the proper information to have a safe and effective treatment and know the right questions to ask when discussing the treatment with the facility.  Sometimes they find that they have to find another facility or risk a bad outcome.  You can ask the vets at the university if they are familiar with the research of Dr. Mark E. Peterson, a veterinary endocrinologist who is considered a foremost expert on feline hyper-t and has done research for many years. He was also the one who first recognized and described the disease.  He has recently researched protocols for dosing for I131 treatment, and confirmed the use of a low dose protocol was safest for all cats.  He is the one who wrote the article I gave you the link for about whether an elevated T4 and/or Free T4 are always diagnostic for hyper-t.  If Mabel's T4 is still not above the reference range when she is retested, you might want to discuss with the university vets the suggestions given in that article about waiting the retesting if the diagnosis is not clear.

I hope you know that I am not trying to take the place of the vet. I just want you to have a good foundation of information to make an informed decision about Mabel's treatment.  My concern is the borderline nature of the diagnosis.  If you had said he T4 was "7" or "10" or anything well above the reference range, there would be no question about the diagnosis.  But 3.7 is in what they call the "gray zone", so caution is warranted.  It may or may not indicate early hyper-t.  I will be looking forward to hearing about what the vets at the university have to say about the hyper-t diagnosis.


Title: Re: New Hyperthyroid diagnosis
Post by: alek0 on May 01, 2019, 08:51:29 PM
Good luck with Mabel's dental, hope everything goes smoothly. Mitzie's dental is also tomorrow.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 02, 2019, 04:11:58 AM
Thank you all for your continued thoughts, prayers, help and support with Mabel’s health issues.

Fizzy1, I will definitely consult with the university internal medicine department about the IBD issue also.  That’s a whole other problem but I think it will be manageable.  She seemed to improve a lot on just the diet change, fortiflora, and cobalequin so far.  So I’m hopeful.

Mandycat, thank you again for all of the good hyper t information. Yesterday during the dental exam I asked the medical team if they could possibly do a scintigraphy while she was there today. They said it would extend the anesthesia time too much with all the dental work they had to do, so it will have to be separate, but it definitely can be done and will provide very useful information for tailoring the dosage.  They are fast tracking and streamlining Mabel’s care in other ways however, for example, we got the internal medicine consult right on the spot yesterday, and another one will be scheduled to align with her dental recheck in two weeks.  They are also addressing whatever is going on with the bladder/urine.

Alek0, thank you. hope that Mitzie will be feeling a lot better soon after that tooth is taken out today.



Title: Re: New Hyperthyroid diagnosis
Post by: catmom5 on May 02, 2019, 01:57:19 PM
Happy that you have good vets who are helping sweet Mabel. I always felt more comfortable having a university teaching hospital here for my girls and boys. Hoping for answers and a plan that will work for you.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 02, 2019, 02:39:45 PM
Mabel is home from the hospital now and is doing well.  

Her report says: “Mabel had resorptive lesions on her upper left carnassial tooth 208, upper left second incisor 202, and lower right canine 404.  Her upper left first incisor 201 had no visible crown but had a visible root remnant.  In addition her upper right molar 209 had mobility, calculus and gingivitis.  Tooth numbers 208, 209, 202, and the root of 201 were extracted.  Her lower right canine 404 had extensive bony resorption of the root which could not be extracted.  Instead the tooth’s crown was amputated, and the remaining tooth material was ground down.  The gingiva surrounding each tooth was sutured closed using absorbable suture material.”

This sounds like it was causing her a lot if pain, and it’s no wonder that she was dropping food and eating less. I had no idea of the extent of things, and feel really bad about it.   I’m so glad that we did the dental procedure today.

The staff at the university hospital were absolutely wonderful and cared for Mabel as if she were their own.  They called me with updates several times last evening and throughout the day today and really took excellent care of Mabel.


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on May 02, 2019, 03:23:58 PM
 I am glad Mabel is home and doing well.  I hope she has an uncomplicated recovery from that dental surgery.  Her mouth is going to be sore for a few days, but hopefully she will not have any more pain from bad teeth in the immediate future.  Sounds like the university hospital  has a very good and caring staff.

I am happy to hear that the university does have the ability to do the thyroid scintigraphy scan.  Yes, it will be helpful in determining the dose of I131, but, more importantly, it will confirm or rule out the actual diagnosis of hyper-t since they will be able to visualize the thyroid adenoma on the scan if she is hyper-t.  It is the most definitive way of to confirm the diagnosis of early hyper-t.  If confirmed, it will still be important to carefully calculate the dose of I131 so as not to overdose and cause hypo-t.  An appropriately low dose is very important in these early cases. 


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on May 02, 2019, 04:48:06 PM
Aww, poor Mable!  That does sound painful so I'm really glad all those bad teeth are out.  Good thoughts for you, too, Rich!  Dentals are so stressful for the parents, too!   :-*


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 02, 2019, 05:38:31 PM
Yes it certainly was pretty stressful for this parent  :)  Speaking of stress, they gave me gabapentin to give to her the night before and morning of the follow up visit with dental and internal medicine.  That should help with her stress.  :)  I’m very curious to see how it works.  


Title: Re: New Hyperthyroid diagnosis
Post by: alek0 on May 02, 2019, 09:13:37 PM
Wishing Mabel a quick recovery.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 03, 2019, 01:59:11 AM
Thank you. 


Title: Re: New Hyperthyroid diagnosis
Post by: lesliek on May 05, 2019, 06:51:42 PM
Glad Mabel is home and recovering!


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on May 05, 2019, 09:02:44 PM
Glad Mabel is doing well after having so many teeth removed. I bet she feels much better now. How is she doing?


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 06, 2019, 04:39:43 AM
Mabel is doing okay but at this time can only tolerate small frequent feedings- about a tablespoon at a time every couple of hours.  Sometimes if I present the food during a nap she will eat more. At other times she nibbles and walks away and I have to crawl around on the carpet behind her and just keep putting the dish back down in front of her.  Making slurries was somewhat helpful early on but is not necessary now.  I don’t think all of this a problem necessarily, but just where she is at in the healing process.  She is at risk for further weight loss so I am trying my best to make sure that I somehow get a whole can of wet food plus white meat chicken snacks into her each day.  In other regards she seems okay and is back to laying in all of her favorite spots, playing, interacting with me, etc. 


Title: Re: New Hyperthyroid diagnosis
Post by: lesliek on May 06, 2019, 05:44:55 AM
Try pureeing thewet food with a jar of baby foodmeat. It makes it a fluffy whipped consistency that they liketo lick .


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 06, 2019, 07:01:06 AM
Hi lesliek thanks for the suggestion. I just tried using one of those small Hamilton beach personal size blenders with the one button and it didn’t do a great job.  Everything stuck to the container.  The vitamix is too big.  What kind of machine are you using?  Perhaps I can get amazon same day delivery of something best suited for this purpose.  The hand held blenders look like they might work.  No glass jar to stick to.


Title: Re: New Hyperthyroid diagnosis
Post by: alek0 on May 06, 2019, 05:51:07 PM
One weird thing for my cats has always been that they are willing to eat straight from the can, but not if you put exact same food on a dish. Maybe you can try that approach, just make sure edges are not too sharp. Normally I open the can, test the edges, fluff it up with a fork and offer to her, she ends up eating quite a bit more than from a bowl or plate.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 07, 2019, 02:56:50 AM
Last night she ate all of the white meat chicken and almost all of the canned I left out overnight.  I awoke this morning to an empty bowl and a mostly cleaned plate.  This a big improvement. 


Title: Re: New Hyperthyroid diagnosis
Post by: lesliek on May 07, 2019, 05:30:48 PM
I use my cuisinart stick blender in a tall measuring cup . Works great & the bottom comes off & goes in the toprack of the dw !


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on May 07, 2019, 06:06:34 PM
Good news she ate all her food!


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 08, 2019, 02:23:48 PM
Unfortunately her mouth still seems painful.  I couldn’t discontinue the buprenex after 3 days and asked if I can keep it going.  Is that typical when they have so many teeth pulled at once?  Recheck is next Wednesday.   Trying not to worry.  


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on May 08, 2019, 03:08:33 PM
I think it was about a week before Smoggy's mouth started feeling better. He only had one tooth removed and one fang amputated and ground down. I do remember he was not feeling good when I finished the buprenex. He probably could have used another couple days of it.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 08, 2019, 04:09:12 PM
Sorry to hear that Smoggy went through this too.  I’m going to continue the buprenex right up to the recheck next Wednesday then as long as they will keep refilling it.


Title: Re: New Hyperthyroid diagnosis
Post by: alek0 on May 08, 2019, 05:36:50 PM
I guess each cat recovers at his/her own pace.As long as she is eating and there is no infection, it will all be OK.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 11, 2019, 05:50:16 PM
Tried to stop Mabel’s buprenex but by 20 hours after her last dose she was pawing at her mouth a lot and aggressively grooming.  I gave in and gave her another .1 ml just now.  I looked in her mouth and don’t see any signs of infection.  Otherwise she’s doing well.

Just a little stressed out because on thursday I was bit by my neighbors cat while trying to save her life.  I got a knock at my door asking me to come up and look at their cat.  When I arrived at their apartment her tongue was blue, she was panting, she had pooped everywhere, and her back legs seemed paralyzed.  She was clearly having a heart attack and I was trying to help them get her in a carrier to take her to the the Penn Vet emergency which is not far (they did not even know where it was located so I carried the carrier and rode in the car directing them).  Unfortunately we did not get her there in time.  It was a horrifying experience.  I am so sorry for my neighbor’s loss and am so sad about what happened. My eyes get teary every time I relive the memories.   Somehow I got bit during all of this.  I cleaned it well with chlorhexadine surgical scrub, alcohol, peroxide, etc.  and saw my doctor within 4 hours.  The bite area turned red, and spread the size of a quarter, and I am currently taking augmentin from my doctor.  The wounds look fine now and there’s no red or swelling but my hand feels weird and a couple fingers and my wrist and top of my hand are achy far away from the wounds.  If I rest the hand the achyness subsides.  I start to panic when I think about going to the ER because I live alone and there is no one that can administer Mabel’s medicines and coax her to eat all her food the way I can.  I thought of maybe checking her into the local vet hospital on Monday and let them manage her while I go off to the people hospital, but she’s in a pretty fragile state, and I’m worried what will happen to her if I do that.  It might do more harm than good,  Her recheck and internal medicine appointment is Wednesday at 1:30 and I’m worried if I myself would be still stuck in the hospital and she’ll miss her appointment.  I’m just going to go to sleep tonight and hope and pray that my hand and wrist is better when I wake up tomorrow.  That would be the ideal outcome.  The vet is closed tomorrow so i really need to stay out if the hospital.  Please pray for help and healing so that my hand is normal in the morning if it’s our heavenly father’s will.  I need to be here for Mabel.  Thank you.  


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on May 11, 2019, 06:24:40 PM
I'm so sorry you had to go through that with your neighbor's cat. It sounds like she threw a clot. It's good that you saw your doctor about the bite and since there's no redness or swelling, it appears the antibiotic is working. It's not unusual for your whole hand to be sore for a while but if anything changes (redness, swelling or it feels hot, or you get a fever) you should call you doctor and ask what to do or go to the ER. Don't mess around with infections especially nowadays. Is there an emergency vet you can take Mabel to if you need to go to the ER tomorrow? How long can she safely be on her own at home?

I understand your dilemma. I was very sick when taking care of Thunder. She could not be left alone more than 1/2 hour. Not enough time to go to the doctor.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 11, 2019, 06:37:04 PM
There is no new redness, what was there faded mostly, but it sure stings right at the punctures.  I can stretch being away from home to about 8 hours maybe before one dose of buprenex and a coaxed feeding of wet food would be needed. She also gets prednisolone on m w f, cobalequin daily, and fortiflora mixed in the meals.  She has to be coaxed to eat so if I just put food down and leave it will be ignored.  There are two emergency hospitals in the city I could leave her at or I could try to call her local vets office after hours number and make some kind of drop off arrangement with the on call technician handling the boarded cats there. I’m just kind of watching waiting and hoping I dont have to do any of this.


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on May 11, 2019, 06:47:20 PM
Ok you have options that's good! If you need to go to the ER you probably won't be there for more than 8 hours. If worse came to worse and the hospital wanted you to stay longer, you can always leave, get Mabel taken care of, and then come back. I think you will be fine though as the bite symptoms aren't getting worse.


Title: Re: New Hyperthyroid diagnosis
Post by: GKit on May 11, 2019, 07:24:19 PM
Sending positive and healing vibes.  What a traumatic experience! I hope your hand heals up quickly; good thing you got to the people doctor quickly. If you get very worried about Mabel’s eating and having to manage that don’t forget that using that Zyrtec as appetite stimulant Fizzy mentioned upthread might give her appetite a boost so things are a little easier.


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on May 11, 2019, 08:57:02 PM
It’s good that your antibiotics were started quickly.  I’m so sorry for you and your neighbors. :'(

Hang in there, and keep us posted.  Healing thoughts for you and Mabel.   :-*



Title: Re: New Hyperthyroid diagnosis
Post by: lesliek on May 12, 2019, 05:43:31 AM
If you are close to Penn vet , you are near me also . Can't do much yet but will be happy to help if I can.


Title: Re: New Hyperthyroid diagnosis
Post by: catmom5 on May 12, 2019, 07:27:50 AM
So sorry you had such a traumatic experience. No doubt the kitty had a saddle thrombus, and there is little anyone could have done. (Experienced this with my 7 year old, Dexter Louise, and it's frightening to experience) Thank you for helping your neighbor.

I agree with others who tell you to watch your hand very closely. You did the right thing to get yourself to a doctor right away. Hopefully you caught it in time.



Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 12, 2019, 10:23:15 AM
I’m sorry to hear you went through this too.  It is such an awful thing and I imagine it must be quite painful for them.  It’s very sad.

My hand and fingers are improved somewhat today.  Areas that hurt a lot yesterday hurt less today,  but now I have brand new pain in my wrist and along the forearm bone.  What’s weird is there’s no red streak and no swelling whatsoever. No fever, no nothing.  Just achy pain in the structures under the skin but not the skin itself.  My dad came over today and I tried to show him how to feed and coax Mabel to eat.  The buprenex administration was a non starter.  He’s almost 80 and can’t see well enough, nor does he have the dexterity to do the draw, but I’m grateful that he stopped by.  We had a nice lunch together.  Going forward I might stick it out another night at home and possibly take Mabel to the local vet tomorrow for care so I can go to the ER.  I also thought about trying the certizine so she will eat better and can remain at home, but am hesitant to introduce something new while I’m not there.  Also thinking about feeding her and going to ER tonight and hoping that they let me out within 8 hours.  So I’m not sure what I’m doing yet.  Still watching and waiting and trying to assess if it’s getting better or getting worse.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 12, 2019, 11:41:41 AM
Update: I just fed her and left a bowl of white meat chicken down on the floor.  Going to the ER now. Hopefully will be out soon.


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on May 12, 2019, 01:00:05 PM
Hope everything turns out ok.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 12, 2019, 01:30:52 PM
I was just seen by two docs and am pleased to report there’s no sign of spreading infection.  They think all the areas that hurt now are from twisting my hand and arm to look at the wound a hundred times a day and I’ve irritated a lot of things.  It seems to be healing well- no palpable lymph node, redness, streaking, edema, etc.  they just took an X-ray gave me a tetanus shot and I should be going home soon with a splint to keep the arm and hand still.  They also think I have carpal tunnel from the computer but that’s a whole other problem I didn’t even know about.  Glad to be going home soon to Mabel.  Thanks everyone for all your support. 


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on May 12, 2019, 02:09:56 PM
That’s such a relief!  You still need to keep an eye on it, okay?  Did they give the tetanus in the same arm?  The last time I had a tetanus shot, my arm was so sore for 10 days!  I couldn’t even use it.  I sure hope you don’t react the same way, but just know that it’s possible.  Ugh. 

Very happy you get to go home! 


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 12, 2019, 03:26:51 PM
Thank you. :).  They put it in the same arm unfortunately.  Guess I can take Tylenol if it becomes painful.  What a relief though.  I’ve been on edge since Thursday knowing how bad those bites can get, and worrying about Mabel’s care.  Now I can relax.  When I got home she was up in a dining room chair and all the chicken I left in the bowl was gone.  Kind of suggests that maybe she only has an appetite problem with RC gastrointestinal canned !  :).  If only it were that simple.


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on May 12, 2019, 04:53:57 PM
Thank you. :).  They put it in the same arm unfortunately.  Guess I can take Tylenol if it becomes painful.  What a relief though.  I’ve been on edge since Thursday knowing how bad those bites can get, and worrying about Mabel’s care.  Now I can relax.  When I got home she was up in a dining room chair and all the chicken I left in the bowl was gone.  Kind of suggests that maybe she only has an appetite problem with RC gastrointestinal canned !  :).  If only it were that simple.

I was hoping that it was the same arm, at least you’ll have one functioning arm. :P   But it might confuse the issue regarding where the pain is coming from, lol. 

It’s good news that Mabel ate while you were gone.  Go, Mabel. :)

Please keep us posted.


Title: Re: New Hyperthyroid diagnosis
Post by: GKit on May 13, 2019, 03:12:59 PM
Glad everything went well at the ER. And good girl Mabel for eating the chicken!

Best wishes for continued uneventful healing.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 14, 2019, 02:04:43 PM
Tomorrow is Mabel’s dental recheck and internal medicine consult at Penn Vet.  She’s been off buprenex for a couple days now and seems to be doing okay and back to being feisty.  :). I also picked up mirataz from her local vet but haven’t tried it yet.  Not sure what they’ll do tomorrow and didn’t want to introduce a change the day before.  One thing I’m curious about is if I start using it will Mabel get dependent on it and won’t eat at all if / when it is discontinued?  I don’t think I would be comfortable with that.


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on May 15, 2019, 09:42:09 AM
I'm glad she's feeling better and off the buprenex. Hope the recheck goes well!


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 15, 2019, 03:38:52 PM
Good news.  Mabel had a great check up today.  Her mouth healed very well.  I’m waiting on lab results from internal medicine now.  When we got home she ate half a can of food!  :)  I was really pleased to see her eat that much after fasting.  If I only feed her every 8 hours that may solve the whole appetite problem.

Keeping an eye on my hand still.  I seem to have some tendon pain on top of the hand and through my wrist. It comes and goes though.  If I rest the hand completely it gets better but it’s very hard to rest it.  Don’t know if all the pain is from me irritating it or if a tendon sheath got nicked and bacteria traveled.  Still no redness or swelling but lots of “deep” discomfort.  Might have to go back to er if it don’t improve.  :(


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on May 15, 2019, 04:25:42 PM
Yay Mabel :).   Were you able to talk about any of your questions about increasing the prednisolone?  Maybe they want to see how she does after the dental.

I have no advice about your bite, I know you’ll keep on top of it.  Wish I had more to offer!  Hang in there, we’re here for you.   :)


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 15, 2019, 05:39:27 PM
Thank you.   :)  They are not really recommending any changes to anything just yet pending the lab results. I should know sometime tomorrow what the treatment plan will be.  They also got the cytocentesis to follow up on the blood/crystals also.


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on May 16, 2019, 01:17:30 PM
Great news! Mabel’s T4 was 3.3  I just need to monitor and periodically recheck her at this point.  Her urinalysis also looked good.  Will know the cobalamin level in about a week.  I’m so glad that I never started Methimazole weeks ago thanks to everyone here urging me to be cautious and confirm the diagnosis.  I131 would have been a disaster but they would have probably confirmed.  So now it’s a matter of just getting her to eat more RC canned. She’s back to nibbling today instead gulping half a can like yesterday


Title: Re: New Hyperthyroid diagnosis
Post by: NedF on May 16, 2019, 02:45:06 PM
Great news! I'm so happy she's doing better now!


Title: Re: New Hyperthyroid diagnosis
Post by: Mandycat on May 16, 2019, 04:09:21 PM
Thank goodness you heeded the suggestions to be cautious and not start treatment with the methimazole.  Mabel may or may not eventually become hyper-t, but that doesn't appear to be the case at this time.  Just monitor her, and if the T4 increases significantly in the future, you know that Penn can do the thyroid scintigraphy scan to confirm a diagnosis so there is no doubt.  I am so happy that she seems to be doing much better now!   :)


Title: Re: New Hyperthyroid diagnosis
Post by: Fizzy1 on June 07, 2019, 06:29:36 AM
How is your bite wound?  Hopefully you’re all healed up by now.  How is Mabel doing?


Title: Re: New Hyperthyroid diagnosis
Post by: rbauer on June 08, 2019, 11:43:49 AM
Mabel has been doing well on hills i/d stew wet food, cobalequin, pepcid, and prednisolone every other day.  She’s eating good but has lost some weight on wet food only.  No litter box problems.  Thank goodness I listened to everyone here and did not try to treat her thyroid.

My hand is still not right after three courses of antibiotics. While I don’t have a fever, and it looks good on the outside,  it still hurts on the inside.  Getting an mri next week.  I’m also supposed to go to physical therapy.


Title: Re: New Hyperthyroid diagnosis
Post by: lesliek on June 14, 2019, 05:23:16 AM
It took almost a year for all the inflammation to settle down with my bite. My mri later showed the ligament to my thumb had torn .