Need Advise Please! My Tinker has Feline Hyperthyroidism

[Bonkers]

  I took Tinker to the vet yesterday since she had been ill and not eating. Everything checked out ok but the vet took blood and sent it off to the lab to run some tests. He called today and stated that her thyroid level was 7.4 where as it should be around 4.7 according to this lab. We talked for quite a while and opted to start her on Trapezole (sp?). I have not picked up her meds as yet and would love for anyone who is famililar with this condition to provide me with any info they would be willing to share.

It would be most appreciated.      Coz I am freaking out!!!!!  

[coontuffy]

Awww Bonkers.......no reason to freak out.

Tapazole has been around forever and it is easy to administer.

I had a kitty with hyperthyroidism long before surgery or radioactive I131 were available.

Allow me a suggestion, if I may.
Before starting the Tapazole, please ask your vet to rerun the thyroid test and to do a thyroid profile.  I say this because you mentioned that Tinker was not feeling well, necessitating the trip to the vet.  Hyperthyroid kitties drink huge amounts of water, their behavior is very hyper, jumpy edgy, and they eat like horses without gaining weight.

http://www.naturalhealthtechniques.com/BasicsofHealth/lab_result_meaning1.htm#Thyroid_Antibody_test

Thyroid Tests:To evaluate the thyroid your doctor will take blood to run a Thyroid Function Blood Panel, which will include many of the tests below depending on the doctor's education and the tests available at the laboratory. It is important to understand each test because there is a lot of confusion among doctors, nurses, lab technicians, and patients as to which test is which. In particular, the "Total T3", "Free T3" and "T3 Uptake tests" are very confusing, and are not the same test.

You will want to have several thyroid factors evaluated from the following:

TSH (Thyroid Stimulating Hormone, sTSH): The TSH test determines if your brain is producing the instructions for the body to respond by producing T4. Thyroid Stimulating Hormone is secreted by the pituitary gland and regulates the thyroid gland.

Too High: Rule out hypothyroidism.

Too Low: Rule out hyperthyroidism.

Total T4 measures the Free T4 and T4 bound to carrier proteins circulating within the blood.

Free T4 (Thyroxine, FT4) test is the basic thyroid molecule that circulates around the body before being activated to T3. The Free T4 directly measures the free T4 in the blood. It is a more reliable, but a little more expensive than Total T4. Some labs now do the Free T4 routinely rather than the Total T4.

Too High: Rule out hyperthyroidism, however technical artifact occurs when estrogen levels are higher from pregnancy, birth control pills or estrogen replacement therapy.

Free Thyroxine Index (Free T4 Index, FTI or T7) : A mathematical computation allows the lab to estimate the free thyroxine index from the T4 and T3 Uptake tests. The results tell us how much thyroid hormone is free in the blood stream to work on the body. Unlike the T4 alone, it is not affected by estrogen levels.

Total T3: This is usually not ordered as a screening test, but rather when thyroid disease is being evaluated. T3 is the more potent, active, and shorter lived version of thyroid hormone. Some people with high thyroid levels secrete more T3 than T4. In these hyperthyroid cases the T4 can be normal, the T3 high, and the TSH low. The Total T3 reports the total amount of T3 in the bloodstream, including T3 bound to carrier proteins plus freely circulating T3.

Free T3 (Triiodothyronine) test determines if the T4 is being converted to its active form by the liver. This test measures the free-floating T3 in the body.

T3 Resin Uptake or Thyroid Uptake. This test confuses doctors, nurses, and patients. First, this is not a thyroid test, but a test on the proteins that carry thyroid around in your blood stream. Not only that, a high test number may indicate a low level of the protein! The method of reporting varies from lab to lab.
The Resin T3 Uptake is used to assess the binding capacity of the serum for thyroid hormone. The T3 Resin test is only useful in conjunction with Total T4 or Total T3. If a patient has a high total T4, it may be due to overproduction of thyroid hormone (hyperthyroidism) or to an excess of one of the thyroid binding proteins, usually Thyroid Binding Globulin (TBG). If the high Total T4 is secondary to high TBG, the Resin T3 will be low; otherwise it will be normal or elevated. So, if the Total T4 or Total T3 deviates from normal in one direction and the Resin T3 Uptake deviates in the opposite direction, then the abnormality is due to changes in binding capacity. If not, then it can be attributed to a true change in thyroid function (i.e. hyperthyroidism or hypothyroidism). Estrogens increase the binding capacity and decrease both the free labeled hormone and the Resin T3 uptake.

[Bonkers]

  Thank you SO MUCH coontuffy for responding but all your great info is a little overwhelming to me at the present time as I am still in shock at her diagnosis.

 I know the vet said a T4 was performed but exactly which one I am not sure. Tinker has been an avid water drinker for quite awhile now and I always assumed it was due to her advancing years along with the possibility of CRF. She is about 14 or 15 years old.

Tinker has been very slowly losing weight but more recently her appetite has not been that great. Her heart rate is fine. Dr Jodi told me in rare instances a decreased appetite can be a symptom of hyperthyroidism. So what do I do now? Do I need to find out exactly which T4 was performed? I believe he said she would be taking 5mg per day of the drug, but after doing a real quick search, I saw that some recommend starting out at around 1 or 2 mg per day.

She has always been a puker and I am also concerned about how her tummy will tolerate the meds. 

[coontuffy]

I need a bit more time because I need to check my Plumb Veterinary Drug Handbook for a good starting dosage on the Tapazole.  My thinking and most vets are with me on this one, is to start at the lowest possible dose.

I need to know how much Tinker weighs please.

Bonkers, don't be in a huge rush to get started.  A week or so will not hurt her at this point.

Understand too, there will be a need for you to take Tinker on a very regular basis for repeat blood testing.  It takes awhile for the Tapazole to get going and repeated blood testing will let the vet know if the dosage is the proper one.  Just like humans, and Tapazole is a human medication, this stuff needs tweeking.

I'll be back a bit later.
I need to feed a starving husband with a nasty temper, cause he's so hungry.
I've got a bunch of cats gnawing on my ankles.........

ETA:  How old is Tinker please?

[Bonkers]

   Ok, I will try to chill out.    Tinker is about 14 or 15 years old and weighs 7.3 pounds. Upon looking at my receipt from the vet it shows she had: 
Chemistry Profile/CBC/T4 (V/D).

 I sort of know about the importance of regular tests to check the thyroid level as I myself am hypothyroid.

 I can't express enough my gratitude to you in helping me understand all this. 

[sherrylynne]

Bonkers, I am so sorry to hear about Tinker! From what I've been reading lately, with medication hyper-T is definitely controllable.

[Sharon L.]

I had a cat that went on Tapazole for hyperthyroidism when she was 14 ... and she lived to the grand ole age of 23. It was also more convenient  (and cheaper) to get the medication from the local pharmacy instead of from the vet.

/Sharon

[lesliek]

Bonkers-A friend just started her 10 yr old cat Russell on it & he is doing well.  They did do repeat Free T4 & T3 before starting it & the vet has her bringing him in for bloodwork every 2 weeks until they settle on a long term dosage. She has 3 cats & they all are used to sleeping & eating together,so she opted for the meds instead of I131.Russ is very easy to pill & has had no bad side effects so far. He has started to gain weight again & seems much more like his old cat self.

[Bonkers]

  Thank you all for your reasurrances and support. I was shocked that it would be my Tinker who would have a medical issue as she has never been ill a day in her life. I should be, and I am, very grateful that it was not something more serious.

Sharon, The meds were ordered thru my pharmacy and I am hoping there is a generic version of them.

Leslie, What is the importance of rechecking the T4 & T3 before starting the meds?

[Bonkers]

  I picked up Tinker's meds on Saturday afternoon and gave her her first pill. I made sure she had eaten before giving it to her. She now has not eaten but just a few licks of food since.    

  I am thinking that maybe the 5 mg dosage is too high for her. I will see how she does this morning and if she is still not eating I will skip a dose or two and start her back on either 1/2 or 1/4 of a pill. I have read that loss of appetite can be a side effect of the trapazole. Has anyone experienced this happening to their cat? And if so, how was it handled?

[coontuffy]

I am sorry Bonkers.
I do have some more info for you.

From the Plumb Veterinary Drug Handbook Fifth Edition

Methimazole..........Tapazole  (no "R" in it Bonkers )

Adverse Effects:  Most occur within the first 3 months of treatment:  vomiting, anorexia, and depression most frequent.

Initial starting dose for Cats

2.5 mg (total dose) PO (by mouth) once a day for 2 weeks.  If no adverse effects are noted by both the owner and in blood work, then the dose can be increased to 2.5 mg PO twice daily and blood tests run again after 2 weeks.


Bonkers, I think you are correct that the dose is too high.  Tinker is also a very small kitty at 7.3 pounds.  I would report the inappetance or anorexia to your vet.  I also would be careful about playing around with the dosages and You may need to get a pill that is actually 2.5 mgs versus splitting the 5 mg in 1/2.

With my Acorn, we kept her on a very low dose for forever.  A new vet in the practice insisted on raising her dose because Acorn's T4 was a tenth over the high normal.  Acorn weighed 8 pounds, she was very small and petite like Tinker.  I questioned the increase and the snarky vet asked me "which vet school I graduated from."  The elevated dosage, and fool that I was, I went against my gut and gave the higher dose.  Acorn did horribly and the head vet in that practice fired snarky vet.  Acorn died a short time later.

[5CatMom]

Bonkers,

So sorry to hear that your Tinker is ill.  Hope you will get her medication adjusted and see improvement very soon.

Hugs.

[kaffe]

I only got to read this thread today, Bonkers.  I know how scary a diagnosis of hyperthyroidism is.  But wait... did you have the Thyroid panel done?  At least the one with both T4 and T3?  Most good vets don't put kitty on Tapazole treatment until a definite diagnosis has been reached and that can't be done with the regular T4 alone. 

Is the lab Idexx?  Must be with those numbers.  I am more familiar wit Antech values...

Also, 5mg a day of Tapazole is too high - join te Feline hyperthyroidism group right away and you'll see/learn lots of very helpul stuff.  I really would question the vet about startng tapazole treatment on just a ONE T4 reading and tarting at 5mg per day.  Tapazole is a powerful drug and a small percentage of cats cannot tolerate it. 

If diagnosis is firm, check to see if your kitty can be a cadidate for I131 trreatment becuase that cures the condition; whereas, Tapazole has to be taken for life.  Some cats are hard to pill and some cats cannot tolerate methimazole (sp) at all.   If I131 treament is an option for you, ususally the vet will put kitty on Tapazole for at least 2 wks and then check kidney function (hyperthyroidism masks underlaying renal disease).  If numbers are ood, then you may rejoice because kitty will then be a good candidate for I131 treatment.  Radio-iodine facilities are everywhere these days and pricing varies... the length of time the cat needs to sta in the clinic also varies depending on which state you live in.  When I was in Oregon, it was 3 days. 

If you recall, back in early 2008, one f Kaffe's annual blood tests returned with a high T4 reading.  The vet told me that in such cases, they recommend a retest at the very least or a full thyroid panel done.  If hyperthyroidism truly is present, then cat is prescribed Tapazole.  When I heard that, I immediately researched and joined the hyper-T group.  After reading all I could, I reformulated Kaffe's diet and asked the vet to give me one month before retest.  All I did was add raw broccoli and raw cabbage into his raw food and give supplementary L-carnitine 250mg per day spread over several meals.  After one month, a second full panel blood test was done and T4 was normal! 

Sometimes, for unknown reasons, T4 can spike and then fall to normal levels again.  That's why a retest or a thyroid panel is a must.

If you cat is not exhibiting hyperthyroid symptoms (drinking and eating a lot, loosing weight, super-active, vocal, greasy, unkept coat), dont be afraid to question one vet's diagnosis based on one blodd test result.  Mind you, at that time, Kaffe was drinking more and was very very active and vocal - but I was not convinced with that what he had was hyper-T.

[Bonkers]

I only got to read this thread today, Bonkers.  I know how scary a diagnosis of hyperthyroidism is.  But wait... did you have the Thyroid panel done?  At least the one with both T4 and T3?  Most good vets don't put kitty on Tapazole treatment until a definite diagnosis has been reached and that can't be done with the regular T4 alone.  

Is the lab Idexx?  Must be with those numbers.  I am more familiar wit Antech values...

Also, 5mg a day of Tapazole is too high - join te Feline hyperthyroidism group right away and you'll see/learn lots of very helpul stuff.  I really would question the vet about startng tapazole treatment on just a ONE T4 reading and tarting at 5mg per day.  Tapazole is a powerful drug and a small percentage of cats cannot tolerate it.  

If diagnosis is firm, check to see if your kitty can be a cadidate for I131 trreatment becuase that cures the condition; whereas, Tapazole has to be taken for life.  Some cats are hard to pill and some cats cannot tolerate methimazole (sp) at all.   If I131 treament is an option for you, ususally the vet will put kitty on Tapazole for at least 2 wks and then check kidney function (hyperthyroidism masks underlaying renal disease).  If numbers are ood, then you may rejoice because kitty will then be a good candidate for I131 treatment.  Radio-iodine facilities are everywhere these days and pricing varies... the length of time the cat needs to sta in the clinic also varies depending on which state you live in.  When I was in Oregon, it was 3 days.  

If you recall, back in early 2008, one f Kaffe's annual blood tests returned with a high T4 reading.  The vet told me that in such cases, they recommend a retest at the very least or a full thyroid panel done.  If hyperthyroidism truly is present, then cat is prescribed Tapazole.  When I heard that, I immediately researched and joined the hyper-T group.  After reading all I could, I reformulated Kaffe's diet and asked the vet to give me one month before retest.  All I did was add raw broccoli and raw cabbage into his raw food and give supplementary L-carnitine 250mg per day spread over several meals.  After one month, a second full panel blood test was done and T4 was normal!  

Sometimes, for unknown reasons, T4 can spike and then fall to normal levels again.  That's why a retest or a thyroid panel is a must.

If you cat is not exhibiting hyperthyroid symptoms (drinking and eating a lot, loosing weight, super-active, vocal, greasy, unkept coat), dont be afraid to question one vet's diagnosis based on one blodd test result.  Mind you, at that time, Kaffe was drinking more and was very very active and vocal - but I was not convinced with that what he had was hyper-T.

 Sorry Kaffe, I missed this post. Yes, IDEXX was the lab that was used. and her level was 7.4. So all that was performed was the T4. I am unsure if her recent bout of illness could in anyway effect the read. Her vet is out of town untill next week and I am hesitant as to whether I even want to start her on the 2.5 mg dose untill I speak with him again.

     I do remember about Kaffe's coming back high last year. But I do not remember how high it was or what caused it. What was her number? How does L-carnitine, broccoli and cabbage help to lower it?

    There are only two places in my state that perform the 1131 and my vet told me it would cost around $2,000.00. If this is true, the 1131 is not an option we can afford.

     Tinker has lost a little weight but it has been gradual. She is still not eating well but seems to have somewhat improved since I put her on a B complex supplement called Pet Tinic. She has always been a grazer and has never eaten large amounts of food at one sitting. I have also given her a little Rescue Remedy in case she is stressed. I am assit feeding her with Wellness kitten food.

[Bonkers]

  I neglected to mention that I am also avoiding any pet food that contains kelp. Kelp can also contain high levels of iodine