When to euthanize a cat with hyperthyroidism?

do you have to euthanize a cat with kidney failure
When to euthanize a cat with hyperthyroidism? Dr. Bruyette welcomes veterinarians and veterinary technicians to raise endocrinology questions. Click here to submit your question, or send the subject line “Endocrinology Questions” to vm@advanstar.com. Are there any studies that may evaluate age and T4 or creatinine concentration to make statistical comparisons of the life span of treated and untreated cats with hyperthyroidism?
Thomas McCoy (DVM)

Harvard Avenue Veterinary Clinic

Tulsa, Oklahoma, this is a good question, but I don’t think there is a clear answer. According to reports, the survival time of cats with iodine 131 treatment, surgery or methimazole treatment of hyperthyroidism.
David S. Bruyette, DVM of DACVIM

Since the first reports on hyperthyroidism and its treatment were published in the late 1970s and early 1980s, almost all cats later diagnosed with hyperthyroidism have been treated. We all know the morbidity and mortality of this disease very well, so professionals and pet owners have adopted (and appropriately) policies for early diagnosis and treatment. We now also know that the diseases we diagnose and recognize today are usually discovered accidentally in routine laboratory tests or in cats with milder clinical symptoms. 5 In fact, in asymptomatic cats, we compare a “watchful and waiting method” with the homeowner, emphasizing the owner’s awareness of clinical signs and regular veterinary evaluation to monitor the progress of the disease. As long as the veterinarian and owner make a fully informed decision, both methods are acceptable.
Considering the safety and effectiveness of various treatment options, the recognized morbidity and mortality caused by untreated or improperly controlled hyperthyroidism, and the ease of diagnosis and monitoring, such research will be difficult to carry out. Ultimately, the decision to treat or not to treat hyperthyroid cats rests with veterinarians and pet owners, who have to make wise decisions by considering multiple variables (such as age, concurrent diseases and medications, severity of clinical signs, applicability or accessibility) Decided. One of various treatment options), and then decide which treatment option is in the best interests of the patient.
David S. Bruyette, DVM of DACVIM

West Los Angeles Animal Hospital VCA

1818 S.
Sepulveda Avenue. West Los Angeles, California 90025

Veterinary Diagnostic Investigation and Consultation

26205 Jinxiu Road

Malibu, CA90256. reference


What is the life expectancy of a cat with hyperthyroidism?

hyperthyroidism in cats prognosis
Caring for a sick senior cat and the lessons I learned from it

Kidney (kidney) disease affects one in every three cats. 94% of cats with hyperthyroidism are over 10 years old. One in five cats is diagnosed with cancer.
Unfortunately, for older cats, diseases and chronic diseases are very common. My experience with the old woman cat Lily is similar to many others. What should you expect? Although every cat’s story is different and no cat will follow the same scrapping path, I want to share my story and the lessons learned from it so that others can find problems early and understand what might happen. Warning: Some photos below may be difficult to see, and details that are difficult to read. Physical examination is the key to upper grades

My family rescued Lily when she was just 8 weeks old from the local shelter.
During those 13 years, she led a quiet, independent, indoor cat-keeping life.
Bring the cat to the vets! Like many cat owners, we were left behind in taking her to the vet, so we didn’t think about it too much because she always looked happy and healthy.
But one day, she suddenly looked a little soft and her eyes were not so bright, so it was time to see the vet. Her routine veterinarian’s advanced blood test team showed that she had early cat kidney disease and cat hyperthyroidism. None of these diseases can be cured, but they can usually be diagnosed together and controlled. We have developed a treatment plan to take two doses of transdermal methimazole per day to regulate thyroid levels, and formulate a special prescription diet to control the kidneys. The price of keeping up with it is expensive, but it is worth it for our girls. Lesson 1: Especially as they get older, even if you think they are healthy, take them to the vet every year.
Always pay close attention to changes in his/her appetite, water intake, weight and other behaviors. Cherish the time

Then everything was fine for about a year and a half. We gave her medicine every day, she ate a lot of food happily, and we took her for a blood test every few months, and her weight gained a lot as a result. She is even more social than anyone I have ever met. It’s like she is a brand new cat! For a while, we forgot that she had any chronic diseases, and we continued happily. Lesson 2: Enjoy them as much as you can.
Accept that the ending may be nearby and be prepared for it, but as long as you leave them while they are still there, you can enjoy it. Time is always short.
Hospitalization and emergencies

Then came soon. Lily’s veterinarian found her breathing irregularly during a routine visit. After an ultrasound examination, they found that there was fluid around her chest and heart, which needed to be checked by a specialist immediately.
The procedure went well and she went home later in the day. But later that night, her breathing deteriorated, and we rushed her to the nearest emergency room, Mass Vet, at 11:00 on Tuesday evening. Lily was hospitalized for three days due to renal failure treatment, lung cancer assessment, fluid clearance and oxygen support.
The choice of humane euthanasia is always on the table, but we persisted until she did. During her stay, she met six different veterinary specialists, including Dr. Sosa in cardiology, Dr. Davies in intensive care, Dr.
Tromblee in radiology, and Dr. Frye, Dr. McDermott and Dr. Walker in the emergency room. I received multiple update calls every day and visited her through an oxygen box. She has had a good time, and sometimes she is not sure whether she will succeed. Finally, on the morning of the third day, she was discharged from the hospital and went home. Lesson 3: Hospitalization of pets can harm your emotional health and wallet.
There are a lot of things to prepare when you raise an advanced pet, this is just a possibility.
Last days at home

Lily can’t walk around, so we set up a campsite for her in the kitchen, with beds, blankets, bowls and trash cans to make her feel comfortable.
Some days are good, some days are not good. After she ate, she didn’t eat it. Sometimes she put it on the sofa, and sometimes she put it in the trash can. At this point, she weighs only 5 pounds, and her whole healthy life weighs only 12 pounds. We know that she is no longer our Lily. Her character disappeared, and we can say that her body is still alive. We waited for her to pass away peacefully in her sleep, but that day never came.
Her body has been fighting, but she is no longer there.
Lesson #4: Hospice care is the most difficult part for them and you.
The best thing you can do for them is to be there.
Sit down with them, touch them, talk to them, because they are somewhere there. They need you now more than ever. The most difficult decision for pet owners

Therefore, we chose euthanasia.
Even though I have always supported and “appreciated” humane euthanasia, it is different when your child is born, and it is difficult for me to reach an agreement for her life. But now she is suffering, and it is on us. A week after her 15th birthday, she slipped peacefully into an examination room in my mother’s arms. In the arms of her favorite person.
This is a long journey, just like everyone said: “She lives a happy and long life.” I will always thank her and her and all the veterinarians who have extended her life. Their lives go far beyond nothing.
The veterinarian’s possibility.
To this day, I have been looking at her sunny place on the kitchen window, thinking of my beautiful lilies.
Lesson 5: You know your pet better than anyone. If you think it’s time to let go, it may be.

Do cats with hyperthyroidism suffer?

how long does a cat live with hyperthyroidism
Cats have two thyroid glands, located in the neck, which play a vital role in regulating the body’s metabolic rate.
Hyperthyroidism is characterized by overproduction of thyroid hormones and subsequent increase in metabolic rate.
This disease is common in older cats. Although hyperthyroidism enlarges the thyroid, it is usually benign or non-malignant. In cats, less than 2% of cases of hyperthyroidism involve malignant thyroid tumors. Hyperthyroidism can affect many organs, especially the heart. Are certain cats more likely to have hyperthyroidism? Older cats are at greater risk of hyperthyroidism. Although the specific mechanism is not yet clear, environmental risk factors have been investigated, which may cause some cats to suffer from hyperthyroidism.
Exposure to high levels of dietary iodine may cause susceptible cats to develop hyperthyroidism. What are the clinical symptoms of hyperthyroidism? The typical hyperthyroid cat is middle-aged or older.
The average age of an infected cat is about 12 years old. Only about 5% of cats with hyperthyroidism are younger than 10 years old. The most common clinical sign of hyperthyroidism is weight loss due to increased metabolic rate despite increased appetite. Sick cats are usually restless and may become cranky or aggressive. They may increase water consumption and urination. Cats with hyperthyroidism usually show higher vocalization, especially at night.
They may experience periodic vomiting or diarrhea, and their fur may appear disheveled. In some cats, anorexia develops as the disease progresses.
The two secondary complications of hyperthyroidism may be obvious.
High blood pressure (hypertension) and a special form of heart disease called thyrotoxic cardiomyopathy.
Approximately 25% of cats with hyperthyroidism will become hypertensive. In some cats, blood pressure may become so high that retinal hemorrhage or retinal detachment occurs, which can cause sudden blindness.
With proper treatment of the disease, cardiomyopathy and hypertension can be reversed. “Thyrotoxic cardiomyopathy may occur because the heart enlarges and thickens to meet the needs of metabolism. In some cases, cats will experience heart murmurs associated with cardiomyopathy. Treat the disease appropriately, including cardiomyopathy and hypertension. Reversible. However, unless the retinal detachment is treated immediately, permanent blindness may occur. What causes hyperthyroidism? The exact cause of hyperthyroidism has not been determined, although the role of dietary iodine is still being studied, as a susceptible cat Influencing factors. How is hyperthyroidism diagnosed?
The first step is to determine the blood level of a thyroid hormone called total thyroxine (TT4).
Usually, the level of TT4 is so high that it can be diagnosed without a doubt. Sometimes, cats suspected of hyperthyroidism have TT4 levels within the upper limit of the normal range. When this happens, a second test will be performed, usually a free T4 (FT4 by ED) or T3 inhibition test by balanced dialysis.
If these tests are of no diagnostic significance, a thyroid scan (thyroid scintigraphy) can be performed at a veterinary referral center, or TT4 can be measured again within a few weeks. How is hyperthyroidism treated? Since less than 2% of hyperthyroid cats have cancerous growths of the thyroid gland, treatment is usually very successful. Before choosing any form of treatment, there are some tests that may include other blood tests, urinalysis, chest X-rays, ECG and blood pressure measurements. An ultrasound of the heart (called an echocardiogram) may be recommended based on the cat’s condition, especially if you are concerned about cardiomyopathy.
Thyroid scintigraphy can also be recommended to confirm the diagnosis, and to determine the size of the organ before surgery or radioactive iodine examination. “There are several treatments; your veterinarian will determine the best option for your cat.” There are several treatments, and your veterinarian will determine the best option for your cat. When choosing the best treatment for a single cat, many factors must be considered. Treatment options for hyperthyroidism are:

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surgery. Surgery to remove the affected thyroid gland can be very effective. Since cats with hyperthyroidism are usually over eight years old, there is a certain degree of risk. However, if your cat is healthy and the initial diagnostic tests and treatment did not reveal any underlying disease, the risk is small. In many cats, only one thyroid lobe is abnormal, so only one operation is required. “Surgical removal of the affected thyroid gland may be very effective.” Some cats with hyperthyroidism have thyroid cells in abnormal areas called ectopic thyroid tissue (thyroid tissue is located under the tongue, under the neck or all the way to the bottom of the heart), and You may still be in a state of hyperthyroidism after surgery.
It is best to perform a nuclear scan before surgery to exclude ectopic thyroid tissue. If surgery is chosen as the treatment method, the antithyroid drug methimazole (trade name: Tapazole® or Felimazole®) can be prescribed several weeks before the surgery. During this time, bulimia will subside, the cat may become fat, and blood pressure and heart rate will return to normal. Methimazole is also given before surgery to determine if the cat has secondary diseases that are masked by hyperthyroidism, such as kidney or liver disease. Your cat may be hospitalized for one or two nights after the operation, and should start eating and return to normal after returning home.
One to two weeks after the operation, another TT4 level will be measured. Oral drugs. Taking methimazole for life can control the effects of overactive thyroid.
It takes several weeks for methimazole to restore thyroid hormone levels to normal levels. Some cats have side effects on methimazole, which may include vomiting, lethargy, anorexia, fever, liver damage, anemia, and a decrease in white blood cells. In some cases, a reduction in platelets (thrombocytopenia) may also occur. Since platelets are important for blood clotting, thrombocytopenia can cause excessive bleeding.
Because of these rare but serious risks of side effects, a simple blood test every three to six months requires close monitoring of the cat when using this drug.
This type of treatment is suitable for cats who have a very low risk of surgery due to other health problems or are particularly old. As mentioned above, it can also be used for several weeks to stabilize cats at higher risk of surgery due to cardiac complications. The required dose of methimazole will change over time. Therefore, once the condition is stable, it is recommended to monitor the thyroid level of the treated animals every 3-6 months.
Radioactive iodine.
Radioactive iodine therapy (I-131) is a very effective method for the treatment of hyperthyroidism.
After injection of radioactive iodine, it will destroy the abnormal tissues of the thyroid without harming other organs.
I-131 therapy does not require anesthesia, so there is no need for daily medication. Treatment usually requires one to two weeks of hospitalization in a veterinary hospital licensed for radiotherapy.
Prescription nutrition. Iodine-restricted diet (Hills Prescription Diet y /d®) can lead to relief of clinical symptoms and lower thyroid hormone concentration. There is no medicine for food. More than 10 years of clinical nutrition studies have shown that by controlling the iodine content in the diet, the body of hyperthyroid cats will return to normal thyroid hormone production. This is not an iodine-free diet, but a diet with a precisely controlled iodine content of 0.2 ppm-very small amounts. In order for this prescription diet to be effective, it must be the only food, which means don’t cheat with snacks.
Because every cat is different, your veterinarian will advise you on the best treatment. What may work for one cat may not work for another cat. Other treatment monitoring. Usually treatment of hyperthyroidism will cover up hidden kidney failure, which will require additional care and is best detected early in the course of the disease.
Will my cat be cured by treatment?
In some cats, the disease may recur.
The recurrence of hyperthyroidism after I-131 treatment is rare.
If abnormal cells are missed or new abnormal cells appear during surgery, the patient may become hyperthyroid again. If you stop taking methimazole, hyperthyroidism will recur. Cats that only receive a prescription diet will remain normal, but if they stop eating, they will become hyperthyroid again. What is the prognosis of hyperthyroidism? Many cat owners with hyperthyroidism are hesitant to undergo radiotherapy or surgery due to the advanced age of the cat.
It is important to remember that old age is not a disease.

How do you know when it’s time to euthanize your cat?

signs your cat is dying of thyroid disease
Our cat Kitty is only 16 and a half years old. She lives with my parents and I have been listening to the latest news about how much she eats for the past few months. Sometimes she would hide under my father’s desk and only come out a few hours later. Now, my mother says that Kitty has eaten very little recently, and it is “skin and bones”.
However, she said that Katie has been doing normal things (mainly sleeping), and she usually behaves normally. several questions:

1) Even if Kitty shows no signs of illness or disease, is she still injured? how do you know? 2) Please, don’t be too visual, how will such a decline usually end? Will she die peacefully in sleep, or will it get worse? 3) She hates veterinarians, and my mother doesn’t want her last minute to be an anxious and stressful car trip.
Do you have any suggestions for veterinarians in the southern area of ​​Pittsburgh, and if necessary, they can do euthanasia on-site service?

“No matter how many cats I feed, my cat seems to be losing weight.”

“My cat seems to be running out of food!”

“Why does my cat lose weight? I keep feeding her, but to no avail-she still yells.”

These are the number of times I started dating a hyperthyroid cat. However, they always end with a reassuring pet owner, knowing that there are a variety of treatment options. This is a directly treatable disease, especially when detected early. This is what you need to know.
The thyroid controls the body’s metabolism. Whenever I gain a few pounds of weight, I often hope that I can stimulate the thyroid for a period of time to burn off the excess fat, but a, we cannot. An overactive thyroid (hyper thyroid) will cause the body’s metabolism to increase, and an overactive thyroid (hyPO thyroid) will cause a decrease in the body’s metabolism, leading to drowsiness and weight gain.
Cats usually don’t have hypothyroidism…just like the owners of fat cats hope they can blame it! Excessive thyroid hormone causes the body to burn calories quickly. No matter how much these cats eat, they will continue to lose weight.
They seem to increase their caffeine intake.
Some owners even noticed their heartbeat. However, other systems will also be affected.
This is why just raising thyroid levels is not a good weight loss plan. Symptoms of hyperthyroidism may include increased appetite, weight loss, thirst, decreased desire for sleep, and increased vocalization.
Many cats also have poor, greasy, flammable hair.
Blood pressure rises, sometimes reaching dangerous levels.
These cats are often irritable because of this. Many people do not see this symptom until the cat is so severe that it suddenly becomes blind. (Fortunately) this condition only occurs in a few cats with hyperthyroidism-usually before they are diagnosed and treated.
High blood pressure (hypertension) causes the retina (the thin layer of cells at the back of the eye) to fall off. When the brain does not receive a signal, it means that there must be insufficient light, so it tells the pupil to expand (dilate) as much as possible. These cats often complained that “his eyes look interesting.” The poor students did their best, but the cat still saw nothing. Not all cats with hyperthyroidism develop severe high blood pressure enough to cause retinal detachment.
Hope that we will catch and deal with irreparable damage before it happens. Another organ affected by high blood pressure with an overactive thyroid is the kidneys. Older cats usually do not have award-winning kidney function anyway, but elevated blood pressure can make them look better than they actually are.
In the case of high blood pressure, all this blood flows through the kidneys, and they think “this is great!” The kidneys that have just started failing will be “false” because of the increased blood pressure. However, once we control the thyroid level and thus blood pressure, the true colors of the kidneys will appear. Your veterinarian may say that kidney levels are elevated and kidney function is insufficient (want to use the term “failure” until it is severe). Will treating the thyroid gland and lowering blood pressure cause kidney disease? No, it just opened the curtain behind the kidneys, so now we can see their true effect. There was no function before, we just couldn’t see it. Even if high blood pressure makes the kidneys look better than the blood tests, the kidneys are still working hard and will not function well in the long run. Avoid the temptation to keep blood pressure high in order to make the kidneys “look” good. Another organ system affected by hyperthyroidism is the heart.
Considering the hypertension aspect of the disease, this is not surprising. In this disease, the heart wall thickens or hypertrophy, just like any other muscle growth when the workload increases. This growth of the heart is very bad because the walls of the ventricles grow inward.
Imagine an empty glass jar and how much water can be put in it. Now draw the shape of the jar, but increase the wall thickness inside. what’s happenin? There is not much water in the jar! This is the heart of these cats.
The wall thickens, and almost no blood can be contained in the chamber. When the heart cannot pump past blood, this is obviously a bad thing.
First of all, a complicating factor that causes this situation is the formation of blood clots. One of the conditions we see most often is called “saddle thrombosis.” Yes, blood clots can get to wherever they want, but a common way is to start from the heart and move down the aorta, and the main blood vessels move down the body.

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Hyperthyroidism is a common disease that usually affects middle-aged and older cats.
This is caused by the excessive secretion of thyroid hormone in the thyroid cat. Thyroid hormones affect almost all organs, which is why thyroid diseases sometimes cause secondary problems such as high blood pressure, heart disease and kidney disease.
What causes hyperthyroidism?
The most common cause is an increase in the number of thyroid cells.
These abnormal cell clusters form small nodules called adenomas on the glands. Most of these adenomas are formed by non-cancerous cells, and only a few cases of hyperthyroidism are caused by malignant tumors. Recently, it has been speculated that there may be a connection between the increase in cat thyroid disease and the paint used in cat food cans. Another theory is that flame retardants used in furniture and carpets may be related to hyperthyroidism in cats. What are the signs of hyperthyroidism? The most common signs are weight loss, increased appetite without gaining weight, and increased thirst and urination. Hyperthyroidism can also cause vomiting, diarrhea, and hyperactivity. Hairpins may become dull and dull. Some cats will start to vocalize more frequently. Fast heartbeats are common, and cats may also experience heart murmurs and high blood pressure. How is hyperthyroidism diagnosed? Your cat’s veterinarian will perform a physical examination and palpate alongside and outside the trachea with your thumb and index finger to see if the thyroid gland is enlarged.
Heart rate and blood pressure will be checked, and a complete blood chemistry check will be run. Most cats with hyperthyroidism have elevated levels of the thyroid hormone T4 in the blood. However, sometimes cats who also have kidney, heart, or gastrointestinal diseases may have normal T4 levels. How is hyperthyroidism treated?
There are currently three treatment options: drug therapy, surgery and radioactive iodine therapy. Each option has its advantages and disadvantages, and you should carefully weigh all options and work with your veterinarian to make the best decision for your cat and your lifestyle. drug

Drug therapy uses a drug called Tapazole to control but not cure the disease.
It is usually taken twice a day in the form of a pill or a transdermal gel, which can be wiped on the inside of the cat’s ear. The cat will need methimazole treatment for the rest of its life.
Although some cats are well tolerated by the drug, it can have serious side effects, including elevated liver enzymes, low white blood cell count, low platelet count, itchy face and gastrointestinal problems, including vomiting and loss of appetite. If these signs appear, the drug must be discontinued and other treatments must continue.
Although thyroidectomy is a fairly simple method, it should only be performed by an experienced surgeon, as there may be serious complications, including damage to the parathyroid glands, which are located near or inside the thyroid gland, during thyroid surgery Vital. Maintain a stable blood calcium level.
Radioactive iodine

Radioactive iodine, also known as I-131, is the gold standard for the treatment of hyperthyroid cats. It involves a one-time injection of radioactive iodine under the skin. Radioactive iodine destroys the abnormal tissues of the thyroid, but does not damage the surrounding tissues or parathyroid glands. The cat will have to be hospitalized for a specific period of time (usually 3-10 days, depending on the location, the length of hospitalization is determined by the state government).

Since I raised my first cat at the age of 13, I have never been surprised by the changes in the veterinarian.
At that time, people rarely took their cat to the veterinarian unless he was sick and the problem was easy to solve. For example, abscess or low-grade infection-euthanasia is usually the treatment of choice. After 30 years, life expectancy has increased.
Cats can undergo chemotherapy, radiation therapy, various advanced and high-tech surgeries, dialysis, blood transfusion, and even kidney transplantation. Diagnostic tests are also increasing exponentially.
Veterinary clinics used to have very few ways to find out what’s wrong with cats. Now, your veterinarian can use a wide range of tools, from standard X-ray and stool examinations to internal blood tests, ultrasound and EKG.
Professional clinics can also use CT and MRI scanners. These advances are largely due to changes in people’s attitudes towards pets. They did it. But this is the question: even if we have the ability to do everything possible to fight for the life of a cat, should we?
This is a moral issue worth exploring. I’m not talking about being cold, but saying: “Tighten, my cat is really sick, so let her go.” I’m talking about using an incredible series of veterinary treatments to extend the life of the cat. Make it more than any level of quality. This is an ethical issue. I face more problems than I want, and I have enough time to think about it.
This is the question I want to ask myself to determine if and how long to treat. 1. What is the prognosis?
Even if your cat is very old, as long as your cat’s quality of life is good, sometimes expensive treatment is needed. 2. Is my cat suffering now?
If I choose treatment, can this situation change? When my beloved Dahlia suffered from cancer, I chose palliative care until I was diagnosed.
I tried my best to make her breathing as easy as possible by giving her medicine and draining water from her chest cavity to minimize the pain. But when the biopsy came back, my veterinarian told me that the prognosis was very poor.
She told me that if I wanted to, I could do chemotherapy, but it might not make Dahlia for more than a month, and she would suffer all the time. I chose euthanasia. 3.
Even if it is ugly, can I still be treated at home? Some diseases may be difficult to treat. This may be because we are squeaking, or because cats are extremely resistant to treatment. If your cat has kidney disease, you can save money by learning how to inject fluids under the skin at home-but you can overcome the instinctive reaction of sticking a needle into a furry friend.
Can you cope with terrible wound dressing? 4. Do I make this decision for my cat or for me?
I have seen people treat cats longer than kind or humane because of their fear of cats and death-related issues. However, although it may be painful this time, it may also be an amazing experience. If you are willing to do your own emotional work and check your own worries about death and dying, not only can you help your cat’s head and heart become clearer, but you will be more prepared for the future. loss. What questions do you ask yourself when considering whether to treat a cat for how long and how long is sick? Have you ever faced this decision, and how do you feel about the choice you made? Are people trying to persuade you to do something different? Let’s talk in the comments.

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By Elise


Dear Dr. Neely,

A week ago, my cat was sick, lying in one place all day, fever, and not eating much. We took her to the vet’s office, and after a blood test, she was diagnosed with hyperthyroidism.
Our veterinarian also said that she was a little diabetic.
I really can’t afford to test again now because my finances are very tight. He prescribed tapazol pills for us, taking half of the 5 mg pills every 12 hours. She rebounded for about a week, but in the past few days, she fell again.
Do not eat or move. She seemed to breathe a little, and she seemed to be very ill. We almost euthanized her last week because we couldn’t afford the cost, and I was worried that this might happen again. Can you provide any suggestions? I was shocked and wondered if she just needed a higher dose or if her heart has been severely affected. thank you very much,


Dear Alice,

Thank you for your attention to your cat to write. Your veterinarian has started administering the medication to your cat at the seemingly normal starting dose, which is estimated based on your kitten’s initial blood volume. Without knowing the value of the cat’s blood test, especially the thyroid level, I cannot be sure whether the cat needs more or less medication. The symptoms you describe actually sound like the cat is taking too much medication or taking too much medication, but the only way to be sure is to recheck the cat’s thyroid and kidney values ​​within 3 weeks.
Fortunately, the cost of a follow-up blood test should be less than the cost of the initial diagnostic blood test, and your veterinarian should be willing to discuss the price of this blood review so that you can plan accordingly. An important part of rechecking the cat’s blood function is also checking how the cat’s kidneys respond to the treatment of cat hyperthyroidism.
After starting treatment, blood flow decreases and renal insufficiency may be more obvious. Therefore, when you check the cat’s thyroid level again, your veterinarian will also check her kidney values. Cat kidney disease may also cause symptoms in your cat, or at least contribute to their symptoms.
The breathing problem of the cat you described worries me.
Depending on how long the cat’s hyperthyroidism has not been treated, the result may be a serious heart attack.
Due to this type of heart disease, fluid may accumulate in or outside the cat’s lungs. This is very serious and the veterinarian should check it as soon as possible. I also want to point out that saying that a cat is “a bit diabetic” is like saying that a woman is “a bit pregnant.” Ultimately, the veterinarian needs to determine whether the cat has diabetes. Your veterinarian may simply mean that your cat’s blood sugar is slightly elevated, and this may simply be due to the stress of going to the office.

Hyperthyroidism is a common disease in cats, most of which afflict middle-aged and elderly cats. Hyperthyroidism, also known as thyrotoxicosis, is caused by increased production of thyroid hormones (called T3 and T4) due to enlarged goiters in the cat’s neck.
In most cases, goiter is caused by non-cancerous tumors called adenomas. Some rare cases of hyperthyroidism are caused by a malignant tumor called thyroid adenocarcinoma. Although the cause of hyperthyroidism in cats is unclear, possible contributing factors include the lack or excess of certain compounds in the diet and long-term exposure to chemicals that destroy the thyroid in the food or the environment. Thyroid hormones affect almost all organs of the human body. Therefore, thyroid disease usually causes secondary problems. Clinical signs

Cats suffering from hyperthyroidism usually have a variety of signs, which may seem subtle at first, but become more and more serious as the disease progresses.
Hyperthyroidism may also cause vomiting, diarrhea, and hyperactivity. The outer skin of sick cats may appear fluffy, dull or greasy (see Figure 1). diagnosis

A veterinarian who suspects a cat has a thyroid problem will perform a physical examination and palpate the cat’s neck area to check for thyroid enlargement (see Figure 2). You can also check the cat’s heart rate and blood pressure.
If thyroid disease is likely to occur, your veterinarian may order blood chemistry tests and analyze thyroid hormone levels. Most cats with hyperthyroidism have elevated levels of the thyroid hormone T4 in the blood, but a small proportion of cats with hyperthyroidism have T4 levels within the normal range. If your cat’s T4 level does not rise, but the veterinarian still suspects that your cat has hyperthyroidism, it is recommended that you perform other tests. The blood chemistry team and urinalysis will provide information about other organs and provide your veterinarian with general information about the health of the cat. treatment

There are four treatment options for cat hyperthyroidism: drug therapy, radioactive iodine therapy, surgery and diet therapy.
Each treatment has its advantages and disadvantages. The treatment of hyperthyroidism in cats depends on the specific circumstances, including the patient’s overall health, the owner’s ability and willingness to treat the cat with regular medication, and financial considerations. drug

The effect of antithyroid drugs is to reduce the production and release of thyroid hormones in the thyroid. These drugs cannot cure the disease, but can control hyperthyroidism in the short or long term. The advantage of drugs is that they are easily available and relatively cheap. Life-long treatment is usually required, usually by mouth twice a day. For some owners and cats, this dosage schedule may be difficult to maintain. Antithyroid drugs can also be used in gel form, which can be applied to the skin. In most cases, the effectiveness of this transdermal gel is acceptable.
Regardless of the drug used, blood tests should be performed regularly during treatment to assess whether the therapy is effective, and to monitor kidney function and potential side effects.
Radioiodine therapy

If available, radioactive iodine therapy is the treatment of choice for cats with hyperthyroidism. During treatment, radioactive iodine is administered as an injection and is quickly absorbed into the blood. The iodine required to produce T3 and T4 is absorbed by the thyroid, and the emitted radiation destroys the abnormal tissues of the thyroid without damaging the surrounding tissues or parathyroid glands. The advantages of radioactive iodine therapy are that the procedure most often cures hyperthyroidism, has no serious side effects, and does not require anesthesia.
However, it does involve the handling and injection of radioactive materials, and this is only allowed in facilities where the use of radioisotopes is specifically permitted.
Radioactivity is not a major danger to cats, but people who are in close contact with cats need to take precautions.
Treated cats must remain hospitalized until their radiation levels fall within an acceptable range. Usually, this means that the cat needs to be hospitalized for three to five days after treatment.
Due to strict treatment guidelines, most facilities will not allow visitors to enter during this isolation period.
In all cases of hyperthyroidism, about 95% of radioactive iodine treatment can be cured within three months of treatment. Rarely, the level of thyroid hormone is permanently reduced after radioactive iodine treatment, which is called hypothyroidism. If there are clinical symptoms such as drowsiness, obesity, and poor hair quality, you may need to supplement thyroid hormone. surgery

Thyroidectomy is called surgical thyroidectomy. It is a relatively simple surgical method with a good success rate. The advantage of surgery is that it may produce a long-term or permanent cure in most cats, thus eliminating the need for long-term medication.
However, this operation requires general anesthesia, and if an older cat has heart, kidney or other problems that may cause complications, it may increase the risk.
One of the main risks associated with surgical thyroidectomy is unintentional damage to the parathyroid glands, which are located near or inside the thyroid gland and are essential for maintaining stable blood calcium levels. Diet therapy

Some studies have shown that in some cats with hyperthyroidism, limiting the amount of iodine in the diet may be a viable option for the treatment of this disease. This is particularly useful for cats who have a medical condition that cannot be treated with other treatments. However, due to concerns about the effect of long-term iodine restriction on overall health and that this diet may actually be counterproductive and aggravate the possibility of hyperthyroidism, dietary restrictions on iodine are somewhat controversial.
Research on this potential treatment option is ongoing. When considering limiting dietary iodine as a treatment for hyperthyroidism in cats, discuss these issues with your veterinarian.
Secondary issue

Due to the important role of the thyroid in the body, some cats with hyperthyroidism will experience secondary problems, including heart disease and high blood pressure.
If left untreated and controlled, these changes may eventually damage the normal function of the heart and may even lead to heart failure.
Therefore, some cats with hyperthyroidism may require additional treatment to control secondary heart disease. However, once the underlying hyperthyroidism is controlled, the changes in the heart will usually improve or even completely relieved. Hypertension or hypertension is another potential complication of hyperthyroidism, which can cause additional damage to multiple organs including the eyes, kidneys, heart, and brain. If high blood pressure is diagnosed with hyperthyroidism, medications may be needed to control blood pressure and reduce the risk of damage to other organs. Like heart disease, after successful treatment of hyperthyroidism, high blood pressure usually disappears, so permanent treatment may not be required.

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