Any vets in today?

[Simpo Two]

There's something I'm not sure about re my 13y/o female cat, and I'm hoping somebody can clear up an ambiguity please...

About a year ago she started losing weight and being sick in the night; a blood test revealed she had hyperthyroidism, and she was prescribed thyronorm. Gradually some weight came back and she stopped being sick. She's had a couple of blood tests since then; the weight has varied between 3.1 and 2.8kg and the dose rate has been adjusted from 2.0 to 1.5 to 1.75 (twice a day).

I took her in last week for another test as she was getting thin again and also sleeping more than usual. I thought she needed a higher dose, but the vet (not the one who saw the cat but one who just saw the results) said she was getting too much medication, her blood levels of (something) were below the threshold and so he advised me to reduce the dose to 1.25.

Can this be right? If the medication helps her to gain weight, how can she have lost weight if the dose is too high? Logic suggests that too much medication would make her fatter not thinner...

Another point is that the vet who rang me up to give the recommendation hadn't seen the cat, only looked at the figures. Is he right?

[Simpo Two]

Anyone? She was sick last night on the lower dose, so any rays of knowledge would be much appreciated please.

[LunarOne]

I'm not a vet nor a doctor, but lots of medications have an ideal concentration where too much can be as bad as too little and can switch off certain chemical processes. So it's very possible that your cat might lose weight without medication and with too much medication. Sometimes, the symptoms seen when taking too much of something can be the same as when taking too little or none. Sometimes, it can cause completely different effects. Medical practitioners will often start at a low dosage, and then ramp it up to see how the problem responds and verify with blood testing. They may choose to decrease the dosage if ramping up the dosage either reduces efficacy or causes other issues. Normally the idea is to find the lowest dose that has the most positive effect. Clearly, a higher dose is not always better.

[Simpo Two]

Thanks very much - that general summary makes logical sense. It seems that a change in dose is reflected in about 4 days, so I guess we'll have to suck it and see.

[LunarOne]

You're welcome. Our family cat had a similar problem in his latter years that required daily medication - he really didn't like taking it. We all became experts at popping the pills into his throat and forcing him to swallow without being torn to shreds. Not a skill you think you're going to need!

[Simpo Two]

LunarOne said:

You're welcome. Our family cat had a similar problem in his latter years that required daily medication - he really didn't like taking it. We all became experts at popping the pills into his throat and forcing him to swallow without being torn to shreds. Not a skill you think you're going to need!

Luckily thyronorm can be given on food, otherwise I wouldn't have any fingers left! The slight catch is that if she leaves some of the food she doesn't get the full dose, so you have to give small portions.

[PositronicRay]

Simpo Two said:

LunarOne said:

You're welcome. Our family cat had a similar problem in his latter years that required daily medication - he really didn't like taking it. We all became experts at popping the pills into his throat and forcing him to swallow without being torn to shreds. Not a skill you think you're going to need!

Luckily thyronorm can be given on food, otherwise I wouldn't have any fingers left! The slight catch is that if she leaves some of the food she doesn't get the full dose, so you have to give small portions.

I tend to put a small amount of food down with the medicine, followed by the rest to graze on.

[Simpo Two]

Sick again this morning. That's two mornings in a row on the new lower dose... vet not there to ask of course. Vet's advice and my own instinct are in conflict (and that vet hadn't seen the cat).

[garythesign]

I have no advice to offer but hope things are sorted

Christmas is a horrible time for illness, whether four paws or two feet

Good luck

[LotusMartin]

I’ve found FirstVet video consultations hugely helpful. We get them free with our dog insurance. I’ve found the vets very experienced and knowledgable - might put your mind at rest over the christmas period until you can get her to the vets again?

[Simpo Two]

LotusMartin said:

I’ve found FirstVet video consultations hugely helpful. We get them free with our dog insurance. I’ve found the vets very experienced and knowledgable - might put your mind at rest over the christmas period until you can get her to the vets again?

Interesting; is it possible to use them (for a modest fee) if not insured? A phone call will suffice (and stress-free for the cat as opposed to dragging her off the vets which she hates)

I plan to leave it at 1.25 for now and see how it goes; it may be that she needs time to adjust. But if no better after a week, I think 1.50.

PS Thanks Gary

[LotusMartin]

yes. I think it’s about £30 if your insurance doesn’t cover. lots do though.

[Mr Tom]

Hi, hyperthyroidism can be tricky to control. Vets tend to measure total T4 in blood to guage if the disease is controlled.
Sadly with hyperthyroidism there can be other diseases that go alongside - renal (kidney) disease being common as well as hypertension (high blood pressure). These can and may already be tested for but if not then this may be worthwhile.
Thyroid can also drop with lots of (unrelated) diseases and could be the case here. Whilst I don’t want to cause undue worry I would be concerned somewhat about cancer eg gastrointestinal lymphoma.
In summary whilst knowing only what you have said:
Enquire about a full haematology and biochem blood test
Enquire about an abdominal ultrasound (to image the abdominal organs)

Online/video vets are likely to be minimal use in this case due to the complexity of the case - they are more for acute issues. Use the money to see your own vet (if not urgent).

Lastly - never feel awkward asking for another vets opinion. I would never be offended. Sometimes a set of fresh eyes can be useful

I hope this is of some use,

Tom

Disclaimer - every vet has varying opinions on a case. This is mine and may be different to what someone else says. Consider this a guide not gospel

[Simpo Two]

Mr Tom said:

Hi, hyperthyroidism can be tricky to control. Vets tend to measure total T4 in blood to guage if the disease is controlled.
Sadly with hyperthyroidism there can be other diseases that go alongside - renal (kidney) disease being common as well as hypertension (high blood pressure). These can and may already be tested for but if not then this may be worthwhile.
Thyroid can also drop with lots of (unrelated) diseases and could be the case here. Whilst I don’t want to cause undue worry I would be concerned somewhat about cancer eg gastrointestinal lymphoma.
In summary whilst knowing only what you have said:
Enquire about a full haematology and biochem blood test
Enquire about an abdominal ultrasound (to image the abdominal organs)

Online/video vets are likely to be minimal use in this case due to the complexity of the case - they are more for acute issues. Use the money to see your own vet (if not urgent).

Lastly - never feel awkward asking for another vets opinion. I would never be offended. Sometimes a set of fresh eyes can be useful

I hope this is of some use,

Tom

Disclaimer - every vet has varying opinions on a case. This is mine and may be different to what someone else says. Consider this a guide not gospel

Thanks very much for your input, much appreciated. I was told that too much or too little thyronorm can lead to neurotic behaviour (she seems more jumpy about loud noises than before) and/or can affect the heart. However they said that was OK last time.

She's due back for another blood test in a fortnight and I'll ask to see the senior vet/partner, also called Tom as it happens. He's a cat person and offers some continuity because they seem to have a high turnover of vets, locums etc. I'll ask him about the issues you mentioned. Overall she seems happy, though can't retract her claws much now so tends to stick to things... had a nasty incident last week when she got a dew claw interlocked with a claw on her other paw... the distress miaows woke me up (4.00am on a Sunday); by the time I was able to separate them it was bleeding and ended up with two duvets and a sheet with 3" bloodstains, and lots of red paw-prints up and down the stairs. Pretty alarming. Wondered about spending £xxx on an emergency vet but hoped nature would do the trick - after all cats get much worse than that in the wild and recover. Luckily after about an hour it stopped, but I didn't get much sleep.

[garythesign]

OP. Good luck with your cat

Mr Tom. Thank you so much for taking the time posting yesterday. On Chrismas day too. I think that is going above and beyond.

To our professionals who post on here, I hope you have had a fine Christmas day and wish you a happy new year

[Simpo Two]

garythesign said:

OP. Good luck with your cat

Mr Tom. Thank you so much for taking the time posting yesterday. On Chrismas day too. I think that is going above and beyond.

To our professionals who post on here, I hope you have had a fine Christmas day and wish you a happy new year

Seconded. My vets posted a Christmassy thing on Facebook but that's not much help...!

On the plus side, she wasn't sick this morning so hopefully it was just the 'shock' of a lower dose. It seems to take a 3-4 days to work through.