Hyperthyroidism in Cats
Excerpt : Disease Hyperthyroidism is caused by a tumor, usually benign, of the thyroid gland that secretes excessive amounts of thyroid hormone. This has many effects on the body since the thyroid controls
Disease
Hyperthyroidism is caused by a tumor, usually benign, of the
thyroid gland that secretes excessive amounts of thyroid
hormone. This has many effects on the body since the thyroid
controls many basic body functions such as heart rate and
contraction, appetite, weight control, heat tolerance, water
consumption, to name a few. When a cat is hyperthyroid, these
functions become exaggerated.
Clinical signs
In most cases, they eat with exceptionally good appetites but
lose weight. They drink and urinate more. Frequent vomiting
(several times a month) and/or diarrhea often occur. Their heart
beats faster, and the heart muscle can become thickened
(hypertrophied), a state that can lead to heart failure. High
blood pressure can occur, and hypertension can lead to further
strain on the heart and eye problems (such as detached retinas).
Behavior changes such as nervousness, restlessness or even
aggression can result. If left untreated, this condition will
result in a progressive weight loss and overly stressed organs.
Diagnosis
Cats with these signs are suspected of being hyperthyroid and
sometimes an enlarged thyroid gland can be felt along the bottom
part of the neck alongside the windpipe. However, the diagnosis
is made on the basis of a blood test.
A complete panel and urinalysis are helpful to rule out
concurrent diseases, and it is specifically a T4 level or
sometimes, a free T4 (done by a different laboratory technique)
that diagnoses this condition.
Assessment of the cat's blood pressure is recommended since
hypertension is a common complication of hyperthyroidism.
Sometimes, this resolves with the treatment of the hyperthyroid
state. However, sometimes, it necessitates specific medication
to control. As with humans, high blood pressure has several
negative side-effects including
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additional stress on the heart
and kidneys and the risk for sudden blindness due to retinal
detachment.
Once your cat's condition has been diagnosed, your veterinarian
will discuss treatment options. There are 3 treatments, each
with advantages and disadvantages.
Medication
The most commonly used medication is methimazole (Tapazole).
This can be prescribed through a human pharmacy as a tablet or a
veterinary compounding pharmacy as a flavored chewable tablet or
a flavored liquid, given orally, or as a transdermal form (a
paste applied topically to inside the ear). Depending on the
cat's starting T4 levels and the cat's response to the
medication, it is given 1-2 times a day.
Side effects
Negative reactions to the medication can occasionally occur:
decreased appetite (some leveling off from a ravenous appetite
is normal after starting treatment), vomiting, diarrhea and
itchiness of the head and neck. Adverse reactions, if they
occur, usually happen in the first 3 months of treatment.
Monitoring
After starting medication, at minimum, a blood test of T4 levels
will need to be rechecked every 3-4 weeks until control is
achieved. This is not a time tested and can be done at any time
in relation to when the medication was given. It is ideal to
do a complete blood panel that includes a T4 level since this
allows for evaluation of the cat's other organs. Liver enzymes
are often increased with hyperthyroidism; they should go back
into the normal range with treatment of hyperthyroidism. When
they remain increased or continue to go up, there is concern for
concurrent liver disease. The kidney values are evaluated also
since some cats will also have mild kidney failure that is
"masked" by the hyperthyroid state. In these cases, cats will
only "show" their kidney problems once the hyperthyroidism is
treated.
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It also measures platelets and red blood cell counts
that are sometimes decreased in numbers by the medication.
Control
Control of hyperthyroidism is achieved when the cat is doing
well - no longer vomiting or having diarrhea, is no longer
losing weight and is showing no ill effects from the medication
and when the lab values are within normal. For most cats, this
can include blood tests every 3-4 weeks until the proper dosage
is attained.
Long term maintenance
For long term maintenance, a complete physical exam and complete
blood panel including T4 and urinalysis and blood pressure
measurement are recommended for every 6-12 months thereafter.
Pros of medication
It is relatively inexpensive. Depending on what formulation, how
often the medication must be given and which pharmacy is used,
costs can vary from $35-$60/month. Cons of medication
The cost of the medication will accumulate over the cat's
lifetime since this is a long term treatment. A cat will not
become "unhyperthyroid" and thus, is dependent on the Tapazole
to suppress the overly active thyroid gland. If the medication
is stopped, the cat becomes hyperthyroid again, and the disease
process continues.
Blood tests need to be done at regular intervals to ensure
continued control of the hyperthyroidism, and these laboratory
costs can accumulate (depending on which lab tests are done, the
cost can vary from $50-$100 each time). Frequency of testing
depends on how the cat responds to the medication and presence
of concurrent diseases.
Treatment with radioactive I 131
This treatment permanently treats the cat's condition by
eliminating the hyperactive thyroid tissue. This radioisotope
works specifically on the thyroid gland and doesn't affect the
other organs. This treatment can be done at any time
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during a
hyperthyroid cat's life, even after initiation of treatment with
tapazole. Recent blood work and urinalysis is required before
referral for this treatment. If a patient has been on tapazole
for more than 90 days, stopping the drug for 7 days prior to
I131 treatment is required.
Long term maintenance For long term maintenance, treated cats
are recommended to have their T4 levels monitored the first and
third months post treatment. A complete physical exam with a
complete blood panel including T4 and urinalysis and blood
pressure measurement are recommended for every 6-12 months
thereafter.
Pros of I131
It is a permanent treatment, and it avoids the need for daily
medication with Tapazole and eliminates the need for frequent
lab testing. It is the treatment of choice for cats that are
experiencing adverse effects to Tapazole.
Cons of I131
The treatment is done at only a few facilities with the
necessary equipment (a referral can be made for hospitals in the
area providing this service).
It can be costly. Total treatment costs are usually around
$850-1000. This includes a scan using technetium (not done at
all facilities), the I131 injection, general health and
radiation monitoring and the stay at the hospital.
After treatment, since the cat and the cat's wastes (urine and
feces) are radioactive, they need to be hospitalized for a
period of time until their levels drop to an acceptable level.
The usual stay in the hospital is 4-10 days during which the cat
cannot be visited. Even after discharge, for a period of
time-usually 2 weeks, there are certain precautions to be
followed such as limiting close contact and extra care with
removal of urine and feces from the litter box.
While usually only one treatment with I 131 is needed,
occasionally, a second treatment is
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needed. This is needed in
less than 2% of cats. Almost all cats are cured after a second
treatment.
Also, while most of cats that have received I 131 will have
normal thyroid function after treatment, there are a few cats
that have too low thyroid levels (hypothyroid) after treatment.
This can occur in less than 5% of cats. If these cats show signs
of low energy levels and dull coats with dandruff, these cats
will need thyroid supplementation. This medication, thyroxine
(Soloxine), is a long term treatment. However, it is less
expensive than Tapazole, and fewer medical problems arise from
hypothyroidism compared to hyperthyroidism.
Surgery
Surgery can be done to remove the hyperthyroid gland
(thyroidectomy). This approach is usually recommended in cases
where the thyroid tumor is malignant. Long term maintenance
For long term maintenance, treated cats are recommended to have
their calcium levels monitored daily the first 5-7 days post
surgery. A complete physical exam with a complete blood panel
including T4 and urinalysis and blood pressure measurement are
recommended for every 6-12 months thereafter.
Pros of Surgery
It is usually a permanent treatment.
Cons of Surgery
These cats are often at risk with anesthesia. Occasionally, the
hyperthyroid tissue can re-grow, resulting in recurrence of the
hyperthyroidism, months to years after a successful
thyroidectomy. Occasionally, hypothyroidism can result after
surgical removal, thus necessitating thyroid supplementation.
Occasionally, inadvertently, the parathyroid glands, responsible
for control of calcium and phosphorus levels of the body, can be
removed during surgery to result in low blood calcium levels, a
life-threatening problem that can result in seizures and muscle
spasms. This condition is usually temporary, and
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calcium
supplementation can help treat this, but calcium levels must be
closely monitored post-operatively.
Ablation
This relatively new technique is done only at UC Davis School of
Veterinary Medicine where ultrasound-guided ablation of the
hyperthyroid tissue is done by an injection of ethanol. The
technique is considered safe with relatively few side-effects.
Prognosis
Like most other diseases, hyperthyroidism is best diagnosed and
treated in its early stages. The prognosis depends on the cat's
condition at the time of diagnosis, its response to treatment
and the presence of concurrent diseases such as kidney failure,
diabetes, liver disease and cancer.
Whatever mode of treatment that is chosen to treat your cat's
hyperthyroidism, it is important that you consistently give
medication, follow up for necessary tests for monitoring your
cat and notice changes in your cat's overall demeanor, energy
levels, appetite, water consumption and urine output.
It is important you work closely with your veterinarian in
following up with the appropriate tests and advice to ensure
control of your cat's disease. Together, you can provide a good
quality of life for your cat.
If you have any questions regarding this disease or its
treatment, don't hesitate to contact your veterinarian.
The above is general veterinary information. Do not begin
any course of treatment without consulting your regular
veterinarian. All animals should be examined at least once every
12 months.
About the author:
Linda Mar Veterinary Hospital and its cat-only affiliate,
Coastal Cat Clinic, are small animal practices located in
Pacifica, California. To find a veterinarian or to learn more
about the vet clinic and our staff,
visit:[http://lindamarvet.com/]
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