My cat who was being treated for hyperthyroidism with methimazole suddenly became quite ill last week. His white cell count was down to 1000 and according to one blood test his platelets were (seems radically low so I suspect it might have been an error) 13,000. BUN, Creatnine, and Bilirubin were all elevated but his ALT was normal. Upon release from the hospital (after IV treatment) there was much improvement but his ALT which was normal was now elevated.
My concern is this. How to proceed. I love this cat very much and do not want to cause him undo suffering. I am concerned about possible side effects of alternative meds and we have ruled out radio active iodine treatments. My goal for him is optimum health, comfort, and humane treatment over simple longevity. One vet recommended against surgery because he was high risk, and another said that if his next blood tests were normal that surgery was an option. I am happy to proceed with surgery if there is some likelihood of a positive outcome. Unfortunately with a different cat of ours he ended up having to be put down 2 months after surgery making the end of his life a misery. I do not want that to be this cat’s fate. Any thoughts are appreciated.
Thank You
These are known, but uncommon, side effects of methimazole. DO NOT use it again. Around here, surgery costs as much as radioactive iodine. Radioactive iodine is the best choice, as it will get tumor cells no matter where they are. Cats have thyroid tissue that can even extend down into the chest, so surgery can not always remove all the problem. There aren’t any real contraindications to the radioactive iodine (except if the cat is in kidney failure as well, it could get worse). If the costs are similar where you are, I really would do the iodine. Kitty might not like being quarantined for a few days, but it really is the best way to go. Admittedly, dealing with the litter when you get home is a bit of a pain. I have multiple cats and what I did was just bag up all the litter and held it for about 2 weeks before putting out in the trash, since trying to get one cat to use special litter and flush it just wasn’t going to work.
Laurie S. Swanson, DVM
Waukegan Pet Clinic
Waukegan, IL
Surgery is ok if the kidneys are fine; otherwise no. Go to someone who is experienced with the possible after effects of the surgical procedure. Low calcium can be a problem. There is always a risk. There is a risk in not doing surgery as well as in doing surgery.
Larry Baker, DVM
The Northgate Pet Clinic
Decatur, IL
After reading over your question, I think the decision to not keep him on methimazole is wise. I have had 2 cats with radioactive iodine therapy and I loved it for all of us. That does not mean it is right for every cat, though. If you are thinking about surgery, it might be a good idea to have a technesium scan done prior to surgery to make sure that there is no overactive tissue in his chest cavity. (It can’t be removed surgically and will keep him from being completely free of symptoms). An alternative medication is ipodate (sodium). It has a different mechanism of blocking the thyroid conversion (the cats on this medication need to have their T3 tested, not the T4). It would need to be compounded, but does not have the bone marrow suppressive action that methimazole does.
I hope this helps you and your vet!
Lori L Coughlin, DVM
The Cat Practice
Oak Park, IL
The concern of using the rx route is that it can be toxic to the kidneys and the liver. I personally would want to try an alternative approach first for this reason. There have been many cats that have been helped with homeopathy for example. If you were to choose surgery, I would request to have only one gland removed. Most surgeons remove both glands along with the parathyroid glands. These glands control the calcium balance in the body which is very important. Another approach would be to have radioactive treatment done. Some have found this to be effective but one wonders what impact this toxic approach would have in long term use on the cat. It is also important to feed your cat a fresh raw organic diet. If not raw, I would add enzymes to the diet. I would not vaccinate your cat as well as studies have found this could possibly a factor in the auto-immune disease.
Dyanna McCain, DIHom DVetHom
Holistic Animal Healing
Los Angeles, CA
If the cat is having bone marrow and other toxicity from the methimazole, he is not a good candidate for that drug. If radioactive iodine is not going to be done, the only other good treatment is surgery. Surgery is usually more successful than your previous experience, but any animal can have surgical complications, plus the disease itself takes a toll on the body so other problems can certainly occur as well. Surgery usually achieves a cure if the disease is in only one side of the thyroid gland and it is removed. However, a high number of cats will have the other side of the thyroid become abnormal within the next year or so. Some cats even ultimately get both sides removed, but this is more difficult and complications more common and thyroid supplements may even then be needed. Care must be taken in surgery to spare the parathyroid glands, which are very small and can be hard to see. I do not know of any effective alternative treatments for this disease.
Melinda R. Burgwardt, DVM
Melinda R. Burgwardt, DVM
Lancaster, NY