Pallina, hyperthyroid cat. Seeking advice

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Antonio
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Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

This is Pallina, female, 16 years old.
Pallina2011r.JPG
Pallina2011r.JPG (75.36 KiB) Viewed 8845 times
I found her on a freezing cold day of January in 2002. I brought her home and my intention was to find her a good home. But nobody showed up to adopt her so she stayed with us. According to the vet she was about 8 months old, so we picked May 3rd 2001 as her birthday.

She has never suffered from anything in her life apart from a chronic liver condition with ALT and ALP values a little over the range. We tried several approaches to the problem in the past but nothing really worked.
She's been eating renal food, wet and dry, for years because her friend Lola, recently gone to the Bridge, had CKD and it was impossible to give each of them a different food.
She has had blood tests twice a year for all her life, everything was perfect but her liver.

In last summer I noticed that she was eating less and was losing weight so I took her to the vet who ran an ultrasound scan and a blood test.
From the ultrasound scan the vet saw a suffering liver and he thought it was caused by the thyroid. The blood test told us that the vet was right.
The doctor advised me to start a therapy with Tapazole, 1/4 pill twice a day and repeat the blood test in 20 days time. After three weeks the report showed us that Pallina's kidneys were a bit under stress so the pill was reduced to 1/8 twice a day.
Pallina began to vomit the fractions of pills nearly everytime so her daily dose wasn't really taken.
The vet switched us to the transdermal gel in Pallina's ears twice a day and this is working fine.
Because the daily dose was guaranteed we started noticing one of the side effects of Methimazole, Pallina was getting slow and lethargic.
The vet advised me to give Pallina the gel only once a day, but this led to a worsening of the thyroid parameters and the last blood test told us that the fT4 is twice higher than the max value of the range (164 rather than 88).

Since the beginning, in last August, I asked the vets to have Pallina treated with iodine 131. Over here in Italy our stupid laws do not allow veterinary clinics and hospitals to handle that hazardous material. We have to go abroad, probably Germany, Holland or Great Britain.
Though I clearly stated that I wanted to follow this therapy, the vets seem deaf to my request, I don't know why. They're trying to lead me to another therapy.
Yesterday they talked me about doing a thyroid scintigraphy to assess the problem and if the nodule is only one they would prefer to surgically remove it. If there are more than one nodule they will see what is possible to do.
I'm not so happy with the surgery because it has more side effects and complications than the I-131 therapy.
I am struggling with having these vets do what I want to do. I wouldn't change them, though. So far these are the best I have found. These are the vets who diagnosed Lola one year ago and followed me along the terrible path from her rare disease to the oral squamous cell carcinoma.
But I am willing to do the possible and impossible to have my cat successfully treated. I am willing to go everywhere to get the best cures for her.

Pallina is still vomiting almost daily. The blood reports of the last 8 months have showed a persistent liver condition. At this point I asked the vet to have a pancreas test to check a possible pancreatitis and so it was. We have a liver disease, a inflammated pancreas and daily vomit, probably an IBD.
The only med that we were given was a shot of Convenia 12 days ago. Then we have been adviced to switch to a monoproteic wet and dry food. We are trying pork, that Pallina is eating rather happily when it's wet, but the dry food is absolutely not welcome. The problem is that the canned food isn't complete. I'm currently adding some Taurine in her wet food.
Tomorrow we have a follow-up visit with the vet who is also doing her the acupuncture. But I think this is more a palliative than a real cure.

I would like to read some experiences with cats with hypertiroidism which were treated with I-131.
Has anybody of you had to treat a hyperthyroid cat with this therapy?
Any suggestion, opinion and advice are welcome!
Thanks!
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Janey »

Hi Antonio, I’ve had four cats with hyperthyroidism although none treated with 1-131 so I can’t advise on that, unfortunately. The first two cats we had from kittens became hyperthyroid later in life and were given Carbimazole, at the time I was also hyperthyroid taking Carbimazole so there was only my hubby not taking it! We then adopted an oldie and he was hyperthyroid, also high blood pressure, kidney issues and all these improved once he was stable on Carbimazole. The last cat we adopted, another oldie was also hyperthyroid and taking Carbimazole and she was fine on that too. Sorry I’m not much help, had quite a few cats with the issue but not the same treatment as yours.
Best of luck with Pallina, the photo is gorgeous.
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by booktigger »

Sorry to hear you are struggling to get her hyper-t under control - now she is an only cat, you could try the hyper-t diet, can't remember it's name, but it has been discussed on here recently. My neighbours cat had the transdermal gel, it is only designed to be given once a day, but because she had vomiting issues with the dose, we did one dose one day, a slightly different one the day after. Did your vet say you have to alternate the ears when administering it? What are they using acupuncture for?
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

Janey wrote:Hi Antonio, I’ve had four cats with hyperthyroidism although none treated with 1-131 so I can’t advise on that, unfortunately. The first two cats we had from kittens became hyperthyroid later in life and were given Carbimazole, at the time I was also hyperthyroid taking Carbimazole so there was only my hubby not taking it! We then adopted an oldie and he was hyperthyroid, also high blood pressure, kidney issues and all these improved once he was stable on Carbimazole. The last cat we adopted, another oldie was also hyperthyroid and taking Carbimazole and she was fine on that too. Sorry I’m not much help, had quite a few cats with the issue but not the same treatment as yours.
Best of luck with Pallina, the photo is gorgeous.
Thanks for your contribution, Janey!
Everything is good, even when it seems useless :)
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

booktigger wrote:Sorry to hear you are struggling to get her hyper-t under control - now she is an only cat, you could try the hyper-t diet, can't remember it's name, but it has been discussed on here recently. My neighbours cat had the transdermal gel, it is only designed to be given once a day, but because she had vomiting issues with the dose, we did one dose one day, a slightly different one the day after. Did your vet say you have to alternate the ears when administering it? What are they using acupuncture for?
The diet you're talking about might be Hill's Y/D?
We had tried it but it wasn't appreciated. Pallina only ate two or three cans of wet food and a dozen kibbles. At first I was happy, but two days later I was really disappointed!

Didn't know about the gel to be used once a day. The vet told me to give her twice a day in order to administer the correct amount of methimazole, 1.25 mg a day. He also told me to give her a regular dose in the morning and half a dose in the evening, but this was before we learned that her T4 and fT4 values were so bad.
Nothing was said about alternating the ears. As matter of fact I use both ears everyday. I mean, I put some gel on my finger and then spread it inside both ears, twice a day. Do you think it's wrong?
The acupuncture is for trying to control her stress (she licks her tummy constantly) and her vomit (doesn't seem it is working, though).
We had 6 sessions of acupunture so far, tomorrow it's the seventh. In fairness I don't think it is really helpful and Iwould like to discontinue it because it's a stress for Pallina.
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by booktigger »

Yes, that will be the diet.

I know my neighbour was told it only needed to be used once a day, and to alternate her ears, if you are using both that could explain why it isn't working because its being spread too far. Are you using gloves when you administer it? As its transdermal, it can enter your bloodstream as well - we ended up using the back of a plastic spoon as we could feel a tingling on our fingers despite using gloves, and my neighbour had issues with her thyroid levels.

I've only heard acupuncture being used for arthritis, and my vet said if there was no improvement after the initial 4 week course then it wasn't going to work
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

booktigger wrote: I know my neighbour was told it only needed to be used once a day, and to alternate her ears, if you are using both that could explain why it isn't working because its being spread too far. Are you using gloves when you administer it? As its transdermal, it can enter your bloodstream as well - we ended up using the back of a plastic spoon as we could feel a tingling on our fingers despite using gloves, and my neighbour had issues with her thyroid levels.

I've only heard acupuncture being used for arthritis, and my vet said if there was no improvement after the initial 4 week course then it wasn't going to work
No, I'm not using any glove. I use my naked finger because I can't do nearly anything with gloves on. Yes, I think that since it's transdermal I'm assuming part of the medicine, but I wash my hands right away and the amount of gel passing through my skin is so little that I shouldn't get any harm.
But I'm not sure that splitting the gel in two ears is different than using one ear only. However I will ask the vet tomorrow during the acupuncture. I will also ask her about alternating the ears.

The vet told me that acupuncture can cure nearly everything. As a matter of fact it stopped the bleeding from Lola's mouth two months ago. One session was enough to fix the problem.

Thanks for your tips!
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by booktigger »

I would use something, like I said, we used plastic disposable spoons. Would be interesting to see what your vet thinks
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

Yesterday in the evening we had a new visit at the vet.
Pallina had her 7th session of acupuncture. I don't know whether it is working, but we keep doing it.

As for the transdermal gel the vet said it is a good thing to alternate the ears, mornings and evenings, twice a day is better than once a day in her opinion. She adviced me to use different spots each time within an ear, I replied that cats have small and quickly moving ears, I consider myself lucky if I can hit the target without messing too much :)
I will use a glove to put the gel in Pallina's ears, because with a naked finger I would take half of the dose I am giving her, not a problem for me but a problem for her that gets half of what she should get. I will use disposable gloves, I cut all fingers of the glove and use each of them each time, so I do not waste a whole glove for a single finger to be protected.

The vet didn't know anything about the I-131 treatment, I explained her something about it, she found it very interesting. I can't understand how a doctor who has been working for about 30 years can be uninformed on a medical treatment!
She will gather information about this, she knows two doctors who went working in UK and she will call them to have opinions and tips. We are still looking for a clinic for the scintigraphy. It's all so unknown to her and her colleagues. Apparently I would be the first of their patients to ask for such a treatment for a cat and possibly one of the few in Italy.

I could have more info today. I will keep you posted.
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

Hi all,
though several days have passed by, my vets haven't told me anything new about the I-131 treatment yet.
The crazy thing is that I know about it more than they do and on an evening of the last week they called me to have explanations on how the whole thing works. Isn't this crazy? :shock:
I had explained them nearly everything, I gave them three different addresses of referral clinics, I asked them to investigate on the protocol each of them will use, but so far nothing has happened, despite I asked them for updates.
The reason is that over here in Italy nearly nobody has followed this route with their cats, my vets told me that there are very few examples before me and they have no experience at all, probably they are a bit scared by this "new thing"!

However, Pallina has improved a lot on the vomit side. We are being followed and supported by a nutritionist now who has found that Pallina is intolerant to grains, chicken and fish, hence the constant vomiting, so the nutritionist has prepared a new diet with no grain at all and pork meat. The carbohydrates come from amaranth seeds to be added to the wet food. So far it seems it's working fine, Pallina has gained weight and is happier.

Today's Pallina birthday, she's 16 today! :D
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Janey »

Happy 16th Birthday Pallina! Glad to hear she is doing well :) It does sound like the vets are unsure about the treatment.
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by booktigger »

Happy Birthday. Am glad you have got the vomiting under control
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

Something strange is happening.
In the last two or three weeks Pallina regained her appetite and stopped vomiting. We had found a good wet food that she loves very much, or I should say he loved.
Because all of a sudden she stopped eating. She usually had three cans a day of food (80 grams each can) and was putting on some weight, which was good enough. This until Sunday evening.
Then, on Monday morning, yesterday, she totally refused her food. She told me she was hungry, but she just walked away from her bowl.
Later yesterday she was still hungry, but didn't want to eat anything until late, when she had half a can of fresh wet food before we went to bed.
I thought that the issue was solved, but this morning she acted the same. She walked away from her bowl but kept following me asking for food.
I don't know what it can be...
I suppose a sore throat or something of the kind, the vet on the phone agreed with me.
Hopefully she hasn't enough of this kind of food, I just purchased 200 cans on offer! :shock:
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by booktigger »

Fingers crossed its nothing serious, and just being awkward because you have stocked up
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Janey »

Glad to hear things have been going so well up to now. Just a thought, if she’s asking for food and not eating it sounds like my little devils when they want a different type! I always give them a big variation of food, always different flavours, and often different makes each meal. If you’ve been giving the one on offer for a while she may just be wanting a change? hopefully that’s all it is.
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Mayday21 »

Hello Antonio, hope Pallna had a great birthday & continues to improve. I've had experience with all types of treatment wth my Elsa who suffered hyperthyroidism. She was diagnosed in Aug 14. Tablets 3x day but as I work it was 2x & over 2 weekends 3x. No improvement so we were referred to a specialist at the Cat Clinic here. He prescribed the paste to be administered via her ears 2x. Right for night & left for morning. And yes I had to wear gloves. Thought we were getting there when she started vomiting bile. Spoke to the specialist & decided to do the radio iodine treatment. She was hospitalised for 3 weeks - 1 week in the radiation room & 2 weeks at clinic for monitoring & hazardous waste disposal. I visited her every day & was given a stop clock as I could only stay with her for 10mins. She was going ok - put on some weight not mine ch then about 1 yr after the treatment she started going off her food. She was on RC Renal wet & dry. Alas around 14 mths after the treatment she meowed & I found her in my middle bedroom behind the bed. She'd collapsed in the legs. Called the vet I volunteer for & made it there thru tears. We put her to sleep and she's in an urn beside my TV as she always laid beside me when I was watching stuff. Keep us posted on Pallina. Vivian
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

booktigger wrote:Fingers crossed its nothing serious, and just being awkward because you have stocked up
This morning things seem a little better, she ate the usual amount, but she's a bit slow and apathetic. I checked inside her mouth and saw nothing, no inflammations, no sores or else. She breathes normally and her temperature this morning was 37.8°C, maybe a little low?
I sent a message to the vet, waiting for a reply.
Janey wrote:Glad to hear things have been going so well up to now. Just a thought, if she’s asking for food and not eating it sounds like my little devils when they want a different type! I always give them a big variation of food, always different flavours, and often different makes each meal. If you’ve been giving the one on offer for a while she may just be wanting a change? hopefully that’s all it is.

I always varied her food so to keep her out of boredom ;) , but now this can't be done any longer. The nutritionist and the regular vet found out that Pallina is intolerant to chicken, fish and grains and advised me to switch to a totally new protein and we decided that pork and potato had to be the new diet. The carbohydrates quota is given with amaranth mixed with her food.
I really can't give her anything else or she could start vomiting again.
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Re: Pallina, hyperthyroid cat. Seeking advice

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Mayday21 wrote:Hello Antonio, hope Pallna had a great birthday & continues to improve. I've had experience with all types of treatment wth my Elsa who suffered hyperthyroidism. She was diagnosed in Aug 14. Tablets 3x day but as I work it was 2x & over 2 weekends 3x. No improvement so we were referred to a specialist at the Cat Clinic here. He prescribed the paste to be administered via her ears 2x. Right for night & left for morning. And yes I had to wear gloves. Thought we were getting there when she started vomiting bile. Spoke to the specialist & decided to do the radio iodine treatment. She was hospitalised for 3 weeks - 1 week in the radiation room & 2 weeks at clinic for monitoring & hazardous waste disposal. I visited her every day & was given a stop clock as I could only stay with her for 10mins. She was going ok - put on some weight not mine ch then about 1 yr after the treatment she started going off her food. She was on RC Renal wet & dry. Alas around 14 mths after the treatment she meowed & I found her in my middle bedroom behind the bed. She'd collapsed in the legs. Called the vet I volunteer for & made it there thru tears. We put her to sleep and she's in an urn beside my TV as she always laid beside me when I was watching stuff. Keep us posted on Pallina. Vivian
Vivian, such a shocking story with your Elsa!
How old was she?
Do you think that the issue that had her to collapse was related to the thyroid or the I-131 treatment? Or her kidneys?
So far I am only giving her the cream into her ears, but I can't manage to alternate ears every time. At the moment it seems that the situation is under control, though I don't know whether the current condition of diminished appetite and apathy has something to do with her thyroid or it's something else.
This morning she acted a little better, she ate more but she's still slow and sleepy.
Hopefully she is on the way to recover.
I will keep you posted. Thanks for your precious support.
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Mayday21 »

Hi Antonio not sure how old Elsa was. She was abandoned/lost in our 2011 floods & Little Paws asked me to take her as she was depressed. At that time vet thought around 7 so she could have been 11-13. I believe the radio iodine treatment did give her a little more time. Btw with hyperthyroidism they can suffer high blood pressure which she didn't have. It was her kidneys. Xmas 2015 I just let eat what she wanted. Xmas Day & Boxing Day it was prawns, New Years Day not interested in prawns had chicken. And I'd only lost my darling Mayday in Nov 2015: not 3 months later Elsa. I now have four furbabes: Lilith originally christened my three (Snow Girl, TC (Top Cat) & Harper) the "Three Puss-Kateers" .. now we have Bentley a 6-mth blue & white & is a mini-mi TC. Keep us posted. Fusses to Pallina - she's a sweet looking girl. Vivian
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

Hi Vivian, you did an amazing gesture accepting four new babes in your home. You're great!
The vets never checked Pallina's blood pressure, so I don't know if it's alright. High and Low blood pressures are a real threat to kidneys, so anything that alters the normal blood pressure leads to consequences for the kidneys.
My other cat, Lola, who went to the Rainbow Bridge 6 weeks ago, suffered from a rare disease which, among other things, would give her a high blood pressure. She had a retina detachment from this, but her kidneys had no consequences.
Pallina has restored her appetite. She had two cans yesterday and this morning she was quite hungry.
Now I'm wondering if this renewed appetite in the last few weeks is due to the new food that she likes very much or to her thyroid. I wonder if an apathetic hyper-T can turn into a "normal" hyper-T.
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Re: Pallina, hyperthyroid cat. Seeking advice

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Hi Antonio can't provide any comment re apathetic/normal thyroid. So sorry that Lola went to the Rainbow Bridge. Take care & keep us posted. Everyone here is very supportive & understanding. Fusses to Pallina. Vivian
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

Things with Pallina are a little like a rollercoaster.
There are days when she is lively, active and very hungry. Everything is perfect in those days.
There are days (very few luckily) when she isn't fine at all, like on last Sunday, when she stayed into a cardboard box and slept and with less appetite.
Then there are days when she's active, lively and hungry, but again she doesn't want to eat, like two weeks ago, then on last Thursday and today. She is desperately hungry, calls for food, vomits clear juices for an empty stomach, but her usual food puts her off.
I don't know what's going on, I have no idea, neither have the vets.
Due to this intermittent appetite she lost much weight and dropped from 3.2 kg to 3 kg (7.05 to 6.6 lbs) in about two weeks.

I have found a clinic in Belgium where they could do the I-131 therapy, I have sent an email to them, am waiting for a reply. Apparently it isn't a referral clinic, a pet's owner can access to it directly without the mediation of a veterinarian.
I fear that this strange situation, though, is an obstacle to the therapy. I think that they want a rather healthy cat before beginning the treatment, and if Pallina is losing weight and lacks appetite she couldn't be a good candidate.

Any suggestion is very welcome. Thanks!
Last edited by Antonio on Tue May 23, 2017 12:57 pm, edited 1 time in total.
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Kay »

the clinic ought, if it follows the UK model, to defer giving Pallina the radioactive injection until they are sure she will eat adequately, and that there is nothing else going on with her
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Re: Pallina, hyperthyroid cat. Seeking advice

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The reason they require a relatively healthy cat is because there are limited things they can do following the I131 treatment, so if there was something undiagnosed, they might not be able to treat it. If her kidney values are out, they also wouldn't treat with that, as the increased blood pressure due to hyper-t helps kidney failure, and curing it can then make kidney issues worse. When did she last have a blood test that covered liver and kidney function?
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

Kay, until two weeks ago there was nothing that made me think something was going wrong. She was eating up to three cans a day, she was putting on weight and was healthy and lively.
Now she's still healthy and lively, but eating is getting a problem because we don't and can't know whether she is going to eat no problem for a week or a month or what.
How can we know how she'll be doing in a month or two?
What if this problem came out one day after the I-131 injection?
Furthermore, since nobody knows what this problem is, how can we fix it? :(
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Re: Pallina, hyperthyroid cat. Seeking advice

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booktigger wrote:The reason they require a relatively healthy cat is because there are limited things they can do following the I131 treatment, so if there was something undiagnosed, they might not be able to treat it. If her kidney values are out, they also wouldn't treat with that, as the increased blood pressure due to hyper-t helps kidney failure, and curing it can then make kidney issues worse. When did she last have a blood test that covered liver and kidney function?
Booktigger, Pallina had her last blood test on May 15. The levels for kidneys and liver were rather bad.
GPT 427 [23-109]
ALP 218 [0-120]
GGT 8 [<3]
Creatinine 2.3 [0.5-1.8]
BUN 68 [30-65]
Cholesterol 263 [65-250]

All the rest is perfectly fine. Unfortunately the liver issues of Pallina are chronic, she has always had higher levels for it. The kidneys issue has started a couple of months after the beginning of the Methimazole therapy.
I disapproved it since the first day, I would have liked to treat her with I-131, but the vets told me they needed time to decide.... Nine months have passed by...

I'm still waiting for the report for the thyroid. It always takes 10-15 days to be issued. Is it this way in your country too?
Last edited by Antonio on Tue May 23, 2017 12:56 pm, edited 1 time in total.
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

One of the vets who are following Pallina once told me that not many people want to invest much money in their pets' health, and veterinarians struggle to cure those pets with the little resources they allowed to use.
She said "You can't imagine how hard our job can be when we would be able to cure a pet but their owners don't want to spend."
I'd say "You can't imagine how hard being a responsible owner can be when I would like to have my cat cured but veterinarians do not help me!"
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Kay »

my Trigger, who had the I131 treatment in 2012, always had high ALT levels but it wasn't considered significant

the clinic I took him to had never lost a cat during the treatment, and I believe that is more or less the case elsewhere, except the two UK clinics who treat cats with thyroid cancer, because they have to have much higher doses and are more seriously ill to start with

I do urge you to join the Yahoo group for feline hyperthyroid, and post her readings on there - you will get a lot of invaluable help, as most of the members are in the US, where blood test results are much more understood by cat owners
Antonio
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Antonio »

Kay, you say that the clinic where you took Trigger to has never lost a cat during the treatment.
Does this mean that the treatment can be life threatening? What can possibly go wrong during the therapy?

I joined the Yahoo group already and described my situation of Pallina. One of the group members has given me the details to contact the clinic at the University of Ghent in Belgium.
I will post the last reports as soon as I have the thyroid paper... Every time it takes so long... The thyroid reading is never up to date, it always refers to a situation two weeks old.
Thanks for your support!
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Kay
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Re: Pallina, hyperthyroid cat. Seeking advice

Post by Kay »

no, not at all life threatening

this assertion is just in response to us over anxious owners who think our cats may starve to death away from home!!
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