Angie (00:00)
Welcome back to Tails of Truth, where we tell the truth about veterinary medicine. I'm Dr. Angie and this is my

co-host and veterinary nurse, Extraordinaire Jojo. And today we're gonna be talking about hyperthyroidism in kitty cats.

JoJo (00:13)
Yeah, we talk about this a lot. I feel like it's gotta be one of the most commonly diagnosed things we see in cats.

Angie (00:15)
Yes.

Yes. I mean it's pretty common. I see a lot of it. I would say it's like in the top four most common diseases in senior cats.

JoJo (00:27)
So let's start with why might someone suspect their cat has hyperthyroidism? What might they be seeing and how is it presenting?

Angie (00:35)
Weight loss, increased hunger. Like my cat when he was hyperthyroid, he was trying to get food out of the sink. He was so hungry and he'd never done anything like that before. so weight loss, increased hunger, increased vomiting. Cats with hyperthyroidism often vomit. sometimes they yowl at night, they'll get really hyperactive, their coat gets kind of funky and greasy. and it can look like other things. It can look like kidney disease, it can look like

inflammatory bowel disease. or can look like diabetes. So sometimes we have cats that are maybe vomiting and losing weight. And so it's it's definitely on the list of things that it could be. But luckily it's really easy to diagnose because we can just do a blood test. And for ninety nine point nine percent of the cases, a total T4 just tells us whether or not we have it. and then we can get started with treatment. Yeah.

JoJo (01:24)
Yeah, and that T4

is typically part of your cat's annual blood work if you're doing that. Or do you have to add it on? Are some panels making you add it?

Angie (01:30)
Mm I don't know I

well, I no, there are a lot of panels with it, but I see a lot of practitioners that don't add it regularly. I I test T four in cats over eight always, but some practitioners don't test for it and I think that's a mistake. But maybe they think I'm testing for it too much, but you might ask for it just in case.

JoJo (01:48)
Okay.

And so when those results come back, I just had a a thought. In a lot of holistic medicines or integrative fields, there is like the the standard, right? Like the lab test will come back and it'll have a range of what normal is. But that doesn't mean it's optimal. Is that true in animal medicine too?

Angie (02:05)
Yes.

Right.

No. No. It's so much more straightforward and so much easier. Like I have hypothyroidism, so my thyroid's too low. And the range in humans is really large for TSH, so they look at a different hormone, thyroid stimulating hormone in people. and so there's kind of gray areas of like, well maybe three's normal for me, but it's not. It needs to be between one and two. With cats it's not really like that.

JoJo (02:15)
Okay.

Angie (02:37)
It's pretty cut and dry. Now, sometimes cats can have mild elevations in T 4 and with no symptoms, that can create a dilemma in which treatment we choose. But for the most part, hyperthyroidism in cats is usually pretty straightforward, which is nice in a world of nuance.

JoJo (02:55)
Right.

Well, and you know what else is nice is that there are treatment options. People have options. So which is exciting 'cause cats don't always have a lot of options.

Angie (03:01)
Yes, yes.

There are four of them. You have four options. one, you can use Methimazole And even within methimazole you have a couple options. One, you can give your cat a pill. that's probably the best option, but the least used option. and the second option is that you can put a cream on their ear and they get it transdermally. Now, not all cats will absorb methimazole transdermally. but if they do, that's so much easier than giving your cat a pill.

For some cats.

JoJo (03:34)
Angie is compounded now too. You can get it in a mini melt.

Angie (03:37)
Yes, yes. Yep.

JoJo (03:39)
But

that's way easier to administer than a pill.

Angie (03:42)
Sometimes, yeah, it really can be. Yeah, some cats are just we'll take anything and we'll do anything. I've only had one of those and in my entire life, but they I do know others. There are others out there. Yeah. That take their pills with ease. We're like, if I tell someone, I need you to pill your cat every day for the rest of their lives, they're like, that's fine. But for the most part, that's not the answer I get. Most people do not want to.

JoJo (03:54)
That take their pills with ease.

Angie (04:07)
Pill their cat forever, which is so understandable. So we have methimazole. It's usually what we start with, but we also have iodine, radioactive iodine therapy. And that's usually at a specialty hospital or at a teaching hospital where we see just how hyperthyroid your kitty is. usually we're measuring their thyroid, and then we're administering radioactive iodine that goes right to the thyroid.

and it removes the excess thyroid tissue that's causing causing the hyperthyroidism and usually that is a permanent cure. I think it's like ninety percent of the time.

JoJo (04:43)
It sounds

terrifying. And if you're holistic in nature, make this make sense.

Angie (04:46)
I know. It does.

Yeah, I know. It it's actually pretty safe. so radioactive iodine really has preference for the thyroid tissue. So while your cat is receiving radiation in other parts of their bodies, honestly, by the time your cat is hyperthyroid, they're older, it's not going to affect them in any significant way. And I'm not just saying that to be like blase or just to like brush people's concerns off.

It is actually a really effective way to do it, especially if your cat can't be medicated, doesn't respond to methimazole. I had my last cat was like that. He did not respond to methimazole orally or transdermally. And so I took him up to CSU. He had the radioactive iodine, and then we literally never worried about his hyperthyroidism again. So every once in a while there's a cat where it doesn't work, and we have to go back for a second round, which is unfortunate. And even more rare, I'd say some cats can become hypo

thyroid from that and then we're giving them thyroid supplementation so they're getting levothyroxine and that's unfortunate because that's every day sometimes twice a day and that is also for life I've only seen that I only have one of those in the practice right now just one

JoJo (06:08)
Yeah.

But that that's the one you remember. Right. Yeah. Exactly. Okay. But not probably that's probably not accessible for every person. I don't know what it would cost financially, I would imagine. It's gotta be in the thousands. Yeah. Okay. And then to have a specialty center or a teaching hospital within driving distance.

Angie (06:11)
It's the one I remember, of course. Yes.

It's not accessible.

Like two to three thousand. Yeah, two to three would be my guess. Yeah.

Right. Yep. Not everyone can do that.

JoJo (06:37)
But it sounds amazing

to be able to have a one and done.

Angie (06:41)
It's great. The downside is your cat has to stay at the hospital for a week, which is so sad. everyone's sad about it. And because they're radioactive, so they have to let them be less radioactive and then for two weeks when they get home, you can't cuddle with them for any length of time because they're still just like slightly radioactive. and so that's that's less optimal. And I I just know it already that we're gonna get a lot of people being like, How can you be a holistic vet and want my kitty to become

radioactive. So we'll just make this a soundbite now. Just make it a sound bite. Yep. Yes. I mean, I I can tell you that it's a safe thing to do. I've done it for my cat and I I don't worry about that radiation affecting them long term. In fact, if anything, you're saving them from a lot of future veterinary care. So

JoJo (07:15)
Go for it. Set it up here. What's your lead in?

Angie (07:36)
I I would recommend it if you have the funds and if your cat is a good candidate. Some cats aren't good candidates because what happens oftentimes in cats with hyperthyroidism is that we treat their hyperthyroidism and then we reveal that they in fact have more kidney disease than we thought. Because cats hot take. Yeah.

JoJo (07:55)
I was just gonna say that's your hot take. Right there. This is

so discouraging for people when when they get their thyroid disease, their cat's thyroid disease under control and they're like, Ta da da, here's your kidney disease. Served Yeah.

Angie (08:02)
Yeah.

Right. Yes,

just know it's coming. And veterinarian we know it's coming. I I hope your veterinarian tells you it's coming. Because when a cat becomes hyperthyroid and we increase the blood pressure, which that's what happens, your cat becomes hypertensive, it pushes more blood flow to the kidneys. So it makes the kidneys on paper look better than they are. And so when we treat that, we then of course will uncover

The kidney disease, it was always there. So it's not new. but for some cats with really severe kidney disease, we actually don't want to do that. We don't want to hospitalize them for the week, uncover this very severe kidney disease, and have them live for like three more months. That's so unfair to the cat.

JoJo (08:41)
Right.

not trial, but would you do a period of methimazole, get the hyperthyroid disease under control, then you can see where the kidney disease is truly at, and then discuss whether iodine therapy is gonna work. Okay, that's the timeline.

Angie (09:06)
Yes.

Correct. That's what most of the time

they want you to do. Yeah. I couldn't do that.

JoJo (09:13)
Well the good news is

it's booking way out anyhow if you want to have that treatment. I think it's months. Yeah. Maybe not everywhere, but some places.

Angie (09:27)
Yes. So most of the time before you even do iodine therapy, you do methimazole Now in my in the case with my cat, the methimazole never worked. So we just went in uncontrolled. There was just no other choice, and that was fine. And so, if you have a younger cat, then it's probably fine to start with iodine. Although I think most of the time they don't want you to do that. They might

Just tell you to start with the methimazole just so they know where they're sitting. Yeah.

JoJo (09:51)
another truth moment too. So if you're on the methimazole your cat is on the methimazole. I have to remember that. If your cat is on methimazole Yeah. Well, if your cat is on methimazole, your vet is gonna want to recheck blood work in four to six weeks. This is not a money grab. This is in order to find the right dosing, they have to check and make sure that the numbers are moving in the right direction, that you've landed in the sweet spot. And oftentimes it's like they're gonna run the chemistries with that.

Angie (09:54)
Mm-hmm.

Yeah, I know. I say that too. Yeah.

JoJo (10:19)
Even though you just did chemistry, it's just because it's actually cheaper through the lab sometimes to have that T 4

Angie (10:25)
Well and we want to see that your cat's liver enzymes are declining. And we want to see your cat's creatinine and BUN. So the reason there is a reason why we recheck those chemistries again. again.

JoJo (10:36)
Yeah. And you might have to do it again. If the methimazole dose

Angie (10:53)
No, it's every six months. Which is still kind of

JoJo (10:56)
know people often think that's a money grab. And the other thing I hear a lot is, my gosh, now that we have treated the medication is causing kidney disease in my cat. And so then they wanna get off the methimazole because they think that's causing the kidney disease. So that's an important conversation to have ahead of time. So

Angie (11:08)
do you hear people say that? Yeah. yeah.

Right.

Yeah, it's not. And sometimes as veterinarians, we're really good at preparing people and sometimes we're having a really busy day and we're not. So Yeah. This this is what's going to happen. So if your cat has hyperthyroidism and you start treating that hyperthyroidism, you are going to uncover some kidney disease. Just be ready for it. And it's okay. There Yeah, there's

JoJo (11:23)
Yeah. Well 'cause you're just like, I know that this is what it is and what we need to test for. Just do it. Yeah.

Yeah. Yeah, it was there to begin with. It was just hiding

from you.

Angie (11:44)
Yeah, there's the sound bite. Like that's it right there. And it's okay. We'll deal with it.

JoJo (11:47)
Okay. And a radioactive

cat sound I mean, I think that sounds one like superhero. Like there's gotta be a movie about that. you had a client recently ask a very responsible question because they have you throwing the litter away in the toilet. Right? Is that where they have you dispose of it? They have you flush it. And, you know, his thought was, well, how does that impact the water supply?

Angie (11:52)
Yeah.

Right.

That's what they were gonna do for him, yeah.

Yes. I mean, I think by the time it would get anywhere, it's it's like the half life is short enough that it's fine. And so I think it's fine. we are really careful with all of those like we're we're constantly measuring radiation. So they're gonna measure your cat before they leave with a Geiger counter. So like they're gonna know how radioactive your cat is before your cat leaves the facility. And so, yes.

JoJo (12:28)
Yeah.

Angie (12:36)
It I mean it will by the time it makes it back into any kind of like treatment facility, it's gonna be okay. But this one client was concerned. I was like, Well, if you're concerned, you could take all of the litter, you could put it in the corner of the garage, like way far away from you for two weeks, and then you could dispose of it. But this radiation is gonna degrade. And by the way, I'm in my basement right now getting a

JoJo (12:51)
huh.

Angie (12:59)
ton of radiation from the earth. And then next time, JoJo, you got an air get on an airplane, what like next week, you're going to get so much more radiation from that airplane than from a cat we think of radiation in like we try to give as low as reasonably possible dose at all times. You're just always trying to do as little as possible because it's cumulative.

JoJo (13:07)
Yeah.

Angie (13:26)
And so they don't think your cat's so radioactive that it's dangerous. It's just they really want to protect you as much as possible, especially if you're pregnant, then that's definitely important. and of course the younger you are, the more important it is to be protected because you have more time for that radiation to cause damage as you age.

JoJo (13:48)
Hm. That's something for

people to think about if they have young kids in the house or, you know, other pets. How are they going to contain that cat for the week that they're home?

Angie (13:56)
Right. It's it's kind of a lifestyle bummer for a couple of weeks. But then you're done. I'm a huge fan of the radioactive iodine. I I

JoJo (14:01)
Yeah, exactly. Yeah, 'cause you know what else

is a lifestyle bummer? Is pilling your cat every day. It's a relationship breaker s for some people.

Angie (14:07)
Telling your cat. Yeah. It's a total especially Yeah. Especially

if your cat wants to kill you or doesn't want to be your friend anymore. It feels awful.

JoJo (14:20)
just get all these people who are not compliant in giving their cats medication and then we have to start all over in the process. It happens all the time. Yep. Okay. So methimazole, iodine therapy.

Angie (14:27)
Totally. All the time. So so there it is. Okay, so that's yeah, methimazole,

JoJo (14:47)
I've never seen it prescribed. No. Do you prescribe it? Yeah.

Angie (14:56)
Cause

some people are I'm not doing that, I'm not doing that, but I'm like, well, there's this diet, and they're like, Yes. And so that's easy. it's just it restricts iodine like heavily. So you can't, it's not like this is the diet and then you feed something else. It's like only this diet forever. And it works. It's very effective. And so if you're like, I have one cat, or we had a patient in our practice that went up to CSU.

JoJo (15:01)
Okay. Yeah, tell us more about the diet.

Angie (15:22)
had the radioactive iodine and it didn't work. He needed another dose. And she was like, No. But he was the only cat in her house and so they did the diet and it worked. 'Cause she was like, I can't do this again.

JoJo (15:33)
If you had a multicat house

h household, this is a diet that you can't share. You could. Okay.

Angie (15:37)
You could share it. No, you could. The

I don't know if the cats would all want it. It also has gotta be so expensive.

JoJo (15:44)
Is it good? Maybe it probably Is it canned or kibble?

Angie (15:46)
Well, I'm I've never tried it.

I think it's only kibble. Let me see. I'm pretty sure it's YD. Let's see. Y D.

JoJo (15:56)
And that alone

is going to bring their T4 numbers into the normal range. Interesting.

Angie (16:01)
Uh-huh.

Isn't that crazy? Well, and they I mean, just to get off on a little tangent, because you know they're my favorite. we think that we are giving cats thyroid disease from all the either the line the can linings of the yeah, whatever the lining is, like maybe all the BPAs. I don't know, I'm gonna say that wrong. Don't quote me on that, even though I just quoted myself on that. But and then all like the fire retardants in carpet.

And and

furniture. So when I moved into my house and I put carpet in, I put in wool because it doesn't have fire retardants on it.

JoJo (16:37)
Yeah, I remember

you choosing the carpet, which I love by the way. that's interesting.

Angie (16:43)
Yeah, I think it only comes in dry. I don't see it in wet I could be wrong, so someone tell me. But yeah, I think it's just dry. It's just dry

JoJo (16:50)
Well, maybe 'cause you

just talked about cans. So if they're putting in a can, are they just

Angie (16:53)
Yeah.

JoJo (16:54)
You know, messing that up for themselves.

Angie (16:54)
Yeah.

Yeah, but I think it's a disease we've kind of caused in our modern worlds. But next time we have an internist on the on the show, we should ask if there's anything, you know, new with that, if we know anything more.

JoJo (17:02)
Interesting.

Yeah.

Okay.

Angie (17:11)
And then our fourth option, which I don't think anybody does anymore, but it is an option, is to surgically remove the thyroid gland. They used to do that when I got out of school. I've never seen it done since. Have you ever seen it done? guess there's better options, yeah. And I would not want to do that surgery. That sounds terrible. No, thank you.

JoJo (17:17)
Yeah.

Why would they move away from that? 'Cause they have better options, better treatment options? Yeah.

Yeah, it does.

Angie (17:35)
There's a lot of vital structures right there. I don't know. No thank you. So

JoJo (17:37)
Yeah, yeah. No.

Precision. Okay. So we we don't really need to go that I mean, that's straightforward. I you'd have to find a vet who's doing it.

Angie (17:41)
Mm-hmm. Mm mm. Yeah.

So you've got methimazole, iodine, this funny diet and then surgery that no one's doing. Those are the options. Yeah.

JoJo (17:56)
Okay. That's exciting. That's

that's all manageable.

Angie (18:00)
But we this is one place where Western medicine actually is pretty effective. We can we can fix this now. our mutual contact, Rachel, she's a veterinarian and she does a lot of herbal medicine up in Portland. I guess she's in Bend now. but she has had success using herbs with cats that are very early in hyperthyroidism.

JoJo (18:05)
Yeah.

Angie (18:24)
We should link her in the show notes and so people can go see her. Because when people come to see me to do herbs for that moment, I'm like, I'm not very I don't know why I'm not good at it. She's she's probably better than me at that particular I just I don't know if I picked the wrong herb, but I've never been able to stop hyperthyroidism in cats with herbs.

JoJo (18:24)
Okay.

well that's interesting too, because we'll hyperthyroidism if they're just barely above normal and not being symptomatic, we just found it on, labs by chance. Is there a time when you don't treat?

Angie (18:50)
Yeah.

all the time, which I I think I have a lot of disagreement from other veterinarians because I see other veterinarians treating it and if they don't have symptoms, I often don't because I've made too many cats sick with methimazole in those cases.

JoJo (19:11)
So you just monitor it more closely to see how it's progressing. Is there any risk in not treating it though and then the kidney disease is underlying?

Angie (19:13)
I do monitor it. Yeah. Yeah.

I mean, the only risk in not treating it is that it's inherently not good for the tissues of the body, the heart, the kidney, like everything to have hypertension, one. So it's like if my cat if my patient had hypertension, I would treat it. So or if you know, it's definitely hard on the heart. And so we don't want to leave these cats untreated. But man, when they're newly hyperthyroid or they're just barely, I'm always like I'm scared.

I'm scared, Jojo.

JoJo (19:50)
Is it ever false,

like that it's hyper? Yeah.

Angie (19:54)
I mean, that's so incredibly rare. but yeah, it I mean it could be something else going on. but I often times wait for those cats to either become symptomatic for something else to happen. I mean, and we can always trial treat them on methimazole, and if they don't need it, then it methimazole makes them not feel good. I just hate being the reason that happens. Yeah.

JoJo (20:14)
Yeah.

I like this episode. I'm glad we talked about this.

Angie (20:20)
Yes, me too. I could talk about hyperthyroidism in cats all day long, and in fact I do. So I do.

JoJo (20:27)
You too.

I would say that is probably the number one cat question that comes through. Yeah, that one kidney disease. So there's a lot of cats moving through the world with hyperthyroidism.

Angie (20:32)
Is it really kidney disease? Not I B D.

Yeah. I feel like I see more I B D than hyperthyroidism, but I could be wrong. Maybe my pre

JoJo (20:44)
That's true. Maybe it's just

in the field right now. You know how things have like these phases where it's just like, Wow, everybody has this. Yeah.

Angie (20:47)
Yeah.

Yes. Like, yes. There was one day, I think it

was early in the spring, that I diagnosed five cats in one day. Like every blood work I got back was high T 4 high T 4 and I was like, what is going on? Yes. Yes.

JoJo (21:00)
Wow.

Yeah, it's how it works. So Okay, well I hope you enjoyed

this episode and it answered questions for your cat and if you're doing annual blood work, is your vet checking for this?

Angie (21:13)
Yeah.

Yep. I hope they are. Make sure they're checking for a T4. And if you would like to talk to me about your kitty with hyperthyroidism, you can go to boulderholisticvet dot com and click on book a consult and you can grab some time on my calendar and I'll go over your kitty's medical records and we will meet on Zoom. It will be recorded and I will help you create a personalized plan for your kitty.

JoJo (21:41)
Okay, see you there. Bye.

Angie (21:42)
Okay, see ya next time. Bye.