Hyperthyroidism and kidney failure in cats-my vets have confused me. (Very Long)

My husband and I have two cats, a 14yo and a 7yo. We took the cats to the vet not too long ago, for a basic wellness check and shots.

Neither of the cats show any symptoms of any illness, just time for a generic checkup. The only oddity was very occasional peeing outside of the box by the younger cat. We hadn’t been able to tie it to anything, though it seemed that in general she was going a little stir crazy, and so maybe the two were tied. Of course, she could have just decided the box wasn’t clean enough for her too. It was also exceedingly rare.

This visit was the first time we’d been to this practice.

They did all the basic exams on both cats, and then told us they wanted to run a set of tests on the 14yo that they do once a year for all geriatrics, and they recommend starting this at 8yo. I’m not sure of everything they do, but I know it includes a CBC, a urinalysis and a T4. When they told me that they do this test starting at 8yo, I said to pull it on the younger cat as well, so that we’d have a baseline of “normal” for her as she ages. My husband and the vet agreed that this was a good idea, so it was done. Both cats weigh in at the same weight +/- 0.2lbs as they have the last two years.

Of course, our cats were crafty, and thwarted the attempts to get urine there, so we were sent home with non-absorbent litter and a sample jar and told to get a sample from the younger cat, in case of UTI. We don’t have these results back yet.

What we do have, though, is the vet calling to tell us that the older cat is totally normal. The younger cat’s T4, however, is high. We’ve likely got hyperthyroidism. The vet runs through the options (pills, creams, surgery and radioactive iodine). We decide on the iodine treatment, since she’s young and healthy, there’s a facility nearby and, most importantly, it’s a permanent fix.

It’s also an expensive fix. So our discretionary spending (I’d had my eye on a new dress, for example), is curtailed, and we start making plans. The facility that does the iodine treatment needs CBC, T4, free T4, chest X-rays and a urinalysis all done within 30 days of treatment. The cat was showing no symptoms. We get the free T4 done (to confirm the diagnosis before making an appointment with the other facility), and it also comes back high. This is real. So, we talk with the vet we’ve been working with, and she gives us the go ahead to set it all up. We make the appointment with radiocat (warning, obnoxious pop-under), they do have an appointment within the 30 day window of the CBC and so we make the appointment to get chest x-rays.

The thinking is that since we’ve caught this early, by blood work rather than symptoms and such, we can fix it, and get it all done without having to repeat the CBC, T4, free T4, urinalysis and chest x-rays. The iodine treatment isn’t going to come cheap, and none of these tests are in the single digits either. The vet we’ve been working with agrees that this is a good move, especially as the cat is young and apparently asymptomatic (there’s some question about the stir craziness and the peeing).

Our younger cat got the x-rays done yesterday; due to our schedule, this was the only day we could drop her off. This meant that a new vet would be doing the x-rays. We didn’t think much of that, figuring that this was all pretty standard.

The second vet does the x-rays, and then calls us to tell us everything looks good. BUT she thinks we’re making a huge mistake by going straight to radiocat. According to her, and some information she sent home with us, hyperthyroidism in cats often masks renal problems. Thus, we need to put our cat on the pills or the cream first, for at least two weeks, then test renal function again. Only then should we decide to go forward with radiocat or not. Radiocat says the cat needs to be off pills/cream for a minimum of one week before bringing her in.

That, of course, puts us way outside the window for the original tests, requiring that we run the whole gauntlet again, without treatment for the cat so radiocat knows how much iodine to give the cat. Oh, and the cat is now symptomatic. In the 2.5 weeks between the original wellness exam and the x-rays, she’s lost almost a pound, though her eating does not appear to have increased. So, no matter what, something has to happen soon. We want the cat healthy as quickly as possible.

The first vet said nothing about possible renal issues. She green lighted us to get a permanent fix. The second vet seemed to only worry about it because she was a cat with hyperthyroidism, sort of circular reasoning. I’m confused, because none of this comes cheap, but I’m pretty sure I’d rather pill a cat everyday for the rest of her life than deal with a cat with renal issues (and the accompanying reduced life expectancy), and the vets have basically given me to separate sets of advice.

To top it off, both vets have said or done things that have pinged my radar a bit, with regards to testing, sort of like they’re inclined to over test for the sake of testing. I know some vets do it; a vet from my mom’s clinic of going on 13 years now was fired for it. I also suspect it’s rare. However, I’m not a vet, I don’t know what’s best in this, I don’t want my cats to be ill, and I don’t know if I’m over-reacting. I do know that I wonder why the second vet didn’t call us before taking the chest x-rays, to give us her opinion. But I also figure I’m being ridiculous on that, because she probably looked at the chart enough to see that the cat was going into radiocat first, did the x-rays, then looked closer and saw the cat was not yet being treated, and this was a very new diagnosis.

Argh. I’m so confused, which makes me frustrated. I feel like I’m in that part of The Dilbert Future where Scott Adams talks about JiffyCat2000 and petownerwalletectomies.

I know this is long; I wasn’t sure what would be pertinent and what wouldn’t in helping anyone to help my husband and I sort it out, so I sort of threw it all in. If you’ve made it this far, I thank you.

I had two cats with Hyperthyroidism. However, they were both about 15 years old when they exhibited the symptoms and were diagnosed.

I don’t understand why your first vet didn’t take a look at the kidney function right away upon realizind that your cat’s T-4 was high. The thing is, the T-4 could have been elevated due to kidney issues or the thyroid issue has been going on longer than anyone thought and the hyperthyroidism is causing renal problems.

I understand your frustration at the vets not letting you know about wanting renal tests done, I would be furious. I know what a struggle it is, both financially and emotionally, especially if you’re getting mixed info from two different vets. If seeing a third for another opinion is not an option, perhaps do some research on your own then present it to the vets and ask them to spell it all out for you, leaving nothing out. Here’s a start. http://www.winnfelinehealth.org/health/hyperthyroidism.html

Good luck to you folks and your kitty.

Thank you so much Chao. We are frustrated and confused.

The first vet did look at renal function via bloodwork at the same time the T4 test was done, for both cats. No unrinalysis was done at the time because neither cat had any urine for the vets to squeeze out. The plan at the time (before any suspicion of disease) was that we’d do a urinalysis on the younger cat via home sample in case she had a UTI, and only do one on the older cat if the blood tests came back with indications of renal disease. So renal function in both cats was looked at and evaluated as normal from the get go.

The second vet is saying that, due to the hyperthyroidism diagnosis, the current renal evaluation “doesn’t count”. This is because it is (apparently) very typical of hyperthyroidism to improve kidney function in cats, even if the kidney would be failing without the added support.

So, the second vet thinks we should remove the added support in a reversible manner first, then check renal function again, before deciding if we should permanently and irreversibly remove this support. Basically, if the kidneys need extra thyroid hormone, we can pill the cat for the rest of her life and, with the support of blood titers, leave enough extra hormone for the kidneys while taking away the “excess”.

I know renal failure is common in cats. However, I also know it’s usually an old cat problem. So I’m just wondering how likely it is that the kidneys would fail without thyroid hormone, in a young to middle-aged cat. Of course, hyperthyroidism is also supposed to be an old cat problem.

I just don’t want to throw money away, particularly as redoing all the tests plus the permanent solution is perliously close to my personal “no more than this for a cat” number. However, this is my husband’s cat moreso than she is mine, and I think he’s in a “well, but she’s totally healthy otherwise, so there is no upper limit currently” mindset. I love the cat, and could probably be swayed to “bumping” my number, but I don’t want to hit or bump my number without feeling very confident that 1) we’re not just jumping because we don’t know any better and 2) we’re not throwing money at a non-existant or highly unlikely problem.

As far as how common the renal issues are in a young cat with hypertyroid, I don’t know. It’s a good question for a vet. Speaking of that, we really need VETBRIDGE in here, as he may be able to answer some of your questions, or at least give you advice on what you should be asking kitty’s veterinarians.

I know you are hestitant to put out the money, that’s understandable. Both my cats were treated with Methimazole rather than radioactive iodine or surgery, but only because they were so old.

Definitely do more research, never let your vets bully you or try to talk over your head. When my first cat got sick, I had stacks of information that I bombarded my vet with and I got other professional opinions before making the decision to just use Methimazole.

Remember, cats have very sensitive systems and kidney disease is common. It may hurt the wallet but it may give you peace of mind to know that kitty has only one problem to be dealt with over the long term rather than two. (Believe me, dealing with kidney disease in a cat is no picnic, but if it’s caught early, you can treat the kitty.)

Yeah, I’m trying to get it figured out.

I put in a call to the first vet (she’s not in on Mondays), but I haven’t yet heard back from her. Maybe later today or tomorrow. I also read through the link you put up, which also says that hyperthyroidism can mask renal issues, but it suggests yet another method to assess renal function!

I hope the vet calls back soon, or something.

Well, the first vet didn’t call back yesterday. The second vet called back with the results of the UA. Both cats are fine, but she still maintains we can’t believe that the younger cat’s kidneys are functioning properly with the data we have.

Bah. Being confused sucks.

Hmmm. Sounds like they’re just erring on the side of caution. It could be that they’ve rarely if ever run into a case such as this. If you haven’t heard back from the first vet yet I’d be on the horn stalking him/her.

Yes, I plan to call her back today. And tomorrow. But she’s only in 3-4 days a week (3 one week, 4 the next), and her outgoing message basically indicates that she only returns calls on those days. That makes a certain amount of sense, but we have to make a call on what to do with our cat by a week from today. And I’d like to know her thoughts on this matter, as well as the thoughts of any and all vets I can, since I’m certainly not one!

Very frustrating indeed. At any rate, I hope everything works out for you and kitty.

Do I understand correctly that. . . [ul]
[li]Your kitty is hyperthyroid.[/li][li]This condition may or may not be masking renal failure.[/li][li]If it is masking renal failure, the “permanent” cure for the hyperthyroidism, which you’ve currently got scheduled, will necessitate treating the CRF because the thyroid won’t be working to benefit the kidney function as it is now.[/li][li]If it is masking renal failure there is an option to merely treat the hypothyroidism long-term with pills, which would help regulate the thyroid but not interfere with its assistance to the kidney function?[/li][li]There’s the possibility that it isn’t masking a renal problem, but the only way to know that is to try the non-permanent treatment for a period and re-test the kidneys. Doing this delays the permanent treatment to such a length that costly tests that have already been done in preparation for said treatment will have to be re-run at a later date, should renal failure not be found and you still wish to proceed with the permanent treatment option.[/ul] If I’ve got that right, there are 2 primary concerns. Obviously the first is getting the right treatment, depending on what condition(s) your cat actually has. The second is the cost associated with diagnosis and treatment. Whichever choice you make on how to proceed with her care, may have a long-lasting effect on not only her long-term health and treatment, but on your budget as well. I can totally empathize with your dilemma, as I had to change vets more than once to get the right care and treatment for my CRF kitty, so I know how heartwrenching it can be to figure out the right thing to do for their health and your pocketbook.[/li]
I got kindof beat up about this the last time I recommended it, but if either of the vets you’re working with already accept the Care Credit card, and you don’t have it, you might consider applying for one, and if you’re approved (like any other credit application would require), the payment terms can be as long as a year with no interest. The availability of this option might make the decision to step back and try the temporary treatment so you can re-test the kidneys a manageable solution.

Best of luck whatever route you take with your kitty. I hope she pulls through whatever the problem turns out to be.

Thank you, Shayna. You have got it all right. I haven’t yet, but I will check out the Care Credit site that you’ve linked to.

I’m pretty sure this cat will pull through, and do so well. After all, she’s the one who survived being shot in the face with a pellet gun, dragging herself home, and having to be driven an hour away to get emergency treatment! She’s a stubborn brat, and if we hadn’t done this blood test, I would say she’s healthy as a horse.

I’m glad to hear she’s such a trooper! That, coupled with the kind of attentive and caring mommy she has, I have no doubt that she’ll pull through whatever condition she has with flying colors.

If it does turn out that she has renal failure that needs to be treated, and you have any questions, particularly about resources for low-cost supplies, feel free to drop me a line at jill61 at surfcity dot net and I will be more than happy to share all of the research I did to find the best deals. We lost our sweet Mew last December, after 5 years of CRF treatment. She was a champ through the whole thing, bless her heart. I trust you’ll have the same success with yours no matter what the problem turns out to be.

As for the Care Credit card, the “controversy” seems to come from the fact that their fees to the “merchants” (in this case veterinarians) are fairly substantial and billed to the vets monthly, whether or not they actually process any transactions. In my mind, this would be even more incentive for me to want to actually use my card with my vet who’s already set up to accept it and will have to pay that monthly fee anyway – this way I contribute towards justifying that expense. Additionally, the SD vet who pointed these things out to me (can’t remember which one at the moment), indicated that their practice sees a high refusal rate on applicants. I couldn’t speak to that, as I had no problem getting approved on the spot when they put my application in right there in the office, but that was so many years ago that I couldn’t say what my credit-worthiness might have been that made me eligible where others wouldn’t be. To me, it’s at least worth looking into, as the benefits of that card outweigh the few minutes it might take to see if your doctor accepts it and if you qualify. Having that card helped me afford to treat my cat and enjoy an additional 5 wonderful years with her. Others’ mileage might vary, so proceed with those caveats, I guess.

Again, best of luck!

Wow. Shayna, I may e-mail you anyway, or soon. The older cat’s blood work and UA both indicated her kidneys are fine, but the vet felt that her right one had shrunken some, and the blood number was apparently the last number in the normal range. We’re talking about just switching to a kidney protection food preemptively, given the circumstances.

This sucks. The older cat is my cat, and it’s like she’s aging all at once! A year a go I’d never have called her old, but she’s missed the bed and a chair about 3 or 4 times while jumping, and now her kidneys are considering shutting down, and she may be on the verge of glacoma! All of this with the younger cat’s issues, it just makes me want to scream. Particularly the younger cat’s issues, at the moment.

On the other hand, I’m very glad I decided to get that test done!

By all means, please do drop me a line. One thing that might help offer you some reassurance is that renal failure is treatable and not necessarily an imminent death sentence for either of your kitties. I remember bawling for weeks because the first jerk who diagnosed my cat painted a very bleak picture, giving her an outside chance of surviving 2 years, with the greater likelihood being more along the lines of 2 weeks to 2 months! That was when she was 17. When Mew was 21 her current vet remarked that she had 12 to 15 year-old cats who didn’t look as good as Mew did.

I also wouldn’t be too concerned about the problems with jumping thing, either. None of us is as nimble as we were when we were young and spry, so it stands to reason that she’d become a little less able and perhaps even a little more cautious as she gets a little older. The same thing happened with Mew, and we simply made accomodations so she could more easily get to some of the places she liked to jump, and started giving her glucosamine. She went from falling over on her side when simply trying to jump up on a chair, to hurling herself up on the bed again after only a few weeks of taking it. And the improvement lasted throughout the duration of her treatment until she died. So talk to your vet about possibly starting her on something like that.

Hey, sorry to hear about your cats. Just wanted to voice my support. This will have no bearing on your situation, but I had a cat who was diagnosed with renal failure at 7, hypothyroidism at 12 as well as arthritis and cardio problems as well - he finally died last year at 14. So just want to mention that provided you identify the problems early and faithfully medicate, many cats can have long and full lives.

I’m not a vet, so can’t comment on the above other than to say according to my vet the connections between the renal functioning, thyroid functioning etc are very finely balanced, and in addition, the effects of the drugs (should you go onto meds) can also affect different parts of the body. I would say from this that it’s might be an idea to have a really good idea of what you are dealing with before rushing into treatment. Is there a cat specialist in your area? My boy was referred to a real cat specialist as our very experienced vet still felt he was a little too complex for him to deal with. Will leave it to a vet to comment further on your exact situation though, but fingers crossed for you.

I know I’m into this quite late, so perhaps you’ve planned your course of action already. I get the impression that both the veterinarians you are dealing with are general practitioners. Just like you would perhaps see an oncologist rather than stick with your family doctor if you were diagnosed with a tumor, you don’t necessarily need just go by the advice of a general practioner for your cat either.
There are veterinarians who have been through advanced training and then they completed other requirements to become board certified specialists. In your case, a boarded small animal oncologist or internal medicine specialist would be the expert I’d be inclined to trust. If you have any questions at all, I’d really suggest finding the closest board certified internist and talking to them about the hyperthyroid/renal disease link. Both small animal internists and oncologists are certified under the American College of Veterinary Internal Medicine umbrella. You can find the closest one here.

DO NOT ask the veterinarians at Radiocat about your vet.'s recommendations. They stay in business by keeping referring veterinarians happy, and that means never telling the client that their own vet. is wrong. You are very unlikely to get anything more than “that might not be 100% of what I’d do, but your vet. is great …” type advice.

hey BlueKangaroo

IANAV, but I wanted to chime in with my $.02. Just went through this exact same thing with my cat (a cantankerous 12-13 yr old ex-streetfighter).

We ended up going the route of temp-medication to get a good read on the kidney function before going forward with the Iodine.

The hospital that handled the actual iodine treatment started out by doing a preliminary exam that directly checked what was going on with the thyroid. It was done by injecting a marker chemical that behaves like iodine (gets absorbed by the thyroid) and then taking a couple of pictures that show the relative concentration of this chemical in the kitty’s body. The hospital does this to 1.) definitively diagnose hyperthyroidism and 2.) tailor the dose of the iodine - since a tailored dose is more likely to effectively treat the beast. While iodine typically has something like a 99% effectiveness, these people have had only 2 out of 500 treatments fail, and one of those “failures” was questionable.

If you can stand getting a third opinion, you might try calling Radiocat, and seeing if you can talk to a specialist. Express your concern about the kidney/thyroid determination, see if there’s anything they can tell you. See if they do any tests like the one I mentioned - and see if it too could be thrown off by kidney function.

Last thing, and this is totally IMHO: The lion’s share of the cost of iodine treatment is the actual iodine treatment itself. While the workups/exams aren’t cheap, they’re (I imagine) less than half the cost of the Iodine. If by spending the workup costs twice, you possibly eliminate the need for the iodine, then it’s worth it. And if you end up having to go the iodine route anyway, you definitively know that you’re applying the correct treatment. You’re spending money to make sure the “sledgehammer” is targetted correctly.

There ya go - hope it helps, and good luck with the little blighter!

(Incidentally, our kitty is doing GREAT. He too was “restless” pre-treatment, and was eating INSANE amounts of food and water. Post treatment (only a few weeks ago), his temperment has leveled off, his eating is “normal”, and we’re looking forward to several more years of his presence)

Gah - LTFT does have a decent point, though I feel that our specialist was genuinely interested in our cat’s health, and would have preferred not to treat an animal that wouldn’t benefit from the treatment. YMMV.

A call to the specialist might still be useful for information on any additional diagnosis they do (like that marker one I mentioned).

Thanks everyone. I hadn’t thought of going to a specialist, so that’s something I’ll talk to my husband about as well.

I really appreciate everyone’s help and good wishes.

Glad to be of help, Blue

After talking with my Fiancee, I have one more thing to add:

Hyperthyroid can mask kidney (and liver) disease, which means that even if the kitty has hyperthyroid, the other diseases can be at play. And if those diseases are in play, then the iodine treatment can seriously compromise the cat’s health.

So it’s not just a matter of mistreatment (treating for hyperthyroid when the problem’s in the kidneys), it can be dangerous.

What a month of the meds and retesting does is allow kidney and/or liver disease to show up in the panels - in which case daily meds is probably the best route for long-term care.

I don’t know if you were already aware of this distinction - I clearly wasn’t until I mentioned your dilemma to Misery’s Company

Again, good luck! Kitty get better soon!