Hyperthyroidism in Cats

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Hyperthyroidism in Cats

By: Dr. Michael Bernstein

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Section: Veterinary Care In-depth

Treatment In-depth

Treatment for feline hyperthyroidism may include one or more of the following:

Medical therapy with Tapazole® (Methimazole). Tapazole is a drug that interferes with the production of thyroid hormone by the thyroid gland; it does not affect the actual physical structure of the thyroid nodule itself. There are other related drugs available in Europe that can be used for the same purpose.

Patients receiving Tapazole must have their serum thyroid hormone levels measured periodically. They must also be monitored for any adverse reactions to the Tapazole; these reactions can include drug- induced anemia, low white blood cell counts and liver injury.

Treatment with Tapazole must continue for the remainder of the cat's life and the dosage may have to be adjusted periodically. Most cats tolerate therapy with Tapazole very well.

This therapy is also appropriate for cats with heart failure due to hyperthyroidism. This treatment, along with heart failure medication, controls the thyroid condition while the heart failure is "stabilized."

Therapy may include surgical removal of the abnormal thyroid lobes. For example:

For cats that don't respond well to medical therapy, or when owners prefer not to medicate their cats on a daily basis, thyroidectomy (removal of the thyroid gland) is a viable alternative. The advantage of this approach is that surgical removal of the abnormal thyroid lobe or lobes is curative. However, since approximately 75 percent of hyperthyroid cats have adenomas involving both thyroid lobes, a bilateral thyroidectomy is required to control the hyperthyroidism.

Following bilateral thyroidectomy, daily supplementation with thyroid hormone is required.

In addition, there is a risk of damaging or removing all four of the parathyroid glands, which regulate calcium levels in the cat's body and are adjacent to the thyroid gland. Damage to, or removal of, the parathyroid glands would result in serious medical consequences, requiring careful monitoring and therapeutic intervention.

Therapy may include radioactive iodine treatment. For example:

Radioactive iodine therapy (I131) is another potential treatment for hyperthyroidism. The advantage of this therapy is that it is usually a one-time treatment, does not subject the cat to the risk of anesthesia and surgery, has no need for long-term medication and follow-up care is usually not required.

The disadvantage of this form of treatment is that it is available only at facilities that are licensed to handle radioactive isotopes, and hospitalization of the patient for a minimum of 7 to 10 days is usually required in most states. Radiation safety laws in each individual state dictate length of hospitalization; these laws require that the patient be kept in isolation until the radioactivity from the isotope that was administered has fallen to a certain level.

Another disadvantage of this form of therapy is cost; however, although the initial cost may be significantly more than medical therapy, over time it is a very cost-effective means of treatment since, after successful therapy, there is no need for daily long-term medication or frequent visits to the veterinarian to monitor the patient.

Other medical treatments may include:

A new treatment that involves ultrasound-guided delivery of alcohol into the enlarged thyroid gland to kill the tissue has been reported, but requires further refinement to demonstrate safety.

Beta-blockers (atenolol) are sometimes used for medical therapy when a cat cannot tolerate Tapazole treatment. This therapy blocks some of the effects of thyroid hormone excess, but it is not an ideal treatment.

Follow-up

Optimal treatment for your cat requires a combination of home and professional veterinary care. Follow-up can be critical.

Administer prescribed medication as directed and be certain to alert your veterinarian if you are experiencing problems treating your cat. Optimal follow-up veterinary care for hyperthyroidism often involves the following:

Cats receiving Tapazole should have periodic examinations and blood tests to monitor the effects of this drug on the bone marrow and to evaluate for liver toxicity. This is especially important if your cat acts ill, loses his appetite or is lethargic.

Follow-up is rarely required for cats treated with radioactive iodine.

Cats treated by unilateral thyroidectomy need to be re-evaluated because it is common for the gland on the opposite side to become affected at some future time.

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