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Why is my cat eating so much and losing weight?
Dr Barron and Ellen will discuss one possible reason – feline hyperthyroidism
Anyway, today we’re going to talk to you about hyperthyroidism. Feel free to ask questions as they pop up. We have a special guest on the other side of the room who’s going to read them to us so I don’t have to squint. So, first things first, what is hyperthyroidism? Why did we call this metabolism overdrive?Well, unfortunately, when it comes to feline hyperthyroidism, the ongoing joke here in the hospital is like, that’s the perfect diet, because basically it’s because your metabolism is in overdrive, but that’s not necessarily a good thing, because when your metabolism is in overdrive a lot of your other organs tend to get stressed. So, unfortunately– it is a treatable condition, but a lot of times, by the time we see a hyperthyroid cat sometimes their symptoms are way far out, and the doctors need to be doing a little bit more treatment than what everybody would prefer. And so this brings back the reason why we like to see our older kitty cats twice a year so we can kind of keep track of the trends, and to find out how their metabolism is actually performing for them. Because one part of their lab work is a routine thyroid test to make sure that they are not starting to fall into this hyper metabolism trend.So, as Ellen said, this is sort of like it’s a joke where it’s like, “Oh, if I just need to lose a couple pounds, I could just take some thyroid hormone, and there you go,” but it puts way too much stress on your heart. Unfortunately, cats with hyperthyroidism, if it goes untreated, they will develop cardiomyopathies, which is a fancy way of saying heart disease, and other issues crop as well. So, as Ellen was saying, we like to do blood work, we like to check a thyroid level at least every year. If a cat’s losing weight or having some other clinical signs, we like to do it twice a year. So let’s jump into those clinical signs. My favorite hyperthyroid story was not from this clinic but from a previous job when I had a skinny cat who couldn’t stop eating and he was eating his owner’s red dreadlocks, and the owner brought him–Were they fake dreadlocks?No, they were real. And he brought in his cat because his cat was so thin and bothering him and keeping him up all night because he was eating his hair. So what you usually see–What you usually see is you see an older skinny cat that’s eating a lot but still losing weight and is kind of hyperactive and running around. And some of them start yelling a lot, because hyperthyroidism causes you to have high blood pressure, and they’re just kind of excited. And I always think of them of kind of having big eyes, because they’re running around like, “Ah.”They are hyperactive is basically what it is because metabolism is in overdrive, and these poor cats are so calorically deprived that they could eat all day long and still be starving. So I mean we’re talking about the typical household cat maybe can get 250 calories per day, the active cat up to 350. A hyperthyroid cat can eat up to 1,000 calories a day, and still be hungry.Yeah. They just keep eating, and they have a great time with it. They’re like, oh, and they still lose weight, and you’re just like, “Man, how long was I at the gym yesterday? I lifted and I’m–” okay, fine, I’m not going to take my thyroid hormones.Right. But it does take a lot for an owner to recognize the subtle signs and symptoms of it that, “My older cat suddenly is a little bit more talkative during the night, in the evening. He seems a lot more hungrier than usual.” They pester you all the time when they’re chronically hungry. And if the cat keeps going back into the kitchen and you’re noticing your cat not putting on weight. Then, well, that’s a problem so most people don’t really notice their cat losing weight. That’s one of our biggest issues that we have here is sometimes we’ll see the older cat and be like, “How could you not notice your cat has lost four pounds in a couple months?” Well, because you live with them every day.And you pet them and maybe until they started losing some muscle, over their spine, you don’t notice because I don’t play with my cat’s tummy that much. I mean, you play with your cats’ tummy but I don’t play with my cats’ tummy. He doesn’t like that.Right. But the biggest thing we’ll get is like, “Well, he eats. He eats all the time.” Well, then your cat should be blowing up like a balloon if he’s eating all the time. But if your cat is at the same weight or even losing weight, yeah. The doctors are probably going to be like, “I think I already know what’s going on here, but let’s check everything to make sure everything else looks okay at the same time.”And we’re not going to talk about all of the rule-outs for hyperthyroidism and all of the different ways that it can rear its head. But if I were an older cat this is the disease I would want because not only are there two ways to treat it, but there’s two ways to cure it. So we’re going to go through all that. But first off, the most important thing to do, as Ellen already mentioned, is your cat needs to be seen by the vet. If you think any of these things are happening, you need to come in. We need to weigh your cat. We need to listen to your cat because there are other things that could be going on. So let’s say we made the diagnosis. It’s very classic. This cat actually read the book unlike every other– oh, look at Benny. He’s so handsome.Oh, is he cleaning himself?He’s so handsome.He’s perfect.So anyway this is a classic cat, read the book. They never do that. We’re all excited because we’re like, “We can help you. So let’s help you.” So let’s talk about the two ways to treat the cats first. So, the easiest way– I brought a prop. Thank you, Olivia, for getting me a prop. The easiest thing is if your cat will eat YV that’s all you have to do.And there’s one downside to this food, I hate to say that. This company used to make cat treats for the YV cats, okay, because they are only allowed to eat this food and this food only and nothing else and it’s very pitiful to see the poor little pussy cats going around going, “I can’t have treats or temptations or anything else anymore?”, because you have to eat this boring YV food all the time. So, Hills Prescription Diets, can you please look into making some treats for our hypothyroid kitties.What some people do is they’ll–Petition.–bake them. They’ll bake them, like the wet food into like different things.Yeah, but those are like the cool cat people that are brilliant.Yes, they are not the people who just buy them lightly.I mean, who wants to– imagine baking cat food [laughter] in the oven.People do that. It’s very great, I think they’re fantastic. So, anyway, you can just feed them YV. Bam, that’s it. My perception is 50% of the cats will do this, and that’s it.How well do you think their food works?I think it works pretty well. If it’s not a super, super, super hyperthyroid cat, so if your T4 is not in the double digits, or even in the high, like in the high nines, I think it works. Will it work forever? Probably not. At some point, we’ll probably have to add something else in with it, but I think overall it works if the cats eat it. The problem is, most people don’t have just one cat, so if you have another cat in the house you have to feed them a different diet. I know they say you only need one teaspoon or one tablespoon of regular cat food per day to make sure their iodine’s appropriate. You can look at some of our other lectures or talks, these coffee talks we’ve done, where we’ve talked about feeding multi-cat households to try to figure out things with that. However, in general, my thing is, the easiest thing for me and my cat is what I will do. And if my cats were hyperthyroid and I wasn’t going to do I-131, I would just try to change their diet, because no matter what, I will feed my cats every day. That’s not going to change any part of our routine. So, to me that’s the easiest thing. If your cat will eat YV, that’s that.And unfortunately, there is no over the counter diet currently to treat hyperthyroids.It’s expensive. The food’s expensive, but it treats a disease, so you don’t really have a choice. And they had to do a lot of research to do those.Yep.All right, so the second way to treat–Is medicating your cat. And there’s a few ways to medicate your cat. We can do pills, we can do liquids, we can do, at times, transdermal.And compounded treats.And compounded treats. This is actually one of the transdermal gels that do tend to be successful. A lot of people are big into the transdermal medications, but you have to remember that some of the transdermal medications don’t work properly because it depends upon the size of the molecule of the drug that can be absorbed through the skin. And fortunately, methimazole and Tapazole are one of the drugs that can be readily absorbed on the inside of the ear of the cat, and that’s typically the where the medication is applied. The downside of the transdermal medications is that a lot of people fail to remember that you have to wipe the old medication off before you apply the new medication, or else you’re just caking on this waxy substance, and then your cat is not going to get the appropriate amount of medication they need. So, one ear is used for the morning, the other ear is usually used for the evening, and you have to make sure you wipe the old medication off before you apply the new medication, because you can be overdosing your cat, or underdosing your cat. So it’s important to do a lot of hygiene maintenance on your cat when you do that.Yes.So a lot of people tend to either go with the liquid route, the treats, or the pills.Yes. Also the transdermal just doesn’t work as well as the orals, period. It works. Doesn’t work as well. So it might be enough for your cat. It might not. Hi, mom. This is what my cat, Meshuganah, has. She’s hyperthyroid. I’m glad my mom’s listening, because this is about Shugy. Hi, Shugy. Anyway. So, this is a medication that’s given twice a day, and we have to check to make sure your cat’s at the right level. So usually, what we do is we start them on the medication and then they have blood work about three to four weeks later. Then, if we have to change their dose, we’ll change their dose. And check again three months later. Our practice, here, is that we check them every six months–Once they’re stable. Yes. Absolutely. Once they’re stable, we have to see you every six months to make sure that that’s the appropriate dose you should be on, because we’ve had some pets that come that we’re like, “Oh. You’re really underdosed.” Or, “Wow. You’re really regulated, this dose is too much for you.” So the doctors actually have to dapple off on some things for your pet. So it’s really important that you just don’t say, “Yay. My cat’s hyperthyroid. Yay. I got this medication. See you in a year.” It doesn’t happen that way.The other reason you might say, “Hey. Why do you have to do blood work to make sure they’re on the right level?” Is because methimazole can be toxic. It can negatively impact the liver and it can also deplete all your white and red blood cells. Which is really bad. So that’s why we have to not just check the thyroid level. We have to check the thyroid, kidney, liver, and the red, and white blood cells. The other problem with hyperthyroidism is it acts like a seesaw with kidney disease. And since most cats will get kidney disease, because they just do. Because they live longer. And they eat a lot of protein. And they crap out their kidneys as they age, since hyperthyroidism goes like this with it, once we start lowering that thyroid level, that 1/3 of cats, which we can’t always predict, will start having kidney disease. So we need to monitor that because if they also have kidney disease– I’m not saying kidney disease isn’t something to be worried about. Hyperthyroidism, if they’re uncontrolled, will likely hurt them faster. So we have to get that under control and kind of see what all the levels are at. So it can be frustrating and it can take a while to get them under control. And some cats can have an allergic reaction to methimazole as well.Right. Typically they’ll get a very itchy swollen face. So a lot of times they’ll just be scratching at their face the whole time. And once they start that other drug–it happens pretty quickly. Usually within the first few days. And if that happens, we stop that immediately and then we go, “Well, now we have to think about the other routes of treating your cat”.Yep.Which your lucky because there’s actually the really cool–Yes.–cure that’s kind of coming out.So we’ve covered the two ways to treat. Now were going to cover the two ways to cure. The first way, we’re going to talk about and we’re going to throw it out the window. But we have to be thorough because were thorough people. So they can have a thyroidectomy.Which we actually do here when the cats are not able to have the other forms of treatment.Yes, once in awhile it makes sense for the cat. Most of the time it doesn’t, so that’s why we’re not going to go through it. Most of the time we aren’t going to put your cat under anesthesia to do surgery unless we need to. And if there’s reasons to not do it then we won’t. So most of the time we choose one of the other three options we’re going to talk about. So that was the first way to treat. The second way to treat, which is why my cats have cat insurance, is for radioactive I-131 treatment. Your cat will go away to a place–And come back a superhero!Yes, it’s amazing [laughter]. And what happens is they’re treated with a radioactive substance. They’re there for three days, they come back–Yep.You have to collect all of their excrement and either put it in a box or something, for like a month or you just flush it down the toilet. They’re technically not supposed to cuddle with you or sleep in bed. If anyone’s immune-compromised or if anyone’s pregnant, I wouldn’t recommend doing this because you have to be careful with other people in your house. And then after that, we check them at the one-month mark, the three-month mark, and then every year. And that’s it. There’s a very low percentage based on where you go to, which facility you go to, on recurrence. It is expensive up front because we have to do x-rays, and blood work, and urine. And they’re very very adamant about us trimming their nails. That’s a big deal.I know. That’s like the biggest thing, it’s like, first thing on the block is trim those nails.And it’s highlighted.And it’s like, “I am not seeing you for a month. They’re going to grow back by then. Don’t you have a pair of nail trimmers there?” Apparently they don’t. So they might have to come back and get their nails trimmed the day before they go.Well, we’ve never had that request. So I think we’re okay.I know. So hopefully that’s pretty good. But yes. It’s kind of funny to see the requests that they put on there is just, “Nail trims.”But I guess if I was just dealing with cats in cages [laughter], I would want their nails trimmed too. I could understand that. So they go away to this facility and then they come back. And they are treated. There’s a very low percentage of it reoccurring. If it is, they give you a discount the second time. And depending on your lifestyle, it might be the best bet because then they’re treated and that’s that. Especially if it’s a younger cat and usually when we say this is a disease of older cats. It’s usually, I would say, 12 to 15. So I would say if your cat’s younger, especially, this is a life-long disease. Hopefully, you have your cat for many years. And I think the last time we crunched the numbers about two years of methimazole and lab work associated with it on average is about the cost of I-131 treatment. So I think it’s worth it to do [crosstalk].Right, for ten days of a headache, it’s definitely worth it for a lot of people. And that’s why we always say get pet insurance on the younger animals because it does pay for it in the end as they do get older.For certain things, it doesn’t make sense. If you have an older cat already it doesn’t make sense. But the reason my cats have it is in case they become hyperthyroid, because they don’t give vets the best discount on it. Which I understand because it’s expensive. You’re dealing with radioactive materials, everybody has to be specially trained etc. So I know, I am saying that the cat is treated with radiation, they are radioactive, this is something not to just kind of be blase about–No, they even use a Geiger counter, they go–Yes.They check them and everything all the time. Make sure they are safe to go home. And then they will escort you out of the building, out of another door, because they don’t want you near any of the other clientele.Right. Which is how it should be. But that being said, to me this is the easiest way to deal with this disease, unless your cat will just eat the food. If your cat just eats the food, that’s it. Bam. I feel like, when we have a can of YV and they eat it I’m like, “Done.”Yes, then someone finally eats the y/dDone.Prescription foods tend to have that weird thing, cats love it or they hate it. And we have some cats that love the y/d, and then some cats will go home with a case and the client comes back with a very sad face a couple of weeks later saying, “My cat will not touch it,” and it’s like, “Oh, well now we need to do something else for you.” Unfortunately, it does happen.Yes. So again, we like hyperthyroidism because we can treat this. It is not like some older diseases of cats that we can’t treat. Also, things like kidney disease, it’s frustrating, it’s chronic. Hyperthyroidism can be, but most the time there’s a lot of things we can do about it to try to help. So the way we talked about the disease and how we treat it is, we can give them methimazole or they can eat the food, or we can cure it by doing either surgery, which we don’t do that often, or they can have I-131. Besides for that, I don’t have anything else to say, except one of the cons, which I didn’t mention earlier, of the I-131 treatment is once it’s done, it’s done. So if your cat is one of those 33.33333% of cats that becomes– that does have kidney disease that’s being masked by hyperthyroidism, there’s nothing we can do to reverse it. Because it’s treated for hyperthyroidism. Now would I rather them have kidney disease than hyperthyroidism? Probably, because it’s not going to hurt you as fast.Right–Most of the time.–especially with the heart. Hyperthyroidism is a silent heart disease issue that’s waiting to kind of fester and show up with some issues. It’s one of the reasons why if we do have a hyperthyroid cat we usually will say, “We need to get this under control first,” before we’ll do an elective procedure such as a dentistry–Right.–or a groomer, etc. because we don’t want your cat to become cardiac depressed during–Right.–some of our procedures that we can do. Because it is anesthesia and sometimes we do notice the cardiac problems arising in some of our patients that are difficult to work with that need to be sedated. And sometimes we’ll pick up things that are wrong here. We get the lab work back, and a lot of times, some of them do come back hyperthyroid. And the only way we found out was– is that heart didn’t sound right under anesthesia. Or their ECG didn’t look right under anesthesia. So these are the things that we pick up and we can finally be like, “Okay, now we have a cat that might have some cardiac issues in the future because of it.”Yep. It’s just important before we put you under anesthesia that we know your heart’s okay.It is important [laughter].Yeah.If that stops you’re screwed.Yeah.Unfortunately. One thing I did want to touch base on was when we were talking about lab work. There’s this one test that everybody gets really confused about and it’s called the free T4 test.It’s not free.It’s not free.It’s not free.It doesn’t mean it’s free as in zero dollars free.I wish it was, that would be great. It’s expensive.Explain what a free T4 is, so everybody understands it. And that doesn’t mean dollar signs.Sure thing. So there’s total free– there’s total T4, which is all of the thyroid T4 kind of structure in the body. And then there’s free T4. So there’s bound and unbound. The unbound is called the free T4. This tells us if you’re actually hyperthyroid. So if your T4, your total T4, is in the gray zone, which we say on our scale is between 2.5 and 4.0, then we will add an additional test or recommend that you add an additional test. Or say, “Let’s check this again in six months,” because some cats can take up to six months to a year to become hyperthyroid. So if this additional T4 test, which is the free T4, which is by equilibrium and dialysis, which is a long procedure that we’re not going to go into how they get that. If this extra test is over 50, then we know that your cat’s actually hyperthyroid. Just like hormones in our body, hormones in cats can change, and it can be very frustrating. There’s some people that think you need to test the T4 throughout the day to get a curve. I don’t think you do. I think that, for me, if your free T4 test is normal, then I would just say, “Let’s check it again in six months or sooner if your cat starts to lose weight or eats a lot or has any other strange sign whatsoever.” Once in a while, which we didn’t talk about, cats can have something sort of called a thyroid storm, which is when they just sort of go all out. They act like they’re dying. None of the things I’ve said in this talk so far sound like that. Once in a while there’s a cat that just strung– laying on it’s side. Looks like it’s [having?]–And it could have been fine a few days beforehand.Or even that morning. And it looks like it’s dying. And it’s a T4 storm or a thyroid storm and it is an emergency. They have to go to the emergency room. I had one cat here. I can’t remember the name of the cat. The owner was so nice and then they moved, and I was sad they were moving because I really liked them. But the cat was at SouthPaws for two days, they did a great job with it. And it was a T4– or it was a thyroid storm. And it doesn’t look like– it just looks like they’re sick or having a cardiac issue. And it’s actually the thyroid hormone issue. So it is something that can be very life threatening and serious, but again as we have stated a couple times, we like this disease because we can do something about it. Our hands aren’t tied and we can help them feel better. So if anybody has any questions or concerns we can take them now. I see that Steve came on. Hi, Steve. I see Dr. Brown is back from his travels abroad. I hope you brought us goodies that would be nice.I know. British chocolate is the best [laughter].All right. Well, if nobody else has any questions, thanks for spending this time with us. Again, we talked about hyperthyroidism, the ways to treat it, and the ways to cure it, and our recommendations based on that. If we can ever help you again just let us know. Feel free, if you have a comment below, just send us a comment. If you have a question, comment below. If you’d like us to talk about a certain disease or topic about your cat, feel free to mention it because we are happy to talk about what you want to hear. So hopefully, we’ll see you again next Wednesday. Have a great one. Thank you.Bye, guys.