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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat
Satisfied Customers: 17099
Experience:  I am a small animal veterinarian with a special interest in cats and am happy to discuss any questions you have.
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I have a cat with hypothyroidism. He has been on 5mg of Methimazole

Customer Question

I have a cat with hypothyroidism. He has been on 5mg of Methimazole since the 5th February (applied in two doses of 0.05ml to the inside of his ear).
He is not eating much at all and is still losing weight.
Submitted: 11 months ago.
Category: Cat
Expert:  Dr. B. replied 11 months ago.
Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you with your wee one today. When was his thyroid levels last checked? Has his vet rechecked them since you started this treatment?Had it bloods showed any other issues (ie kidney disease, liver disease)?Any retching, gagging, lip licking or vomiting?How is his drinking? Same as before? Normal now or less? Are his gums pink or pale/white? Moist or sticky?If you press on his belly, does he have any discomfort, tenderness, or tensing?
Customer: replied 11 months ago.
HelloHis levels were last checked on the 5th when the medicine was prescribed. No the vet has not checked them since.He had no other issues when his blood test was taken. No organ issues.Yes, he vomits occasionally. Although this is starting to reduce and only certain foods would induce vomiting.He is drinking a lot of water. I would say he is drinking more than he used to.His gums are pink and they are moist.There does not seem to be any discomfort when pressing his stomach. He still likes it being tickled too.He seems relatively normal except for the loss of appetite and weakness caused by that and weight loss. Still alert and not especially lethargic. He's always been lazy in the winter.ThanksGeorge
Expert:  Dr. B. replied 11 months ago.
Thank you George,Now we do have some concerns for Bob's situation.To start, if his vet just started treatment at the start of the month, we will need them rechecking that thyroid level. The reason is because his continued weight loss is likely in part to that hyperthyroidism not being stable. This isn't uncommon in the early phase of treatment because we have to start at a low dose (to avoid overdose), recheck the level, and then adjust the dose until we get the perfect level for him. So, if he is still drinking loads and losing weight, the current does is likely too low to manage his individual overactive thyroid. And that would be something to recheck at this point so we can make those adjustments for him.That said, the appetite loss is a major concern and doesn't fit with his being hyperthyroid. Instead, often we see it linked to kidney troubles (which can be masked on bloods when cats are unstable with their hyperthyroidism) once we start treating the thyroid. Though if all his bloods were otherwise normal, we'd hope that'd not be an issue for Bob. And in that case, we'd be most wary of this being due to an opportunistic infection taking advantage of his delicate state. So, again this will be something we'd want checked when his vet is open. Though for the meantime, we'd want to keep tempting him to eat for us. You can use favorites or try bland options like boiled chicken, boiled white fish, scrambled eggs, or meat baby food (as long as its garlic/onion free. If he did seem a bit nauseous, you can consider giving a small dose of OTC calcium carbonate (60mg every 12 hours) but can hold off if he just seems fussy at the moment.Overall, based on Bob's situation, it does sound like we have an early stage stabilization situation where he isn't at the ideal treatment dose yet. So, we will want that thyroid level rechecked and the dose adjusted as needed. Otherwise, we do need to tread with care with his appetite loss since that is most suggestive of an opportunistic bacteria or virus deciding to bombard his immune system since it is weakened by his current thyroid instability. Therefore,we'd want to use supportive care to keep him eating until his vet is open and then have these checked and addressed for Bob. Please take care,Dr. B. -----------------------------------------------------------------------------------------------------------------If you have any other questions, please ask me – I’ll be happy to respond. *Please remember to rate my service once you have all the information you need, as this is the only way I receive credit for helping you today. Thank you! : )
Customer: replied 11 months ago.
HelloLast week he seemed to have improved and was eating much more regularly and increased amounts and was basically eating anything you would put in front of him (which is like he used to be - he was always fussy with cat food but with meats he would eat basically anything). But then at about Thursday last week his appetite subsided again. Would this tie in with the hypothyroidism not being stable?I got him to eat raw chicken and raw trout yesterday but my concern is that giving him too much of these will cause him to vomit and thus not get anything at all. I suspect it's the smell of raw things that entices him to eat, but again my concern is giving him too much of these things will make him vomit. He is eating a small amount of wet cat food but it's not enough.I wouldn't say he is nauseous.
Expert:  Dr. B. replied 11 months ago.
Hi again,It wouldn't directly tie to that because hyperthyroid cats tend to be polyphagic or have excessive appetites. So, a poor appetite is a rare occurrence for these cats and thus why those other concerns are what we'd be wary of. In regards ***** ***** raw, if he will have it then do offer it as small meals spread over the day. That way we get food in and avoid over stressing the stomach. Otherwise, you can try warming his usual foods or even offer kitten food (since it has more nutrition per bite and will get more into him despite his not eating much for us).All the best,Dr. B.-----------------------------------------------------------------------------------------------------------------If you have any other questions, please ask me – I’ll be happy to respond. *Please remember to rate my service once you have all the information you need, as this is the only way I receive credit for helping you today. Thank you! : )
Customer: replied 11 months ago.
Yes I have been sure to spread the raw food out so he doesn't vomit.Will I be able to ask you a few more questions a bit later on today? I am just about to head out.
Expert:  Dr. B. replied 11 months ago.
Hi again,Perfect, I am glad that you have been. And you are very welcome to send questions later today as needed (the question thread stays open for a week, so we can continue to discuss Bob's situation even after you have left feedback). I will be on/off the computer (on call this weekend) but will answer you as soon as I can. :)Dr. B.
Dr. B., Cat Veterinarian
Category: Cat
Satisfied Customers: 17099
Experience: I am a small animal veterinarian with a special interest in cats and am happy to discuss any questions you have.
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Customer: replied 11 months ago.
Hello againI am sorry to bother you once more but he has not improved after another dose of antibiotics. He has some sort of obstruction in his digestive system. It seems to be before his stomach judging by the wholly undigested state of the small amount of food he has eaten and had subsequently thrown back up again, many many hours after eating it. We are going to get him put to sleep today unless you think examining him with an endoscopy or xray etc is worth it? What things could cause an obstruction? As i said before he seemed to be getting better and had stopped vomiting and was keeping food down a week or two ago after he got his thyroid medicine and antibiotic shot. But he has now deteriorated again. In your experience would that be evidence of a tumour? He is still walking around but is very weak. He isn't even miowing like he used to.What would you recommend?Many thanks
Expert:  Dr. B. replied 11 months ago.
Hi again,If he isn't vomiting the food right after he takes a bite and is doing so hours later; that rules out esophageal obstruction and we'd have to assume the food is making it to the stomach but not further. At his age, this could be due to a blockage (ie non-edible item, hairball, mass) but if the vomiting worsened after antibiotics were given, then its possible they are the root of his nausea. So, you may want to consider giving him a 24 hour break from the antibiotics +/- having his vet dispense an antacid or anti-nausea medication to see if he settles. If he is a cat that does groom a lot or we wanted to rule out a small foreign body, you could even give him a few doses of cat hair ball treatment to push anything there out of the stomach. If you try that and he settles, then it may have been one of those more benign issues. But if he doesn't, then we'd have to think about whether we would put him through surgery or treatment if a mass or something was blocking the stomach outflow. If we would, then those further tests are worthwhile. If we wouldn't and cannot settle him with medical management, then we'd have to think about letting him go.Please take care,Dr. B.
Customer: replied 11 months ago.
HelloHe got better, not worse, after the first anti-biotic injection and the thyroid medicine and was able to keep food down and his appetite increased but then got worse again after about a week of improvement. Now after this second shot he has not gotten any better. He does try to eat when I tempt him with something smelly like liver or fish but as I said it just doesn't stay down.He is very thin, he hasn't eaten properly since last week and has kept nothing down since last Friday as far as I can tell.
Expert:  Dr. B. replied 11 months ago.
Hi again,I appreciate that his initial improvement didn't last, but as we discussed he likely still needs stabilization on the thyroid front and not just more antibiotics. In any case, at the moment, we need to address the nausea that is triggering his vomiting no matter which issue is underlying. So, we want his vet to treat for that or at least put him on an antacid now. If he settles with that, then we have wiggle room to see if we can get him feeling better. But if we cannot settle the vomiting and get him eating, then further tests and such are not going to be helpful.Dr. B.

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