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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 30288
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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2 months ago a blind stray ginger male cat wandered into my

Customer Question

I need an urgent reply please. 2 months ago a blind stray ginger male cat wandered into my conservatory, he was so thin, I could feel all his bones, I called him Danny, and I feed him up, took him to vets she said he was over 10 years old, no microchip, and he had hyperthyroidism, he had blood tests and his thyroid level was 255,very high indeed. he was put on 15mg vidalta, and after 3 weeks, his level was at 134. the vet then put him onto 2x10mg vidalta = 20mg per day to get his level down quicker. Now after a month on these 20mg, his level is too low at 3.86. I believe it should be between 7.5 - 55 ( Is this correct?) I was shocked to learn it had got so low, as I felt I had been harming the poor little mite, who has been so good at taking his medication, he will never be able to see again, but I do want to do my best for him in his later years, he eats well, never leaves anything, but drinks a lot of water, that he now has a dogs bowl. The vet has put him back on 15mg vidalta, and that has concerned me because surely this will just make his thyroid level dangerously lower still? I just need a second opinion on this for my own peice of mind. Is he ok with these 15mg or would 10mg have been better? Please, please advise. Danny has already cost me £300 in 2 months, so much money and I am a pensioner. Kind regards ***** *****

Submitted: 2 years ago.
Category: Vet
Expert:  Dr. Michael Salkin replied 2 years ago.
Aloha! You're speaking with Dr. Michael Salkin
Patricia, the normal range for thyroxin (T4) is 12.9 nmol/L to 51.6 nmol/L in most labs; however different labs have different normal ranges. The newer Vidalta (a sustained release brand of carbimazole) is designed to be administered as a maintenance dose of between 10-25 mg once daily.

3.86 nmol/L was certainly too low; twice daily administration of a once daily drug wasn't wise but isn't expected to be harmful to Danny. Now that the 15 mg is being given once daily as is indicated, Danny's T4 level is likely to be in the normal range. The only manner in which to determine that, however, is to repeat his T4 test 2-3 weeks after his return to the 15 mg once daily dosing. If his T4 level were still too low, he could be dropped to 10 mg once daily.

Please respond with further questions or concerns if you wish.
Customer: replied 2 years ago.

Aloha Michael, Are you in Hawaii? Thank you so much for your reply, I shall now give Danny the 15mg Vidalta tablets knowing that I will not be doing him any harm, I had asked the local vet to give me a print out of his blood results to read later at home as I did not have my glasses with me when I got Danny's results. This is what it states:-

Total T4 3.86 nmol/L 7.5 - 55.00.

Urea H 22.9 mmol/L 6.1 - 12.5 So this seems out of range too, whatever it is?

Creatinine 166 umoll/L 45 - 170

ALT L 4 u/[email protected] 18 - 77

ALT 33 u/[email protected] 11 - 67

Are these readings Ok Michael?

You have put my mind at ease regarding the Vidalta 15mg tablets, its a shame you are not my local vet.

Expert:  Dr. Michael Salkin replied 2 years ago.
Not currently; I split my time between the big island of Hawaii and Rancho San Diego, California. Have you seen the lava flowing toward Pahoa on the news? I lived just a few miles from there.

The urea and creatinine are indicators of kidney function. Danny's elevated urea and almost elevated creatinine are worrisome for kidney insufficiency. I would need to see a complete urinalysis, serum phosphorus, sodium, and potassium as well as a hemotocrit (red blood cell count) to be more accurate for you. It's important not to overdose hyperthyroid cats when kidney insufficiency exists. Keeping such a cat mildly hyperthyroid can protect his kidneys. His blood pressure should be taken as well because both hyperthyroidism and kidney insufficiency can cause hypertension which then can worsen his kidneys further.

Thank you for your kind words. Repeat his T4 after 2-3 weeks at 15mg daily. Alter the dose, if necessary, to keep Danny in the high normal range of T4!

Please continue our conversation if you wish.
Customer: replied 2 years ago.

Hi Michael, the only other results on the print out are:-

Calcium 2.5 mmo1/1 1.6 - 3.0 (that seemed to be in range so didn't mention before)

Phosphate 1.8 mmo1/L 0.7 - 2.1 (again this seemed in range so didn't mention

I will ask the vet to monitor his blood pressure when he goes for his next bloods, I do hate putting him through the stress of going to the vets, the poor little chap was shaking and meowing so much last time, and he's not a young chappie anymore, I wonder if I am doing him more harm than good with all the trips to the vets!

But yes, I certainly would like you as my vet, I feel more reassured by your replies today, than the last two (very expensive, welcome to England!) months spent attending my vet.

Splitting your time between Hawaii and San Diego sounds amazing, one of my girls has been to both those places and loved it so much, She adores America, been about eights times, she also did Trek America from East to West coast, camping out. I haven't seen the news about the lava flow, I will check that out on the net. I want to thank you so very much for your expect advise Michael.

Kind regards ***** *****

Expert:  Dr. Michael Salkin replied 2 years ago.
Those values are good which is a positive prognostic indicator. I understand your concern. It's important to to keep our cat's quality of life in mind before any testing or treatment is provided.

Your daughter is very lucky, indeed. She sounds as if she might be my neighbor some day!

You're quite welcome. I'm going to check back with you in a few weeks for an update. Feel free to return to our conversation - even after rating - prior to my contacting you if you wish.
Dr. Michael Salkin and other Vet Specialists are ready to help you
Expert:  Dr. Michael Salkin replied 2 years ago.
Thank you for your kind accept. I appreciate it.

I'll speak to you soon.

Please disregard the info request.