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Dr. Bruce
Dr. Bruce, Veterinarian
Category: Cat
Satisfied Customers: 20161
Experience:  Small animal veterinarian with 15 years experience.
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My 15 yr old cat has a severe thyroid problem. She had a thyroidectomy

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My 15 yr old cat has a severe thyroid problem. She had a thyroidectomy last but is losing weight again. She hates taking tablets and we have decided to go for palliative care only given her age and the previous treatment attempts. She has lost a lot of weight and is now losing some fur. She seems otherwise fine, albeit permanently hungry. How do I know if she's in pain?
How can I best manage the end for her to ensure it's pain free and she suffers as little as possible - is it likely that she will just not wake up one morning or should I expect to have to call a vet to euthanise her?
Welcome. I'm Dr. Bruce and I've been a small animal veterinarian for over 15 years. Thank you for your question. I'm sorry to hear about this situation with Purdy. Managing a hyperthyroid cat can be a challenge. The surgery to remove the overactive thyroid tissue can be unsuccessful in some cases if all the overactive tissue isn't removed. In her situation, it would be prudent to make sure it is the hyperthyroid situation again by checking her levels. Could her current losing of weight be due to something else such as kidney disease? Diabetes? Cancer? Those would be other considerations. If she is truly hyperthyroid again, then one option for helping her that I don't know if your vet presented this is use of the methimazole topically. There are lots of cats that don't like to take the oral medication to manage their hyperthyroidism. These cats are good candidates for administering their medications twice a day on the tips of their ears with a medicated gel. Here is a good link on this.
As far as hyperthyroid cats, they aren't in pain from it. They are just in a negative energy balance in that they are burning more calories than they are taking in. This is where they always seem hungry and always losing weight. There isn't anything you have to do specifically for this disease as far as managing pain. The best thing you can do is to make sure that they have good access to food and are still getting lots of attention. Some will start to not groom as well so brushing their fur and making sure they aren't getting any skin lesions is important too. As far as will she just one day pass from this? Some actually may. They can have heart changes associated with it that can cause sudden blood clots that can make them pass immediately. If this doesn't happen, then they just progressively get weaker and more frail as time goes by. At some point, their bodies get too weak to function and it would be my recommendation to let them go when it gets to this point by having your vet euthanize her.
I would talk to your vet about the topical gel and see if that is an option there.
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