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I have a cat that 18 years old the last couple of years she…

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I have a cat that...
I have a cat that 18 years old the last couple of years she has been diagnosed with hyperthyroidism and has been on methimazole at 2.5 mg once a day we changed her frequency of the medication and I've been giving her 1.25 mg every 12 hours so it's still the same dose last month her T4 levels was at 3.2 since I change the frequency of the dosage I got her test yesterday and her T4 levels came back at .05 which means she's now in hypothyroidism plus she has renal kidney disease and her BUN and creatinine levels are skyrocketing what I need to know is several things how did her levels drop so significantly for her T4 should I continue not giving her medication according to what my vet said? And is her BUN and creatinine levels so high because of the fact that now her kidney disease is showing more since she's in hypothyroidism I'm very confused sad upset and I don't know what to do a lot of people that I belong to in the hypothyroidism group and kidney disease group on Facebook are telling me that to stop giving her medication and summer saying give her her medication my doctor put her on some subcutaneous fluids 50 ml every 2 days please help
Submitted: 1 month ago.Category: Cat Veterinary
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Answered in 18 minutes by:
12/30/2017
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 32,318
Experience: University of California at Davis graduate veterinarian with 45 years of experience.
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You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Customer reply replied 1 month ago
Ok ty
Customer reply replied 1 month ago
Hello I am still awaiting an answer and I prefer not to use the phone thank you
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago

I'm sorry to hear of this with Tiffy Marie. I believe that you're seeing evidence of non-thyroidal illness on her T4. This effect can be profound and the more severe the illness - in her case chronic renal insufficiency - the greater the suppression of total T4 concentrations. In these cases it's important to also perform a fT4 (free T4) which can also be suppressed by non-thyroidal illness but not to the extent of the T4. In that manner, we can determine just how to dose Tiffy Marie at this time. In general, I'll allow these cats to be slightly hyperthyroid as long as they're not hypertensive (has her blood pressure been assessed?) because mild hyperthyroidism is kidney protective. As you've seen, when we overtreat hyperthyroidism the true health of the kidneys is revealed and at 18 years of age there always is some degree of renal insufficiency. Please respond with further questions or concerns if you wish.

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Customer reply replied 1 month ago
If I can figure it out is there a way I can send you her lab work that I just got done on her because as I told or said her t4 level last month was 3.2 that's considered hyperthyroidism I got her tested retested last night and her T4 came back at .05 and now she's in hypothyroidism how is this even possible? The vet is telling me to stop giving her medication and her BUN and creatinine levels have skyrocketed I just don't know what to do she has me giving her subcutaneous fluids every 2 days at 50 ml kidney failure
Customer reply replied 1 month ago
Hello I am asking another question are you there
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago

You can scan the lab work into your computer and then give me the file link or you can photograph the pages and upload them by using the paperclip icon (if you can see that icon) or by using an external app such as dropbox.com/

Please review my post timestamped 07:35 (my time). I explained how the T4 can act like that.

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Customer reply replied 1 month ago
I'm sorry I am not computer literate is there a way I can email the copies to you I'm using my phone right now and the only way I know how to attach a link is why email I can try it on here where it says add
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago

I understand. Yes, please contact customer service at ww2.justanswer.com/contact-us or 1-***-***-**** for help in emailing.

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Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago

Thank you. Give me a moment to take a look, please...

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Customer reply replied 1 month ago
If you need additional information and you can't read this let me know but I'm basically asking you to focus on her T4 levels from last month to the other day as well as her BUN and creatinine levels from yesterday's results all the way back from July of 2017 to 2016 please let me know if you need additional information thank you so much
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago

Regretfully, those images are too out of focus to read. I can only comment on her T4 dropping precipitously at this time. Once again, here's what I said about this: "I believe that you're seeing evidence of non-thyroidal illness on her T4. This effect can be profound and the more severe the illness - in her case chronic renal insufficiency - the greater the suppression of total T4 concentrations. In these cases it's important to also perform a fT4 (free T4) which can also be suppressed by non-thyroidal illness but not to the extent of the T4. In that manner, we can determine just how to dose Tiffy Marie at this time. In general, I'll allow these cats to be slightly hyperthyroid as long as they're not hypertensive (has her blood pressure been assessed?) because mild hyperthyroidism is kidney protective. As you've seen, when we overtreat hyperthyroidism the true health of the kidneys is revealed and at 18 years of age there always is some degree of renal insufficiency."

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Customer reply replied 1 month ago
Okay I am totally confused what is non thyroid issue is this basically saying that she was hyperthyroid for a while and the medication brought her down to low and now she's not thyroidal issues but her kidneys are more extensive in illness and is it appropriate to keep stuff keep her off her meds Keep Her On fluids and just like you said get her free T4 done
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago

In her case her kidney insufficiency is the non-thyroid issue and is severe enough to suppress her thyroid gland's ability to produce T4. A free T4 test will give us a more accurate assessment of her thyroid state and tell us how to dose her more accurately. Most important at this time, however, is her kidney heath which I can't assess without seeing her test results referable to her kidneys. If her kidneys are functioning very poorly, she would need to be diuresed - at least 72 hours of IV fluids - and I would discontinue the methimazole until I re-evaluated her kidneys following her diuresis. Please continue our conversation if you wish.

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Customer reply replied 1 month ago
Since you're unable to read these Labs what specific tests do you want me to send you her numbers that were just taking on Friday I know her bun and her creatinine levels went skyrocketing even from last month to as way back in July of 2016 she obviously is in chronic renal failure but they just went skyrocketing as soon as her T4 levels drop down from 3.2 to .05 I can give you the numbers if you like me to
Customer reply replied 1 month ago
Her albumin level is 6.0 and it's considered above normal, her creatinine levels is 3.9 mg above normal, high protein level is 8.2 grams, her bun levels is 76 mg skyrocketing this is as early as Fridays lab test results. Her globulin levels is registers a zero. A T4 level is .05 now back in November it was 3.2. In July of this year her creatinine levels was .902 which is considered normal her albumin levels was that 2.5 her BUN levels back in July was 53 milligrams above normal then I also noticed that her lymphocytes and monocytes Willow are neutrophils was 83.5 back in July. What is confusing me tremendously is back in March of 2017 this must have been sent in lab her T4 level was .8 which is right at normal so how do I know if her levels was at .8 mg back in March which is normal now all of a sudden her levels grow skyrocketing so I'm going to assume and I'm hoping you can clarify this for me that when she was normal range and not in thyroid issues no hypo or hyper that they will continue to medicate her and it was affecting her other health issues
Customer reply replied 1 month ago
Yeah I am looking at her T4 levels back in March of this year her T4 levels was .08 which is considered non hyper or hypo so why would this doctor that I go to Keep Her On medications this sounds like they were trying to kill her I'm sorry because after her .08 levels they went up and up and up continually
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago

Thank you, ***** ***** need to see all of her test results. (Her globulin level is 2.2.) If 2.2 is high normal for creatinine on the machine used to test her blood, 3.9 over 2.2 would be 6.1 and that's classified as Stage IV (out of I - IV) chronic kidney disease indicating the need for IV fluid diuresis. I can only suspect that her vet didn't recognize that Tiffy Marie's kidneys were failing and that the dose of methimazole should have been reduced. As I mentioned above, keeping these cats slightly hyperthyroid is kidney-protective.

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Customer reply replied 1 month ago
There is no way I can send my lab results to you directly because if it goes customer service how do I know it's getting to you I don't want to publicize my records to everybody
Customer reply replied 1 month ago
All of this just doesn't make sense all of these regular Labs was were in house I wish I asked them to send them out but I don't know if they're going to read them me
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago

Customer service will only send the results to me. This is a public forum, however, and so if you want our conversation to remain private I can ask my moderator to make it so after our conversation is over.

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Customer reply replied 1 month ago
Okay I'm going to you said email link you sent to me send them over to you and just go from there
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 1 month ago

Sounds good. I'll watch for it. It can take 24 hours for customer service to do this. If you don't hear from me within 24 hours please return to this conversation and let me know.

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