• weight loss
• increased appetite
• vomiting
• excessive drinking
• excessive urination
• hyperactivity
• diarrhea
• the coat may look dirty and dull
• some cats have very rapid toenail growth or thick nails
• some cats display aggression
• a few cats (less than 10 percent) have decreased appetite, depression, and weakness

  In addition to the signs listed above, hyperthyroidism causes

• increased blood pressure
• increased stress on the heart: rapid heartbeat and strong heart contractions, or irregular heartbeat

  Untreated hyperthyroidism can lead to

• congestive heart failure
• kidney damage
• diarrhea that is very difficult to treat
• detached retina (due to high blood pressure) which could lead to sudden blindness
• death

Diagnosis
The levels of thyroid hormone in the body are measured by a blood test. Other blood tests and methods of imaging the thyroid gland may be performed. 

Treatment options
There are three treatment options available, and the method used will will depend on the pet. 

• Medication - to prevent the thyroid gland from producing excess thyroid hormones.  Methimazole (Tapazole) is a commonly used antithyroid drug.  Normal thyroid hormone levels are usually achieved in 1-3 weeks.  Side effects include anorexia and vomiting, but these often lessen with time.  It may be possible to decrease the dose to lessen the side effects while still maintaining proper thyroid hormone levels.  Additionally, some cats may become hyperthyroid again, even while taking medication.  Hospitalization is usually not required.

• Surgery - partial or total removal of the thyroid gland.  Normal thyroid hormone levels are usually achieved in 1-2 days.  Side effects include surgical risks, and hypothyroidism (low thyroid hormone).  The parathyroid gland (a different gland next to the thyroid gland) may also be removed or damaged, resulting in hypoparathyroidism.  Because hyperthyroid cats may have increased stress on their heart, they are usually started on antithyroid medication prior to surgery so the thyroid hormone levels are normal and the effects on the heart are minimized. The cat is hospitalized for 1-3 days.

• Radioactive iodine treatment - to kill the overactive thyroid cells.  Normal thyroid hormone levels are usually achieved in 1-12 weeks. This is considered the best treatment if a facility is available.   It is very low risk, but not all cats are candidates, particularly cats with other health problems that require them to be handled frequently.  After radioactive iodine treatment, the cats can't be handled right away because they must eliminate the radioactive iodine first.  This makes it difficult for a diabetic cat, who requires insulin injections, to be a candidate for radioactive iodine treatment.  Also, few facilities are available for this treatment, and the cat must be hospitalized for 1-4 weeks.

Considerations for Diabetics
Since both hyperthyroidism and diabetes are common in older cats it is often necessary to deal with both conditions.  Usually, the cat has one disease, which is being treated, then the second disease begins and must be dealt with.

If your cat is hyperthyroid first, you will probably have started therapy and gotten the thyroid hormone levels near normal.  Then if the cat then becomes diabetic, the hyperthyroidism (which is controlled) probably won't play a major role in the diabetes management.

The situation is a bit more complicated if the cat is diabetic, then becomes hyperthyroid too.  Since hyperthyroidism has similar signs as diabetes (increased appetite, drinking, urination, and weight loss), a cat that is diabetic who continues to show these signs may be thought of as just needing additional diabetes management care.  But the possibility of hyperthyroidism should not be overlooked.  Since hyperthyroidism causes a general increase in the body's metabolic rate, it will have an effect on the diabetes and diabetes management.  Often, a cat that is hyperthyroid requires higher doses of insulin in order to maintain the blood glucose levels near normal.  As the hyperthyroidism is brought under control, the metabolism slows to a more normal rate, and the insulin dose needs to be adjusted.  Pre-existing diabetes will probably have an effect on which hyperthyroid treatment option is used.

Personal Experiences
Although not all of these cats are diabetic, the experiences with hyperthyroidism may be valuable for you and show some of the options that are available.

• Barney - diabetic, hyperthyroidism treated with Tapazole
  Barney was diagnosed with hyperthyroidism 6 months after being diagnosed diabetic.  The hyperthyroidism was detected during a routine pre-anesthesia blood test (he needed his teeth cleaned).  His thyroid hormone levels were moderately elevated, and his heartbeat was faster than normal.  The teeth cleaning was postponed because the hyperthyroidism was placing a strain on his heart and that meant he could not safely undergo anesthesia.  Barney was started on Tapazole, 5 mg twice a day.  Shortly after starting Tapazole therapy, he started vomiting several times a day.  Since he is also diabetic, it is difficult to know if the vomiting was caused by the Tapezole, or if it was due to his diabetes not being well controlled, or due to some unknown reason.   But vomiting is not something you want with a diabetic because you need to try to keep their food intake as consistent as possible.  Barney's thyroid hormone levels were not extremely high, so the vet thought it would be ok to decrease his Tapezol dose to 1/2 a tablet twice a day.  He showed an immediate improvement and the vomiting stopped.  A follow-up blood test was done, and his thyroid hormone levels were in the low-normal range.  Barney has continued on this low dose of Tapazole.  Since the hyperthyroidism increased metabolism and had an effect on the diabetes, during the time when his thyroid hormones were returning to normal, we monitored his blood glucose levels to be sure he was not getting too much insulin.

• Midnight - FIV, IBD, hyperthyroidism treated with Tapazole
  Our cat who is on Tapazole had a very difficult time tolerating the drug. Because she is somewhat fragile and is FIV+ and has IBD, she wasn't a good candidate for the iodine treatment. We were finally able to reduce her Tapazole dosage down to 1/2 tablet every other day and still stay within the normal thyroid ranges. For owners whose cats can't handle daily Tapazole and can't have the iodine treatment or the surgery (which I hear is very tricky), giving the minimum dosage possible to stay within the acceptable range should be pursued.

• Desi - hyperthyroidism treated with radioiodine
  The radioiodine treatment is unbelievable! The worst part was having our cat stay at the facility for a week with no contact. She was very thin when she was released (she's a timid kitty, so I don't think she ate much) but regained her weight quickly after we got her home. The vet radiologist who did the treatment called us every night to give us updates. The first night he told us they were going to completely check Desi's heart, because he said that by the time many hyperthyroid cats are diagnosed, they have already sustained some heart damage, the worst of which is cardiomyopathy. Luckily, Desi was fine. The other bad part was that we had to keep her pee and poop for 2 weeks before disposing of it. I think this might be a California law, but it wouldn't surprise me if other states also had this requirement.

Resources

• Mar Vista Animal Medical Center Extensive information on the disease, treatment options, care facilities, and more.
• Feline Advisory Bureau Info Sheet - a bit dated, but good general information
• Cat Fancier's Assn. Health Committee. By Susan Little, DVM.
• Radiocat Radioactive iodine treatment
• Henry's surgery

References

• Pocket Companion to the Fourth Edition of Textbook of Veterinary Internal Medicine Stephen J. Ettinger.
• The Cornell Book of Cats : A Comprehensive and Authoritative Medical Reference for Every Cat and Kitten. Mordecai Siegal (Editor), et al.1997.
• The 5 Minute Veterinary Consult: Canine and Feline. Larry Tilly and Francis W.K. Smith, Jr. 1997.
• Veterinary Drug Handbook.  Second Edition.  Donald C. Plumb.  1995.
• The Well Cat Book Terri McGinnis, D.V.M. 1993.

Updated June 2002
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