Hyperthyroidism in Cats

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Hyperthyroidism is a term used to describe an overactive thyroid gland. There are two Thyroid glands located within the neck. The exact mechanism is unclear, but these glands become enlarged and start to release excessive thyroid hormone. Thyroid hormones play lots of important roles in the body but their regulation of metabolism is most significant. 

Hyperthyroidism is a very common condition in older cats. The typical presentation includes a cat which is eating excessively but losing weight. Other common signs include vomiting, diarrhoea and excessive drinking. Cats can also have a hyperactive demeanour, increased restlessness, an unkempt hair coat and increased vocalisation.

Without treatment cats will continue to be excessively hungry, thirsty and lose weight. This isn’t necessarily painful for them but it can impact on their quality and length of life. Thyroid hormones can also stimulate the heart muscle; with prolonged exposure this can lead to significant heart disease which can have more serious consequences.

So How Can We Manage Hyperthyroidism?

Radio-iodine treatment

The gold standard treatment for hyperthyroidism is radio-Iodine therapy; it has high rates of success and can significantly increase survival time. It involves an injection of radioactive Iodine which targets the affected thyroid cells. It is important to ensure that this therapy is appropriate for your cat and that any other illnesses are stable and well controlled. Specialist centre’s have to perform this therapy and your cat will require at least a 2 week stay in most of these facilities. Once at home there will be a period of time where their urine and faeces is still radioactive and must be handled safely. We have had a few of our own patients visit the Hyperthyroid cat centre with really good results. Due to it’s specialist nature this treatment can be expensive and may not be an option for those cats that are not insured.

Oral medications

In many cats we start long term oral medications. These work by reducing the production of thyroid hormones. Medications come in both tablet and liquid formulations and are generally given twice daily. Initial stabilisation and control of the thyroid level can take a couple of weeks and requires repeated blood tests during this time. Once we have found the effective dose you should see an improvement in your pet’s clinical signs. For example, their appetite and thirst should normalise and they should put on weight. Long term monitoring of your cat’s thyroid level is continued, this is based on how they are doing at home but the general recommendation is every 3-6 months. Of course, administration is a big factor to take into account when selecting this option.

Surgery

It is possible to surgically remove the affected thyroid gland. Firstly, we have to make the decision whether a general anaesthetic and surgical procedure is appropriate for the patient. Some cats will present unwell and many will have concurrent kidney and heart disease therefore surgery is often not the treatment of choice. Some cats will also have ectopic thyroid tissue; this is an abnormal piece of thyroid tissue located elsewhere in the body, its presence means that surgical removal of the normally located glands may not completely resolve your pets clinical signs. Your cat will also require stabilisation on oral medications before embarking on the surgery. In the surgery, the affected gland is removed. However, it is common for the remaining gland to later develop the same condition and so multiple surgeries can be required. Post surgery, there can be the risk of low calcium levels; the parathyroid gland which regulates calcium is closely situated to the thyroid gland so can be disrupted during the surgery. As you can see, there can be lots of things to consider and on a whole surgery is not something we generally recommend for our patients.

Diet

Iodine is required to produce thyroid hormones. Therefore, restricted Iodine diets have been formulated to help manage this condition.  Only this diet must be fed for this to be effective. Limitations arise with fussy cats that won’t consistently eat the diet and this approach is not really suitable for outdoor cats that can hunt and eat elsewhere.

Key Hole Bitch Spays at Hollybank Veterinary Centre

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What does a bitch spay procedure involve?

When we spay a bitch we remove both ovaries. In the removal of both ovaries we stop female hormone production; it is these hormones that drive the problems associated with having an entire female. In certain cases we will elect to remove the uterus too. For example, a dog with known or suspected uterine disease. however your vet will have identified the potential for this prior to surgery. In the vast majority of cases only the ovaries will be removed.

How do we perform a bitch spay procedure?

Bitch spays are conventionally performed by open abdomen surgery. The surgeon directly handles the ovaries and uterus via a mid-line abdominal incision.

At Hollybank veterinary centre we now also perform laparoscopic spays which are performed via keyhole surgery; the surgery involves specialised equipment and specialist training. The advantages to a laparoscopic spay include:

  • A minimally invasive surgery and a generally safer procedure
  • Associated with lower levels of pain during and after surgery
  • Recovery times following the procedure are quicker
  • Post operative care is more manageable with minimal rest and no buster collar due to only 3 small wounds being created

 

It is important to note that key hole spays can only be performed in candidates that fall within a set weight and shape category. Dogs that are too small do not really benefit from the keyhole technique over the conventional spay and the technique is less safe for those overweight. This is also true for those dogs requiring their uterus to be removed. The decision will be made at our discretion in the best interests of your animal.

If your pet does not fit within our guidelines they will have a conventional spay. This involves one slightly larger wound. The outcome is essentially the same but post operative care and recovery times differ as they will require slightly stricter rest and will also need a buster collar. If indicated a laparoscopic bitch spay may have to be converted to a conventional bitch spay. Again this decision will be made in the best interests of your animal

Please read our ‘What happens when your female dog is spayed’ guidelines to read in more details why we recommend spaying and when this can be done.

 

 

Brave Pet of The Month….Cooper!

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Cooper is a beautiful Dalmation who presented to us out of hours due to sudden bloating of the abdomen and signs of discomfort. He had eaten his own dinner that evening but had not long stolen some of the family’s spaghetti too!

Prior to that he had been absolutely normal. Of course, Cooper’s signs could have just been gastrointestinal upset with eating something different. However, with a bloated abdomen, there were other more concerning differential diagnoses we wanted to rule in or out for him so we organised to see him that evening.

On arrival, Cooper was  quiet and lethargic. His owner reported that his demeanour had deteriorated further since phoning us and he had suddenly become very weak and wobbly on all four feet. Cooper had pale mucous membranes and weak pulses on examination, his abdomen was very bloated and painful to palpate too. At this point our exam pointed towards twisting of the stomach, also known as a stomach torsion.

What is a stomach torsion?

Stomach torsion is a surgical emergency and can have very serious consequences if left untreated. There are many suggestions and theories as to why this can happen but breed, body conformation and eating routine are thought to play a role. The stomach becomes severely full of gas and can twist on itself causing the gas to become trapped. It is also described as gastric dilation and volvulus (GDV). The condition in itself is very painful and can progress very quickly as shown by Cooper’s presentation.

The condition can result in other secondary life threatening changes:

  1. The large gas filled stomach prevents return of blood back to the heart. This results in circulatory compromise and poor blood pressure. This explains why Cooper had weak pulses, pale gums and was lethargic on arrival.
  2. The constant pressure of gas in the stomach can then result in damage to the stomach wall. The extent and length of this pressure can ultimately cause parts of the wall to die off.
  3. The spleen is connected closely to the stomach by important vessels. Twisting of the stomach can compromise the spleen’s blood supply resulting in irreversible damage to the splenic tissue.

So what happens next?

Animals with GDV can present in critical condition and must first be stabilised with high rates of intravenous fluid therapy. This helps to normalise blood pressure and return of blood to the heart. It is very important to do this prior to the anaesthetic. The stomach then requires decompression of gas and untwisting which requires surgery.

In making the decision to perform surgery we have to consider the surgical and post surgical risks involved. Although we stabilise our patients there is still an ongoing disturbance to the circulatory system and the anaesthetic itself is not without its risks. During surgery the changes that have occurred may be too severe to correct and in others large portions of stomach wall or spleen may need to be removed.  If such intervention is needed then surgical wounds performed on compromised tissues can be at high risk of wound breakdown.

We then have to go on to consider how appropriate emergency surgery is for that individual patient. For example, if that patient has other conditions affecting their quality of life or factors that may impair recovery from a potentially serious surgery. In these cases, we have to make the difficult decision to put our pet to sleep. This is always an extremely difficult decision to make. Fortunately for Cooper, he had been a bright happy boy before this and we decided to perform surgery.

Whilst Cooper was anaesthetised a nurse passed a tube down his oesophagus and the surgeon then helped to guide the tube into his stomach to pass the air. The stomach deflated slightly but due to food accumulation in his stomach it did not decompress as well as we had hoped.  The stomach and spleen were assessed carefully for secondary changes. Cooper’s stomach was very bruised and inflamed and his spleen was congested with blood but these changes were not severe and would hopefully be reversible. We elected to make a small incision into his stomach to aid full decompression which then allowed us to re-position the stomach. 

Having now had one episode of GDV Cooper could be at risk for another. Therefore, we perform a procedure which attaches the stomach to the abdominal wall, this is known as a ‘gastropexy’. This will prevent the stomach from twisting on itself again. Overall Coopers surgery had been a success and we were really pleased at this stage in his treatment.

Cooper would still require lots of supportive care and TLC following his surgery. He remained on a drip and was monitored carefully. He was also given gastro-protectants given the likely damage to his stomach lining. He recovered really well over the next 48 hours and when he started eating with us we decided it was time for Cooper to go home. He would need to continue his gastro-protectants and sensitive food for a while but we knew he would be much happier back at home with his family.

Cooper made a complete recovery and is doing really well. He continues to be a bright and happy boy and it is lovely to see him looking so well with his family.  I am also told that he is back to his normal food loving self!