That's my understanding of it; I do appreciate the discussion, though, in case I've misunderstood my vet. I do not claim to understand the whole scenario fully since it's all a bit new for me, but the explanations I've been told and responses to my questions have made sense to me. Sometimes I ask my vet to explain it over and over until it clicks for me. And I trust her; she's not blowing me off, thinks things through carefully, and she's actually one of the doctors chosen to write questions for the upcoming Board exam for certification in exotics.
Yes, it's unfortunate we do not have evidence this is hyperthyroid, just clinical signs that piece together in that way. Without repeating the T4 test (for reasons explained earlier), we think it's very likely that the lump in Inca's neck -- near where her thyroid gland should/would be -- is likely a thyroid tumor or the gland itself that is enlarged.
If Inca gets a bit better (gains some weight and slower heart rate), I will repeat the bloodwork, including T4, for a better assessment. But I don't want to do that at this point with Inca so small and possibly being more susceptible to the stress of procedures. I feel a tapazole trial is less risky than stressing Inca in the isoflurane box before a blood draw and having her under anesthesia for whatever amount of time it takes to obtain the blood. Ordinarily, I'm fine with it, but that's with pigs who are not compromised.
Also sounds like tapazole produces results before heart meds (maybe?), so if we're going down the wrong path (not seeing improvement from thyroid meds), we can switch to heart meds as our Plan B.
Again, I very much appreciate anyone with similar experiences chiming in on this. And I will e-mail Josephine to ask if she'll take a look at this thread. Thanks very much!
But you don't know if hyperthoidism is the primary problem or even if she has it. Wouldn't the T-4 count show something if it's a thyroid tumour? I don't know myself since we weren't dealing with any lumps. If heart is the primary problem you may be treating fior something she doesn't have.
Results from heart meds can be very fast - often within hours. I don't know how long Tapazole takes to show results but I think we were rechecking after a week. If she isn't hyperthyroid, is there a risk of her being slowed down too much by the drug? At least with heart meds like Fortekor, the risk of compromising her health is minimal.
It's entirely possible she has a tumour that coincidentally is in the same place as where her thyroid gland is. Unless you've biopsied it how can you know it's a thyroid tumour? Not nagging - just trying to understand why the vet thinks it's hyperthyroisim when the T-4 counts don't indicate it.
We didn't bother handfeeding Bart. As soon as we noticed the weight loss - happened inside a week's span, he went off to the vet and had his heart meds adjusted. He was "eating well" despite the huge weight loss. I believe he just had to eat too slowly to hold any weight due to his bad heart.
- Supporter 2004-2020
A quick brain dump based on our Scooby nursing notes:
Scooby's lowest weight was around 670 grams, August of 2006. Her T4 was 12 mcg/dl, against a normal of 3.2. Scooby then started on 0.1 ml of Tapazole 1x a day. After a month, there was no change, and we doubled the daily dose to 0.2, at which we started to see a small improvement in weight. We went to 0.3/day in November and then 0.4 in December. At that point she weighed around 800 grams. We then stayed at that dose, although in retrospective should probably have continued to increase. She had one more blood test that continued to show high thyroid, which we thought was a mistake, but probably was accurate.
In May of 2007, Scooby's weight suddenly crashed (from 800 to 750 in two days); she was inert, had a fever and rapid pulse, and the vet palpated a probable thyroid node. This was the final thyroid storm.
- Little Jo Wheek
I agree it is a good idea to ultrasound and biopsy that lump. It could be a thyroid nodule--in that case adding to the hyperthyroid camp. But, maybe not?
Hyperthyroid and heart go hand in hand. Often hyperthyroid animals need some sort of anti-hypertensive drug.
Due to the higher side-effects with anti-thyroid drugs such as methimazole (Tapazole), it is a bit puzzling that a vet would rather treat for that rather than heart problems. Hmmm... not sure that there is a very easy way to rule out either in a guinea pig since norms for thyroids are still being established. Frenetic does describe the hyperthyroid patient to a "t," though.
My vet said we either risk the thyroid meds without a definite diagnosis, or we risk anesthesia to try to learn more. Given that choice, I couldn't forgive myself if Inca died in the anesthesia box or while under for a blood draw, given that she may have a pretty good quality of life even if we did absolutely nothing at this point. Of course, I don't know how long that can last, but I swear she doesn't act as if anything is wrong with her. Yes, she wants to eat all the time and continues to lose weight, but she's moving/behaving/resting/etc. normally (okay, a bit more energetic than rest of her life).
Pinta, you do bring up a good point about possibly slowing Inca's metabolism unnecessarily, so I will ask my vet about that. So far (after 3 doses of tapazole) I haven't seen any change in Inca whatsoever. I think it's early, but I'm watching carefully.
I will also ask whether an ultrasound can/would confirm that the lump is her thyroid, since I think Inca can have an ultrasound without anesthesia. For a biopsy, though, I'm up against the anesthesia thing, and I don't want to stress Inca with that while she's small and has revved up heart. Looks like I may be buying a stethescope soon to keep tabs on her!
I suppose another idea would be to stop the tapazole and give heart meds to help her heart at the outset, just so we can retest her blood. But honestly, we don't think her heart is at a dangerous state right now (and I'm keeping her as calm as possible just in case), so I'm inclined to wait a bit on the tapazole trial before redirecting.
Pinta, Josephine, mmeadow -- thanks for your contributions!
- Little Jo Wheek
We used to ultrasound cat thyroids all the time (when I worked somewhere with an ultrasound and a radiologist). I'm not sure how experienced your vet is and that may come into play if a radiologist is not doing the ultrasound. It never hurts to ask, though.
The good news is that one night Inca looked/sounded pretty good -- her body actually seemed a bit "fuller" plus breathing okay -- so I plunked her on the scale and her weight was up (from 600g to 625g)! I'm hoping the tapazole is now kicking in and maybe she'll improve a bit over the week ahead. And I'm still waiting to discuss options/doses/timetables (along with my hospital's euthanasia logistics and protocol) with my vet. I'm not getting my hopes up, but I'm grateful for some momentary relief and perhaps another week (at least) with Inca.
Will post if things take a turn, one way or the other. But my little girl is hanging in there for now!
For anyone who doesn't want to reread: We are treating for hyperthyroid even though Inca's T4 (done months ago) was normal. Her metabolism is faster than norm, she loses weight despite eating extra, and vet felt a nodule in her neck (where thyroid is located). My vet and cardiologist do not believe Inca has heart disease based on the echocardiogram, which is why we're not giving heart meds. And I haven't retested her T4 because I was afraid Inca wouldn't fare well for the blood draw (given her fast heart and low weight). Previous blood work and Xrays were OK.
I'll post again if we're able to figure out more or treat successfully.
Since her heart is better (no longer racing) and her weight is up a bit, I'm less nervous about having her anesthetized for a blood draw and possibly X-rays. We may do that this weekend, if vet's schedule can accommodate. I want to check her kidneys (since treating hyperthyroid often reveals kidney disease that's been masked) and her T4, plus whatever else we can learn from her blood.
She seems active, alert, mobile -- normal, if not happy. That's never really changed. But she is filling out a little, at last. Fingers crossed the trend continues.
After rads, Inca was snuffley for a while. She was kept in an oxygenated cubby, and we came home with Bactrim and metacam just in case some infection/inflammation was at work. More likely, Inca may have aspirated some saliva or food remnants while on her back (despite the vet swabbing her mouth). She was snorty just the one day and now seems better (though I'm still giving the meds for a week). It was enough of a scare, though, that I really don't want her anesthetized anymore. I had been thinking maybe another session for Xrays, but honestly, I don't think we'll learn anything.
I needed a refill for the tapazole, too, and vet discovered we've been giving the wrong dose (Grrr!). So now we're giving the dose we should have been giving for the past month, plus we may double it down the line (following cat protocol if initial dose does not seem to help).
Inca's neck "nodule" has not gotten bigger and does not seem to be positioned where lymph nodes would be; we still think it's her thyroid. Vet does not want to aspirate it: "If we stick her thyroid it will get angry and could result in a thyroid storm."
Since Inca seems okay, I think my plan may be just to continue feeding her extra and love her to pieces for our remaining time together. (She is now 5.5 years old.) Don't think we're ever going to figure this one out. If she gets to a point where she's suffering (or perhaps if I can't bear to see her lose more weight), I'll say goodbye and send her off.
But for now, still hoping the tapazole may help...now that we're at correct dose.
How much weight fluctuation is normal? I haven't read a ton of threads to find out, but someone mentioned 15g and someone else mentioned 5%. And on the weight page, info mentions one ounce is okay (28.35 grams).
Guess I need to weigh her the same time of day each time, for starters.
Anyway, I've been giving her tapazole (and supplemental feedings), and she's holding her weight around 650g yet not gaining. After gradually increasing the tapazole dose, I'm about to start the double dose (for Inca that's .32cc at 5mg/ml), per cat protocol, after which I will really conclude this is not hyperthyroid. Her neck lump is now floating around, seemingly unattached, so I no longer think it's a thyroid tumor (vet to plapate soon to confirm).
We may do a FNA to check it the lump and try to learn more, but I'm always nervous about Inca under anesthesia given her age (now 5y9m), low weight, and possible heart probs.
So pretty soon we may try Plan B, which is heart meds. We thought Inca's rapid heart and breathing (plus weight loss) were secondary to hyperthyroidism (because echo didn't show heart issues and because her neck lump seemed like thyroid at the time, and because heart is often secondary to thyroid), but maybe this is really a primary heart problem...or something else entirely.
Don't think any more Xrays are in Inca's future, especially since last anesthesia caused some breathing problems. But maybe an ultrasound, if my vet thinks that may help. Her last bloodwork looked okay. We remain stumped.
I'll post again if we learn more or are able to treat more successfully. And, in the meantime, hoping she's still alive and well in a few weeks for the Boston Pignic...followed by the Blessing of the Animals in early October.
Inca really seems fine; she's just little. But I know our days together are numbered and am appreciating every minute!