overweight hyperthyroid cat?

Re: overweight hyperthyroid cat?

james herriot lied — Mon, 03 Dec 2012 20:35:52 GMT

I had one client, who made up for in belligerence what she lacked in brains, who would storm into the practice - without appointment - literally swearing and cursing at us because we weren't preventing her cat from getting blocked up.

And each time, we'd add up the quantity of food we'd sold her, that she swore blind she was feeding exclusively, and politely put it to her that the cat couldn't survive on half a pouch of s/o daily. And she'd swear for a while longer, before finally admitting that she had, in fact, been on supermarket stuff. But that this time she really would stick to the plan, and she was very sorry that she'd sworn at the staff and yes, she realised that she did have to make an appointment and no, it wasn't fair on the cat.

On the third go, I fired her. What joy.

Re: overweight hyperthyroid cat?

Martin Atkinson — Mon, 03 Dec 2012 17:01:59 GMT

Clients never cease to amaze me with the devious means they can conjure up to avoid compliance yet retain an air of self righteousness and denial which make you feel guilty at not being able stabilise their pet's condition, yet they'll keep paying for tests even though they know its not getting the meds. Never be surprised by how devious clients can be.

Re: overweight hyperthyroid cat?

Simon Neuhoff — Sat, 01 Dec 2012 09:34:02 GMT

[quote user="Stephen Courtney"]

Interesting comment from the pathologist. I am a bit surprised by that, but it makes me wonder how many of my hyperthyroids are getting far less medicine than i am prescribing..........

[/quote]

Compliance is a funny game! I'm sure we all have those clients who, with seemingly complete sincerity, eanestly tell you that yes she gets EVERY tablet that they give them. Yet when you look at the amounts dispensed the maths just doesn't add up....... I usually gently try to hint that something doesn't make sense but short of accusing them of lying the best I can do is talk in general about how important it is that Tibbles gets ALL the meds, lay it on thick...

Re: overweight hyperthyroid cat?

Stephen Courtney — Fri, 30 Nov 2012 22:38:10 GMT

Interesting comment from the pathologist. I am a bit surprised by that, but it makes me wonder how many of my hyperthyroids are getting far less medicine than i am prescribing..........

Re: overweight hyperthyroid cat?

CatherineThomas — Fri, 30 Nov 2012 18:51:10 GMT

When I called to discuss the results with the owner today I said I think there must have been a problem with her getting some of the tablets he admitted that she hadn't had her tablet the night before the blood test because he had run out of tablets. (he obviously didn't mention this when I asked him how he had been getting on with giving the tablets during the consultatin to take the sample) He doesn't think there were any problems with the previous tablets. But the pathologist at the lab thinks that even one missed does could give these unexpected results.

Re: overweight hyperthyroid cat?

Martin Atkinson — Fri, 30 Nov 2012 16:10:39 GMT

Assuming the results are correct, most likely lack of compliance. Neomercazole AFAIA works at blocking the release of thyroxine not reversing the structure of the hyperactive thyroid gland so just a few days lack of compliance may have allowed the T4 to shoot up before symptoms kicked in again. Question how the client gives the pill they may put it in the food expecting the cat to eat it and it isn't and/or another cat is, they may have started crushing it and reduced the bio-availability or just not getting it in and are scared to tell you. Or it is basically a fat cat and present weight is still lower than it would be otherwise.

Re: overweight hyperthyroid cat?

Jo Cobbett — Fri, 30 Nov 2012 11:47:28 GMT

(although the heart rate would support reasonable T4 control)

Re: overweight hyperthyroid cat?

Jo Cobbett — Fri, 30 Nov 2012 11:46:54 GMT

Has the cat been even heavier? I guess if she was 6.5kg two months ago, then lost T4 control she could feasibly be 5kg now but still not controlled?

Re: overweight hyperthyroid cat?

Kate Richardson — Fri, 30 Nov 2012 11:31:47 GMT

I guess also reweigh the cat to make sure not a scales error

Re: overweight hyperthyroid cat?

Stephen Courtney — Thu, 29 Nov 2012 22:22:33 GMT

If the cat did not seem hyperthyroid on exam, at this point I would contact the lab to discuss the situation. It might be a typo - perhaps the result is 19.7? It might be worth re-running the test on the original sample, and i would certainly repeat the blood test if the lab result did not match clinical expectations. Mistakes can happen even in the best system.

In my experience cats with a total t4 of nearly 200 are almost always very suspicious of hyperthryoidism on clinical exam.....but i can remember one or two that weren't classical in the consult room, so there is always room for a surprise or two! but what you describe is a very well controlled cat - so i'll put my 2p on a lab error.

Re: overweight hyperthyroid cat?

CatherineThomas — Thu, 29 Nov 2012 21:47:53 GMT

I know it was labelled and packaged correctly as we took the sample just before the courrier arrived so I put it straight in the bag with the form. I've been to the lab and I've seen how carefully they prcess the samples so I would imagine it would be pretty unlikely for there to be a mix up at the lab.

Even if the cat hadn't had it's tablets for a few days would 10mg of vidalta really be enough to bring a T4 of 197 down low enough for the cat to put on that much weight?

Re: overweight hyperthyroid cat?

Stephen Courtney — Thu, 29 Nov 2012 20:30:11 GMT

Lab error? Labeling error? I would have thought impossible, unless the cat has been off meds fopr enough days to let the TT4 creep up but before the HR etc changes...never had one like this.

My biggest problem is weeding out compliance issues from dose issues when animals are unstable for some reason.