Chronic soft stools in hyperthyroid cat

RE: Chronic soft stools in hyperthyroid cat

Richard Carter — Fri, 23 Apr 2021 19:17:55 GMT

There is a view that trying to stabilise TT4 to a number on a blood test is like trying to measure glucose in a cat- very variable and once your diagnosis is made, then weight checks, monitoring heart rate and urinalysis may give more answers and might be less stressful on the patient so if the diarrhoea has not cleared when well controlled then my view would be to back off on meds and see if anything settles. If not then I would think you have a third problem not identified yet that didn’t respond to preds, vit b

. Stress of being medicated? Try some propranolol!

RE: Chronic soft stools in hyperthyroid cat

Helena Rymaszewska — Fri, 23 Apr 2021 18:19:39 GMT

he is on cobalaplex,the oral b12 supplement due to the difficulties of getting parenteral b12.

Reluctant to stop the meds as he is so hard to bleed when we would need to destabilise him.Thyronorm was suggested but the owner says liquids are harder to give than tablets with him.

thanks

RE: Chronic soft stools in hyperthyroid cat

Richard Carter — Fri, 23 Apr 2021 08:32:50 GMT

And if you stopped thyroid medication for a few days?

vit B deficiency in elderly cats with chronic d+ think is a given so if have weekly injections?

RE: Chronic soft stools in hyperthyroid cat

Helena Rymaszewska — Thu, 22 Apr 2021 18:14:49 GMT

hi Kate,

yes I frequently use dexafort as a trial also.

I was not really aware that oral preds are less well absorbed than parenteral steroid, so I used pred tablets last year, but not at the 2ng/kg dose as suggested .

thanks !

RE: Chronic soft stools in hyperthyroid cat

Kate Richardson — Thu, 22 Apr 2021 17:15:54 GMT

[quote userid="27499" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29776/chronic-soft-stools-in-hyperthyroid-cat/229926#229926"]interesting point ref depomedrone, I ve always been extremely reluctant to use it ![/quote]

You could always try Dexafort as an alternative trial, effect usually lasts 1-2 weeks. I'm not anti- depomedrone, I just tend to reach for dexafort first as an intermediate lasting roid

RE: Chronic soft stools in hyperthyroid cat

Helena Rymaszewska — Thu, 15 Apr 2021 16:06:51 GMT

Thanks David.Yes,he has been challenging,this cat! The gut issue came first but the thyroid had been one of these that started at 29 and then we followed it up and eventually on Free t4 by ED ,we managed to confirm hyperthyroidism.

Interesting point ref thyronorm .

. I was worried ref doing a thyroidectomy in case he had thyroid tissue elsewhere or he actually did have LSA and the op didn’t buy him lots of time.Also wether to do bilateral or one sided thyroidectomy.

Metronidazole has certainly got a poorer press recently ,we used it only in theory for its supposed immune action on the gut.

interesting point ref depomedrone, I ve always been extremely reluctant to use it !

RE: Chronic soft stools in hyperthyroid cat

David Mills — Thu, 15 Apr 2021 15:55:43 GMT

These cases can be difficult to manage. The hyperthyroidism was likely the primary cause and you may be seeing secondary effects of chronic diarrhoea. The mechanism is not fully understood (whether increased motility or actual inflammatory aspects) but I would try and keep the hypert4 fully controlled and see response (proviso as per Anthony that methimazole can cause GI upset - I may consider trialling the liquid formulation for this cat to see if that makes a difference rather than tablets). SDMA is not a test I like at all. Recentish work shows that the theory of balancing hypert4/ckd is outdated and leads to lower MST than controlling for the hypert4 fully so I don't particularly worry about renal disease in these cats (it's always present, just that hypert4 pushes the lab values down).

So I would:

Fully treat the hypert4 (a thyroidectomy would remove the meds requirment/complication), possibly with thyronorm
Give parenteral c/st (oral likely to be incompletely absorbed) - depomed, may need 2-3 injections 3-4 weeks apart

I don't like treating 'bacterial causes' of diarrhoea, definitely not with metronidazole - it severely disrupts normal flora - and the cross over between normal animals and those with a possible bacterial aspect is huge.

RE: Chronic soft stools in hyperthyroid cat

Helena Rymaszewska — Thu, 15 Apr 2021 15:19:27 GMT

Hi, thanks for your advice.

.No ,it was the SARCG profile from idexx but I ve just had a look at the profile you mentioned,so definitely information for next time .(in this case ,possibly too many £££)

I ve never seen campylobacter in a cat tbh.,what treatment trial would you suggest?

The change in felimazole dose has never made much difference to the stools.

I believe the nurse used psyllium as a trial for the fibre though to no avail.

I have been veering towards the higher pred +/- chlorambucil recently (though I am aware I have nt definitively diagnosed the problem )

RE: Chronic soft stools in hyperthyroid cat

Anthony Dennison — Thu, 15 Apr 2021 14:53:24 GMT

Hi Helena,

The faecal sample you did - was it a basic screen or a PCR panel (we use Idexx so it is the Feline Diarrhoea Panel) - can sometimes find weird things on there that can cause it. However it is expensive so can understand if this isn't an option.

Hyperthyroidism can cause diarrhoea, but conversely an overdose of treatment can also cause GI signs - we had a cat recently that had acute diarrhoea, TT4 was checked and found to be high (due to malabsorption) so dose was increased which made the diarrhoea worse. Only thing that stopped it is stopping treatment and starting again from scratch.

I'd imagine if the cat has had diarrhoea for 18 months that the intestines will be thickened to some degree, and annoyingly unless there's a big clear mass, we can't tell the difference between IBD and diffuse GI lymphoma on a scan alone.

Description of the diarrhoea makes it sound more like a distal small intestinal source, there could be some pancreatic insufficiency present but it often doesn't affect cats in the same way as dogs.

Could do a trial treatment for campylobacter as this often can extend or worsen chronic diarrhoea cases.

Could consider psyllium additive rather than just fibre (if this isn't what you meant by added fibre)

Other option is using a higher dose of prednisolone (2mg/kg/day) or add in chlorambucil as well (20mg/m^2 q14d)

RE: Chronic soft stools in hyperthyroid cat

Helena Rymaszewska — Thu, 15 Apr 2021 14:41:56 GMT

In January t4 had been 68 so felimazole had been increased to 5 mg am and then 2.5 mg in pm.

In February,T4 had reduced to 15 and sdma had increased to 20 ,so felimazole was reduced to 5 in the morning and 1.25 mg in evening.(another blood due tomorrow )

RE: Chronic soft stools in hyperthyroid cat

David Mills — Thu, 15 Apr 2021 14:28:17 GMT

Is the t4 well controlled? What was last tt4? Felimazole once or twice daily?