Chronic soft stools in a hyperthyroid cat

RE: Chronic soft stools in a hyperthyroid cat

Helena Rymaszewska — Sat, 24 Apr 2021 15:48:41 GMT

Thanks again Andy

so owner says liquids medications are harder to give to this cat than a tablet.

Radioactive treatment has been considered (costly!) but then is the issue of keeping him away from his other cat housemates, cleaning his bowls ,litter trays etc with some remaining radioactive action.

GI signs happened before we instituted thyroid treatment , so don’t think they are due to the medication itself but happening alongside the hyperthyroidism.

I m not actually keen on removing the palpable thyroid nodule (as he will have his other thyroid still and possibly some extra thyroidal tissue) but at least we may get a break from having to take bloods from him for his thyroid levels (which is hard to do and needs gabapentin on board)

Or alternatively ,not do surgery and go for preds and chlorambucil?

RE: Chronic soft stools in a hyperthyroid cat

Andrew Kent — Sat, 24 Apr 2021 12:45:07 GMT

[quote userid="27499" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29781/chronic-soft-stools-in-a-hyperthyroid-cat/230001#230001"]So last blood test 2 days ago had T4 of 48 (on 5 mg felimazole in morning and 1.25mg at night)[/quote]

So it does seem we could achieve better control of this - maybe you would find a liquid preparation easier to titrate?

[quote userid="27499" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29781/chronic-soft-stools-in-a-hyperthyroid-cat/230001#230001"]

A thyroid nodule is always palpable on the LHS whatever his levels so I am considering removing it.......but obviously the worry is that the gut problem will continue!

[/quote]

Indeed - unless the GI signs are an AE of the medication its likely this would not resolve the signs. Radioactive iodine might be another option.

[quote userid="27499" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29781/chronic-soft-stools-in-a-hyperthyroid-cat/230001#230001"]

He is on protexin fibre supplement at the moment alongside the z/d but no real change to feces.

We had done a home cooked fish only trial a year ago-no change ,but I will suggest Purina ha to owner.

[/quote]

I think that would be reasonable.

[quote userid="27499" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29781/chronic-soft-stools-in-a-hyperthyroid-cat/230004#230004"]forgot to say that I’d decided previously against the Tritrichomonas testing as the problem seems more small intestinal, test is expensive , treatment seems to be problematic ref ronidazole and toxicity and I thought they should get rid of it themselves(I m probably wrong![/quote]

It does generally self limit but I suppose it may not if the cat is unwell (immunosuppressed) for another reason.

Andy

RE: Chronic soft stools in a hyperthyroid cat

Helena Rymaszewska — Wed, 21 Apr 2021 14:57:15 GMT

Hi Andy

forgot to say that I’d decided previously against the Tritrichomonas testing as the problem seems more small intestinal, test is expensive , treatment seems to be problematic ref ronidazole and toxicity and I thought they should get rid of it themselves(I m probably wrong!)

cheers

RE: Chronic soft stools in a hyperthyroid cat

Helena Rymaszewska — Wed, 21 Apr 2021 14:24:44 GMT

Hi Andy

Thanks for replying.

So last blood test 2 days ago had T4 of 48 (on 5 mg felimazole in morning and 1.25mg at night)

We had reduced it to that dose in February as the T4 had gone down to 15 (he was on. 5 mg am and 2.5mg pm) so he does fluctuate a bit.

A thyroid nodule is always palpable on the LHS whatever his levels so I am considering removing it.......but obviously the worry is that the gut problem will continue!

He is on protexin fibre supplement at the moment alongside the z/d but no real change to feces.

We had done a home cooked fish only trial a year ago-no change ,but I will suggest Purina ha to owner.

We ve never had enough blood to do TLI ( as he is difficult to bleed) and it goes to USA ,is expensive etc which is why we trialled the pancreatic supplement first....(again wrong way round I know...)

I will put these suggestions to owner but removal of the thyroid on one side maybe worth doing and then pred/chlorambucil if still not change after a few weeks!

The cat seems pretty happy otherwise.

Many thanks!

RE: Chronic soft stools in a hyperthyroid cat

Andrew Kent — Wed, 21 Apr 2021 13:42:36 GMT

Hi Helena,

Tough case with limited ability to investigate!

How well controlled is the hyperthyroidism? Obviously we can see GI signs in hyperthyroid cats so if there is any room to tighten up this control it may be sensible to do so.

[quote userid="27499" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29781/chronic-soft-stools-in-a-hyperthyroid-cat"]Obviously,if funds had allowed ,we would have done the full shebang of bloods TLI,b12 ,folate, felv fiv etc at the beginning but we did nt ..![/quote]

Any chance of reviewing TLI now?

Any further faecal testing? Doesn't sound large intestinal but I guess tritrichomonas is always a differential in cats so ideally perform that.

[quote userid="27499" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29781/chronic-soft-stools-in-a-hyperthyroid-cat"]I am assuming he must have IBD or LSA - it seems like a malabsorption problem[/quote]

Seems likely - although a bit unusual to get no response to pred. But some do require the addition of chlorambucil, for example.

[quote userid="27499" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29781/chronic-soft-stools-in-a-hyperthyroid-cat"]

The owner is not wanting biopsy or exlap.

Ideas gratefully received.

[/quote]

If you can't do any more then I guess consider a further dietary change (move to something novel protein and hydrolysed as Z/D is chicken based - Purina HA would be one example) and trial steroid and chlorambucil.

If that doesn't help there may be other things we could trial.

Andy