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Amy's cat has a couple of problems: first, he's been a puker since he was a kitten. Second, he's gotten really hyper at night and vocalizes a lot, too. There are two things going on here, and we think one of them is hyperthyroidism.

Thomas has hyperthyroidism, and he had a lot of the same symptoms as Coby before we started treatment.

Dear Most Esteemed and Knowledgeable Kitties:

We have a boy kitty, Coby. He is 11 years old and just the most cuddly, loving little man we’ve ever known. We adopted him from a rescue group when he was 2 1/2 months old. From the very beginning he seemed to vomit more than expected. The vet looked him over and told us that he was super healthy and that some cats just vomit more than others. We’ve changed his food a couple of times but it makes no difference. We free feed dry food. A couple of months ago we noticed some weight loss, more vocalizations (especially at night), more frequent vomiting (no hair, just food and gastric juices), excessive clinginess and periods of explosive hyperness (especially at night). He eats and drinks normally and there seem to be no litter box issues. It may seem gross but we’ll periodically sift the litter after he goes to check for blood and mucus. Once again, our vet is giving us a clean bill of health. He did say that the kidney function was on the high end of normal but “nothing to worry about.” Our vet couldn’t give us any clues on why our Coby is changing. So, my question is, should we look for another vet? Or, is this something we truly shouldn’t worry over. Thank you for all the good works you do. We wish all people could be great animal advocates like your Mom. God bless you all!

~ Amy

Thomas: First of all, thank you so much for the compliments. We’ve trained Mama pretty well, so we think we can take at least some of the credit for her awesomeness. *purrrrrr*

Bella: So, Amy, it sounds like you’ve got two separate things going on, and we’re going to address your second issue first since it’s more important.

Tara: The symptoms you’re describing–the hyperness, nighttime vocalization, and more frequent vomiting–are consistent with a condition called hyperthyroidism.

Thomas: I have hyperthyroidism, so we know what it’s about. So, let’s go into a little more detail here.

Bella: The Cornell School of Veterinary Medicine’s Feline Health Center says that hyperthyroidism is a common condition of middle-age and older cats.

Tara: What happens in hyperthyrodism is that the thyroid glands, which are located in the throat on either side of the wind pipe, start overproducing hormones. Those hormones, known as T3 and T4, affect almost every organ in the body, so when there’s too much of those hormones, they can affect other organs besides the thyroid gland.

Thomas: The most common symptoms of hyperthyroidism are weight loss, increased appetite, increased thirst and urination. But the condition can also cause vomiting, diarrhea, hyperactivity, and nighttime vocalization.

Bella: You should have heard Thomas carrying on at night before Mama got him on medication! I mean, honestly–it disturbed my sleep because I thought he needed help!

Tara: Hyperthyroid cats can also develop a greasy and unkempt coat.

Thomas: How does a veterinarian determine that a cat has hyperthyroidism? Primarily through a blood test, which detects the amount of thyroid hormones circulating in the blood.

Bella: We suspect your vet must have done a blood test because they told you Coby’s kidney values are at the high end of normal. We are surprised, however, that the blood work didn’t show thyroid issues.

Tara: But hyperthyroidism can develop quickly.

Thomas: So, how do you treat hyperthyroidism? There are several options. The most common one is a drug called methimazole (or felimazole, if you get it at your vet’s office). What methimazole does is that it decreases the production of thyroid hormones, which can help your cat feel better and make the symptoms go away.

Hyperthyroidism is common in older cats. What is hyperthyroidism, what are the symptoms, and how do you manage the disease? Get our answers in this week's Paws and Effect post!

Bella: The gold standard of treatment for hyperthyroidism is radioiodine therapy. What this involves is the injection of a tiny bit of radioactive iodine into your cat. The iodine is most attracted to areas where the thyroid is producing too much thyroid hormone and destroys those hyperactive areas. The rest of the normally functioning thyroid isn’t affected.

Tara: There are some logistical and financial aspects of radioiodine therapy you should know about. First of all, it can cost $1,000 or more, depending on where you live, and it has to be done at specialized centers that are licensed to do the procedure. Another logistical issue is that you have to store your cat’s used kitty litter for three months in order for it not to be too radioactive.

Thomas: And if you have multiple cats, that can be a real headache. It was when Mama had radioiodine therapy done on our beloved Siouxsie–especially because we lived in a tiny apartment at the time!

Bella: One thing you should be aware of is that hyperthyroidism can mask kidney disease.

Tara: For some reason, the hyperthyroidism helps the cat’s kidneys cope with the kidney disease better, and when treatment for hyperthyroidism begins, it can make kidney disease worse.

Thomas: That’s why Mama and our vet are being very careful to treat Thomas’s hyperthyroidism gradually, to see what effect the medication has on his kidney disease. It’s a delicate balance, that’s for sure!

Bella: Other treatments for hyperthyroidism include surgery to remove the thyroid gland, which is a problem because it leaves cats with the opposite problem–hypothyroidism–and you’d have to give your cat medication for that illness after the surgery. There’s also a dietary option, a prescription cat food that’s supposed to be low in iodine and therefore keeps the cat’s thyroid levels lower.

Tara: But we think you’ll want to avoid the prescription food because…and this is a great segue into answering your other question…Coby already has digestion issues.

Thomas: We always hate it when vets say it’s normal for cats to puke, and some cats just puke more than others. That’s really not true, and a cat that is tolerating his food well shouldn’t be throwing up all the time!

Bella: We’ve got a couple of recommendations for you around the food issue, because we’ve dealt with it before. You see, Thomas used to have problems digesting his food, too, and he had diarrhea every day for years, as Mama tried lots of different kinds of dry foods and canned foods.

Tara: But when Mama started feeding us a raw diet, Thomas’s chronic diarrhea went away overnight!

Thomas: Not everyone’s up for feeding a raw diet, and a lot of vets are against it for various reasons (our vet is not one of those; she’s quite happy that we’re eating raw food).

Bella: What we’d recommend to you, though, is that you switch away from free-feeding dry food and try feeding him canned food a couple of times a day.

Tara: Try feeding him something with a limited-ingredient diet, just in case something in his current food is bothering him.

Thomas: The most common culprit for digestive woes in cats seems to be grain. You see, we cats don’t have the kind of digestive systems you humans do, and we don’t have the right enzymes to properly process grains. In a cat with a sensitive system, avoiding grains might really help.

Bella: Please keep in mind here that we are not veterinarians! We are not here to diagnose your kitty–we’re just going based on what you’ve told us about Coby’s symptoms and we’ve experienced here at Paws and Effect HQ, and we strongly suggest you talk to your vet about what we’ve said.

Tara: Keep in mind that you should go in with an attitude of curiosity, not an “I consulted Doctor Google, and they’re right and you’re wrong” attitude. You want to be an informed cat caretaker but you don’t want to alienate your vet by saying that someone who’s never seen your cat is suggesting they might have X or Y issue.

Thomas: If your cat hasn’t gotten blood work recently, have them do the lab tests again. There’s an extra blood test called Free T4 that can help to confirm or deny a diagnosis of hyperthyroidism, so you might want to ask about that. You might also want to get a second opinion, both on Coby’s chronic vomiting and his new symptoms.

Bella: Hopefully your vet will be okay with you getting a second opinion. Most vets will be. But even if they’re not, you’re trying your best to figure out what’s bothering Coby, and that’s the most important thing.

Tara: Best of luck to you and Coby, and your whole family.

Thomas: What about you other readers? Have you had a cat who’s a puker? What did you do to solve their problem? Have you had a hyperthyroid cat? How did the symptoms manifest in your kitty, and what treatment did you decide on and why? Please share your thoughts in the comments!