Hyperthyroid but chubby (?) & When to give fluids?

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Riannon - 11 Mar 2008 17:12 GMT

Hello everyone, I have two 15 yr old cats. They both have crf but one is
worse than the other. Missy who was diagnosed 5 years ago now has a
creatinine level of 5.2; I was going to start fluids but my vet says that she
only recommends fluids if a cat is dehydrated and she says Missy is not. But
so many people give fluids to cats that have a number lower than that so I am
very confused as to when to start.

My other cat, Squeezy, also has crf but her creatinine level is only 2.6.
She recently had a T4 test done and it is 4.27 (highest on range was 4). My
vet advises not to treat it yet as it is so low, but I'm wondering at what
point it is best to start treating it. She has absolutely no symptoms - no
weight loss or anything; in fact she is quite large at 14 lbs! Her BP is
also fine.

Thank you for your help,

Riannon

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Rene S. - 11 Mar 2008 17:25 GMT

I'm sorry I can't give you a specific answer, but since you're having
doubts, I highly suggest getting another opinion from a different vet.
You are the best advocate for your cats, and a second opinion can't
hurt.

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Phil P. - 11 Mar 2008 21:39 GMT

> Hello everyone, I have two 15 yr old cats. They both have crf but one is
> worse than the other. Missy who was diagnosed 5 years ago now has a
> creatinine level of 5.2; I was going to start fluids but my vet says that she
> only recommends fluids if a cat is dehydrated and she says Missy is not. But
> so many people give fluids to cats that have a number lower than that so I am
> very confused as to when to start.

Your vet is right. Fluid therapy should not be used long term as cheap form
of dialysis because it makes the kidneys work harder. Fluid therapy can be
used to improve renal parameters acutely but only on a short term basis or
to correct dehydration.

> My other cat, Squeezy, also has crf but her creatinine level is only 2.6.
> She recently had a T4 test done and it is 4.27 (highest on range was 4). My
> vet advises not to treat it yet as it is so low, but I'm wondering at what
> point it is best to start treating it. She has absolutely no symptoms - no
> weight loss or anything; in fact she is quite large at 14 lbs! Her BP is
> also fine.

If her creatinine is 2.6 and her T-4 is 4.7, treating her hyperthyroidism
now will probably cause her BUN/creatinine to rise considerably.
Hyperthyroidism can mask the full extent of her CRF because it increases
blood flow through the kidneys which makes the kidneys look like they're in
better shape than they actually are. In hyperthyroid cats with concurrent
CRF, sometimes to have to try to strike a balance between an "acceptable"
level of hyperthyroidism and an "acceptable" level of azotemia. The balance
you've currently reached is about the best you can do for the time being.

I can't tell you when to start treating her hyperthyroidism because each cat
is different. Some cats do well with T4 at 6 or 8- some do not. You have
to monitor her heart rate and weight very closely. I strongly suggest
purchasing a digital pediatric scale. Its very difficult to notice small
weigh losses (or gains) in a cat you see every day.

Best of luck,

Phil

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Riannon - 12 Mar 2008 17:25 GMT

Thank you so much for your informative reply! You sound like you are on the
same wave length as my vet

>Your vet is right. Fluid therapy should not be used long term as cheap form
>of dialysis because it makes the kidneys work harder. Fluid therapy can be
>used to improve renal parameters acutely but only on a short term basis or
>to correct dehydration.

I see what you are both saying - what makes it so confusing is getting
different opinions from other people who give fluids. On some sites I've
visited, they say that once creatinine reaches a certain point, it's time to
start. My vet said that I would probably find two different views on this
matter - the people who swear by giving fluids and others who don't give
until absolutely necessary. Then I thought - perhaps if I struck a happy
medium by giving them say twice a week instead of daily? But if that is
pointless, then I really don't want to do it - the longer I can wait to do it,
the better. I don't want to stress her out; she's so tiny, she's probably
going to feel that needle a lot (almost 6 lbs). Missy also doesn't seem
dehydrated -she eats at least 90% canned and only 10% dry and drinks well so
she's getting lots of water.

>If her creatinine is 2.6 and her T-4 is 4.7, treating her hyperthyroidism
>now will probably cause her BUN/creatinine to rise considerably.
[quoted text clipped - 4 lines]
>level of hyperthyroidism and an "acceptable" level of azotemia. The balance
>you've currently reached is about the best you can do for the time being.

How sad to think her kidneys could be worse than I know of but yes, my vet
mentioned that Squeezy's hyperthyroidism could be helping her kidneys
function better and she thought it would not be a good idea to treat it yet
as her heart function is fine and she is not displaying any symptoms of
hyperthyroidism at all yet. I recently got a different answer at another
site which of course, confused me again. Some people there thought she
should be started on a small dose of medication now before things get bad.
Again, I would like to wait as long as possible to start treatment
(especially because that medication sounds a bit scary! - the possible side
effects).

>I can't tell you when to start treating her hyperthyroidism because each cat
>is different. Some cats do well with T4 at 6 or 8- some do not. You have
>to monitor her heart rate and weight very closely. I strongly suggest
>purchasing a digital pediatric scale. Its very difficult to notice small
>weigh losses (or gains) in a cat you see every day.

Yes, I will monitor her closely. I just got her blood pressure taken - 3
readings of 135 and 1 of 140. She also has no heart murmer. I would never
have even known she had the start of this disease if I had not had the
testing done along with her usual bloodwork. I'm going to look into the
pediatric scale too - I was using a regular scale -where I stand on it
holding them - but I don't think that works too great.

Thanks Phil

Riannon

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