Thank you for the articles. This one:

does not mention at all the advisability of prescribing Tapazole for this
condition when a cat already shows elevated liver levels. It stresses that
the only cures are radioactive iodine and surgery, and that medication
merely treats symptoms. It does not tellme anything my vet did not already
tell me.

This one:

does indeed discuss the issue of elevated liver enzymes due to
hyperthyroidism, and says that *if* they are secondary to (e.g. caused by)
the condition they will return to normal when the thryoid is treated. What
really worries me is probably what worries my doctor: what if her elevated
liver enzyme levels are NOT secondary to the thyroid disease, and the
tapazole further damages her liver? Liver damage is irreversable. And, this
site, like the one above, also calls radiotherapy the "safest and most
effective treatment." This site says that the average age is 13--so Buddha
is young for this.

This site:

says that fully 87% of cats with hyperthyroidism also have hypertrophic
cardiomyopathy--very scary and another reason to go for a CURE and not just
a treatment of the symptoms. This site gives the average age as 14 and the
incidence of malignancy in the tumors that generally cause hyperthyroidism
as 2%. Still one great benefit of radioactive iodine treatment is that if
there is any cancer, it will be cured. What really bothers me so far about
all information I have seen is that Buddha, although she clearly has a
HUGELY enlarged thyroid, exhibits none of the other symptoms. She is FAT,
and has a lovely, shiny black and white coat. She tends to be a thinker, not
very hyper at all. It makes me wonder what the growth on her thyroid is, and
if it is a simple case of hyperthyroid. This site also mentions that
although treating the symptoms with Tapazole (instead of CURING the disease
with radiation or surgery) although seen as cheaper, is deceiving due to the
fact that it requires lots of rechecking blood levels and lots of medicine.
It also states that side effects "include vomiting, diarrhea, blood
dyscrasias, and hepatotoxicity. " And "As stated in the Physicians Desk
Reference (PDR) and the package insert, "tapazole is intended to be used to
ameliorate hyperthyroidism in preparation for a more definitive treatment"
and as such tapazole is not intended to be used as a long term treatment. "

So at this point I am wondering, why bother with Tapazole? Why put her
through this? The radioactive iodine requires a single shot and not even any
anesthesia, and she is cured.

Advantages of radioactive iodine treatment, from the site above:
"The third option for the treatment of hyperthyroidism is the administration
of radioactive iodine. The advantages of radioiodine cure are many. The
overall success rate is 96% following a single injection of iodine- 131.
Recurrence rate is extremely low. The return to a euthyroid state is rapid,
as circulating thyroid hormone levels drop precipitously within 48 hours
post-administration, and there are essentially no side effects. Not only
does the radioactive iodine only localize in thyroid tissue, it only
destroys hyperfunctional thyroid tissue (wherever it is). Normal thyroid
cells are suppressed through negative feedback loops, and as such do not
concentrate any of the iodine. These spared normal thyroid cells then can
"turn back on,' and make normal amounts of thyroid hormone following
treatment. In this way, cats treated with radioactive iodine typically do
not need any medication and are euthyroid. Because the killing effects (beta
particles) that are released from the radioiodine travel such a short
distance, there is no effect on the adjacent para-thyroid glands and
post-therapy hypocalcemia is not seen. The only disadvantage to the use of
radioiodine is that the cat must be hospitalized in a special facility for
about 4-5 days, while the animal is excreting the radioactivity."

So far, these sites are convincing me that I should take her in for the
radiation treatment asap.

This site:
http://www.gcvs.com/imaging/feline_hyperthyroidism.htm

says this:

"Once hyperthyroidism has been confirmed, there are several treatment
options. They include treatment with radioactive iodine, surgical removal of
the gland, and treatment with anti-thyroid medications. The initial choice
of treatment is often guided by concern about the patient's kidney function
status. Some cats have detectable impairment of kidney function at the time
of their diagnosis with hyperthyroidism, but many do not. It is difficult to
assess kidney function accurately from routine blood testing in cats.
Generally about 2/3 of the kidney function must be lost before routine blood
tests will show any abnormalities. This has made it very difficult in the
past to detect which cats with hyperthyroidism actually have concurrent
kidney failure. However, Michigan State University has introduced a very
sensitive test of kidney function in cats and dogs called the iohexol
clearance test. In this test, a radiographic contrast agent called iohexol
is injected intravenously and the rate at which the kidneys clear the agent
from the bloodstream is measured. The test is carried out in the
veterinarian's office and a series of blood samples is sent to the MSU lab
for analysis.
Since hyperthyroidism induces increases in blood pressure and blood supply
to the kidneys, treating the disease will result in a drop in the blood
supply to the kidneys. In a cat with kidney failure, this can cause a
worsening of their kidney function in the few months after treatment for
hyperthyroidism with either radioactive iodine or surgical removal of the
gland. For this reason, patients with known kidney disease (either detected
on routine blood work or with the iohexol clearance test) are often treated
with anti-thyroid medications rather than surgery or radioactive iodine in
an effort to preserve their remaining kidney function. Using medications
allows the veterinarian better control over the concurrent kidney disease
and may allow the patient to survive longer. "

Which leads me to think I ought to have the radiation done because she has
normal kidney function. In other words, I want to have it done *while she
still* has normal kidney function.

This site:

http://www.axiomvetlab.com/EF%203-0.html

says that if she already has heart disease ("congestive cardiac failure")
she should not have the radioactive iodine. So I think we should have an
ultrasound before doing the radiation. It does not mention anything about
any advantage in placing cats on tapazole before beginning the radiation
therapy.

The site below is really interesting, I like that it has an actual photo of
an enlarge thyroid among other things.

http://www.winnfelinehealth.org/health/hyperthyroidism.html

However, I see no mention at all of any advantage in treating with Tapazole
before having the radiation cure done. And, as with all the other sites, the
only REAL disadvantage is that the cat might become hypothyroid, and that
can be treated with animal thyroid or synthroid. Other downsides: the fact
that the cat has to be away from home for ten days or so, and weight gain,
which in Buddha's case would not be good.

My conclusion is that you are wrong about there being any advantage to
putting her on Tapazole first, except financial. She clearly has the
disease, from her thyroid levels and the enlargement. Of the two cures,
radiation is the least risky. Medication:

A. is not a cure at all
B. has nasty side effects including vomiting, diarrhea, lethargy, and
upsetting the cat two or three times a day every day to pill her, plus the
added upset of frequent vet visits and lab work to monitor her thyroid
levels.

I'm not sure why you have come to the conclusion that medicating with
Tapazole first has any advantage at all. I'll run all this by my vet
tomorrow, then I'll schedule her for the radioactive iodine cure.

Thanks so much for the information. I know a lot more than I did two days
ago.

An enlarged thyroid is not usually because it's cancerous, if that's a
consolation.  It's usually just a symptom of hyperthyroidism (in people,
too).

Cathy

(...)

Small world - my vet!
S.

store and bought one of those cheap packages of 5 large t-shirts. I slept in
one each night and would regularly bring one to the clinic he

A great idea. I think I will have my husband sleep in an old t-shirt and
donate it, as Buddha worships him. He is really her human.

calmed him. The law  here required >longer clinic stays than most states and
I wasn't able to

I really home they won't keep her that long. I have heard everything from
three days to two weeks. Today my vet told me that it is more a matter of
the cat's waste, which is radioactive for quite a while, rather than the cat
itself being radioactive.

of his hard luck story and very delicate, >insecure nature (he was arecent
rescue and I wrote and >gave several copies of a detailed letter to them
telling his story) and they went out of their way giving him

That's great that you made that effort and that they took care of him that
way. Boo is pretty confident--nine years ago I carried her in the palm of my
hand (she was so tiny) to my husband's father, where she was spoiled beyond
rotten, played with, loved, laughed at, cuddled, and overfed into her
current errr, "Rubenesque" shape. :) Then he began to travel a lot and I
asked for her back. She's very assertive and very brave. On the other hand,
since she has been with my husband for so long, she is very attached to him,
so she will be very lonely. This cat has a lovely, totally heart-rending,
deep, throaty howl--I have never heard a more evocative "woe is me!" I guess
part of that is the thyroid disease as I understand it makes them more
vocal. But maybe part of it is kind of like the way the biggest, deepest
voices come out of those great big blues singers! Buddha will sing the blues
every night. She does here if my husband leaves the room long enough to take
a shower. I guess I am worried about her being gone so long.

We had three and a half

I bet. I'd do it for any additional time with this hilarious, sweet girl.
Thanks for the input.