Thyroid surgery

"Mary" wrote in message
.com...

"Phil P." wrote in message


Mary, I'm sorry for not being clearer. Her hyperthyroidism is probably
*causing* the elevation in her liver enzymes. If you treat her
hyperthyroidism, her liver abnormalities will probably resolve.

So you're telling me that my vet, who has practiced here in Raleigh, NC
for
nearly 30 years, does not know this, and I need to tell him?


No. You don't need to tell him. But somebody should.



He literally
*said* that she is not a candidate for tapazole because she has elevated
liver enzymes. If what you are saying is true and he does not know this
then
he is incompetent.


Your words, not mine.


I can deal with that, but I'm not going to decide it
based upon what "some guy in a newsgroup says."

You don't need to decide anything based upon what "some guy in a newsgroup
says." Do your own research,



Can you give me some articles for him to read, something to arm me with
when
I see him?

Type "Feline Hyperthyroidism" in the Google search bar. You'll get about
14,000 hits.

These should get you started and provide you with enough doubt to motivate
you to research the subject thoroughly:

http://www.vet.uga.edu/vpp/clerk/stortz/
http://www.lbah.com/Feline/hyperthyroidism.htm#patho
http://www.marvistavet.com/html/thyr...oms_and_d.html
http://www.gcvs.com/imaging/feline_hyperthyroidism.htm
http://www.winnfelinehealth.org/heal...hyroidism.html
http://www.axiomvetlab.com/EF%203-0.html
http://cvm.msu.edu/vth/spe/sts/proce...hyroidism2.ppt

Can you tell me why an obviously conscientious vet who was
trained at the NC vet school would not know what you're telling me?

You've already answered that question.


And
forgive me, but are you a vet?


You're forgiven, and no.

wrote in message
...
"Phil P." wrote:

We accomplished the same effect with multiple small doses of I-131 but it
took 3 months and cost almost $3K - but it was well worth it.

Mary, what Phil suggest here is an excellent approach as it allows
compromise. Our facility offered this at the same price as one visit.
In other words full treatment one visit $900, or 3 small doses for a
total of $900. There was no financial penalty for taking the gradual
approach.

Ours was more expensive due to the Planar Thyroid Scintigraphy.


Another benefit is that the small doses allow your cat to go home the
same day with lessor handling requirements of waste material.

That's the great part about it! The cat comes home the same day.

Phil


-mhd

wrote in message
...
"Phil P." wrote:

We accomplished the same effect with multiple small doses of I-131 but it
took 3 months and cost almost $3K - but it was well worth it.

Mary, what Phil suggest here is an excellent approach as it allows
compromise. Our facility offered this at the same price as one visit.
In other words full treatment one visit $900, or 3 small doses for a
total of $900. There was no financial penalty for taking the gradual
approach.

Ours was more expensive due to the Planar Thyroid Scintigraphy.


Another benefit is that the small doses allow your cat to go home the
same day with lessor handling requirements of waste material.

That's the great part about it! The cat comes home the same day.

Phil


-mhd

"Phil P." wrote

Thank you for the articles. This one:

http://www.vet.uga.edu/vpp/clerk/stortz/

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:

http://www.lbah.com/Feline/hyperthyroidism.htm#patho

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:
http://www.marvistavet.com/html/thyr...oms_and_d.html

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

"Phil P." wrote

Thank you for the articles. This one:

http://www.vet.uga.edu/vpp/clerk/stortz/

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:

http://www.lbah.com/Feline/hyperthyroidism.htm#patho

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:
http://www.marvistavet.com/html/thyr...oms_and_d.html

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

In the fine newsgroup "rec.pets.cats.health+behav", "Mary"
artfully composed this message within
r.com on 18 Jul
2004:

Liver damage is irreversable.

No, it isn't. Shadow had hepatic lipidosis and his liver values were
horrible. Proper nutrician whether he wanted it or not, reversed his
liver damage. Along with Denosyl (some sort of Sam E).

--
Cheryl

In the fine newsgroup "rec.pets.cats.health+behav", "Mary"
artfully composed this message within
r.com on 18 Jul
2004:

Liver damage is irreversable.

No, it isn't. Shadow had hepatic lipidosis and his liver values were
horrible. Proper nutrician whether he wanted it or not, reversed his
liver damage. Along with Denosyl (some sort of Sam E).

--
Cheryl

"Cheryl" wrote:


Liver damage is irreversable.

No, it isn't. Shadow had hepatic lipidosis and his liver values were
horrible. Proper nutrician whether he wanted it or not, reversed his liver
damage. Along with Denosyl (some sort of Sam E).

Thank you for the correction. This means that whatever damage she has
incurred might be reversed. From within the context of the topic at hand, I
assume you are not suggesting that I take a chance in causing liver damage
in my cat by giving her tapazole simply because liver damage can be
reversed.


--
Cheryl

"Cheryl" wrote:


Liver damage is irreversable.

No, it isn't. Shadow had hepatic lipidosis and his liver values were
horrible. Proper nutrician whether he wanted it or not, reversed his liver
damage. Along with Denosyl (some sort of Sam E).

Thank you for the correction. This means that whatever damage she has
incurred might be reversed. From within the context of the topic at hand, I
assume you are not suggesting that I take a chance in causing liver damage
in my cat by giving her tapazole simply because liver damage can be
reversed.


--
Cheryl

"Mary" wrote in message
.com...

"Phil P." wrote

This one:

http://www.lbah.com/Feline/hyperthyroidism.htm#patho

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.

Although I understand your vet's concern - that the liver enzymes may be
elevated due to a primary reason Vs. secondary, actually the liver does
often repair itself.

As one ex., the cat Debbie I mentioned - who had liver disease (w/ sky-high
values) & was also hyperthyroid, her liver values eventually returned to
normal, w/ proper treatment.

Cathy