Daisy or the importance of onset in the treatment of hyperthyroidism

The patient is a 15 year old desexed female Siamese cat called Daisy. She had been diagnosed about a year ago with hyperthyroidism. She was being treated with Felimazole (thiamazole/methimazole) 2.5mg BID. The owner said the treatment was expensive and difficult to administer. She also reported side effects of listlessness, lack of appetite, and occasional vomiting.

Previous History
The problem started about a year ago, following a rabies vaccination. She became less active and suffered a dramatic loss in weight. Previously, she had developed a local injection site reaction, between the withers. She lost her voice after being involved in a road traffic accident several years ago. She recently relocated from London to Croatia and lives in a household with 2 other cats.

Laboratory results
The thyroxine (T4) level was 70 nmol/L at the time of initial diagnosis (normal 8 - 40). Levels ranged between 40 and 11.4 during the period of treatment. 

1st Consultation: 14/10/2010

2.7kg

Eyes: alternating watery/dry. Painful

Nose: dry

Mouth: moderate tartar

Heart Rate: elevated, over 190 when untreated

Personality/Character

Alert, interactive

‘Love junky’ (but only on her own terms)

Manipulative. Likes to control owner (less so with boyfriend)

Likes to be centre of attention, but also wants to be on her own

Sensitive to other people’s feelings

Jealous of other cats

Used to chew wool (since young) but not recently

Likes

To be warm

Dislikes

Sudden fast movements

Lavender

Vacuum noise

Crinkly aluminium foil

Food

Can be fussy

Likes fresh tuna, prawns, salt

Drinks

Always drinks a lot

Repertorisation using Radar version 9.0 and Synthesis 9.1V

Sum of symptoms (sort:deg)  -  Sum of symptoms (sort:deg)  -  Intensity is considered

Prescription

Reference to materia medica confirmed that Thuja was indicated, since it reflected many (but not all) of the major symptoms. Thyroidinum was also given as part of an ongoing investigation into rebalancing glandular activity (using LM potencies), with the intention of subsequently weaning off Felimazole. 

I routinely use LM potency remedies, beginning with the lowest potency available at the time.

Ø      Thuja LM2 SID

Ø      Thyroidinum LM2 SID

Ø      Felimazole 2.5mg EOD

Ø      Encourage raw meaty diet

2nd Consultation: 18/11/2010

The weight has increased to 3kg. Daisy’s general appearance has improved and she has more energy. She is eating a variety of fresh meats but vomited liver. Her voice is returning although it is still croaky. She also started to chew wool again last week. The homeopathic treatments were given as directed but the boyfriend did not give Felimazole regularly.

Interpretation

The increased weight and improved appearance are encouraging. The increase in energy and appetite for fresh meat may be a response to the treatment but it could also be the result of a reduced exposure to Felimazole. The observation that Daisy started to chew wool again is a good sign since this is the return of a previous long term behaviour that stopped when she started to suffer from hyperthyroidism. Another favourable sign is the return of her voice, which she lost after a road traffic accident several years ago.

Prescription

The homeopathic treatment was continued as before and the Felimazole was reduced to 2.5mg twice weekly.

3rd Consultation: 07/01/2011

Daisy’s weight is still increasing and is now 3.4kg.  Her voice has returned and is no longer croaky. She is eating her raw food diet well. Her nose is not dry and her eyes appear better. Her breath smells better and she is no longer jealous when other cats sit on the owner’s knee. 

Interpretation

An improvement in all the physical symptoms is encouraging. Daisy is improving on a deeper level since she no longer appears to be jealous. The improvement in her breath is perhaps because she is actually flossing her teeth when she chews wool (?!)

Prescription

Reduce Thuja LM2 to once, every second day. Continue Thyroidinum LM2 SID. Stop Felimazole.

Future Plan

Re-visit after one month. Consider using Natrum muriaticum instead of Thuja, if this is indicated. Probably also wean off Thyroidinum.

It is anticipated that Natrum muriaticum is likely to be required at some time in the future, as a constitutional remedy for Daisy. This is for several reasons, especially the mental symptoms.

Sensitive

To other people’s feelings

To crinkly aluminium foil - repertorised as rustle of paper (although most cats are averse to the sound of aluminium foil)

‘Love junky’ on her terms

Likes to be centre of attention, but also wants to be on her own

As with Thuja, Natrum muriaticum has strong sycotic symptoms that are shared by the patient. These include:

Vaccinosis

Hyper: overactive gland

Hydrogenoid: always drinks a lot (uncommon in cats fed properly)

Salt: desires salt and sea food

Felimazole side effects:

It is worthwhile reminding ourselves of the side effects that are recognised for Felimazole since some of these (eg, vomiting, anorexia, and listlessness) may contribute to the patient’s symptom picture.

Vomit, off food, listless

Itchy face & neck (self traumatise)

Bone marrow suppression (red blood cells and white blood cells)

Reduces hepatic oxidation of benzimidazole anthelmintics (advise caution when worming)

Less effective if on phenobarbitone

Immunomodulatory (caution advised with vaccination)

It is also important to be aware of the side effects that occur in people since our clients will be administering the drug. This is particularly important in pregnant women since Felimazole is a suspect teratogen. It is excreted in the urine, so women should wash their hands after handling the drug and when emptying litter trays.