Daisy - the treatment of hyperthyroidism

The patient is a 15-year-old neutered Siamese cat called Daisy. About a year ago she was diagnosed with hyperthyroidism. She was treated with Felimazol (thiamazole / methimazole) 2.5 mg BID*. The owner said the treatment was expensive and difficult to administer. She also reported side effects such as apathy, loss of appetite and occasional vomiting.

History
The problem began about a year ago after a rabies vaccination. She became less active and lost weight dramatically. Previously she had developed a local reaction at the injection site on the withers. Daisy had lost her voice after being involved in a road traffic accident several years earlier. She recently moved from London to Croatia and lives in a household with two other cats.

Blood test:
At initial diagnosis the thyroxine level (T4) was 70 nmol/L (normal 8 to 40). During treatment it fluctuated between 40 and 11.4.

First consultation on 14 October 2010
2.7 kg
Eyes: alternately watery / dry. Painful
Nose: dry
Mouth: some tartar
Heart rate: elevated, untreated over 190

Personality / character
Lively, communicative
Seeks affection (but only on her own terms)
Manipulative: tries to influence her owner (but not the owner's boyfriend)
Likes being the centre of attention, but also wants to be alone at times
Sensitive to the feelings of other people
Jealous of other cats
Used to like chewing wool (since her youth), but not any more

Cravings
- Warmth

Aversion
- Sudden rapid movements
- Scent of lavender
- Vacuum cleaner noise
- Rustling of aluminium foil

Food
- Can be quite picky
- Craves fresh tuna, crab, salt

Drinks
- Drinks a lot

Repertorisation with Radar Version 9.0 and Synthesis 9.1V
Sum of symptoms (sort: deg) - Sum of symptoms (sort: deg) – taking intensity into account

Prescription
The materia medica confirms that Thuja is indicated, as it covers many (though not all) of the important symptoms. Thyreoidinum was also given to bring her thyroid activity back into balance (using LM potencies), in order to be able to taper off Felimazol afterwards.

I routinely prescribe LM potencies, starting with the lowest possible potency.
Ø Thuja LM 2 once daily
Ø Thyreoidinum LM 2 once daily
Ø Felimazol 2.5 mg every other day
Ø Dietary recommendation: raw meat as often as possible

Second consultation on 18 November 2010
Daisy has gained weight to 3 kg. Her general appearance has improved and she has more energy again. She likes to eat fresh meat but vomits liver. Her voice has returned, but still sounds hoarse. Last week she even began chewing wool again. The homeopathic remedies were given as prescribed, however the owner's boyfriend gave her the Felimazol only irregularly.

Interpretation
The weight gain and improved appearance are encouraging. The increase in energy and the appetite for fresh meat may be a response to the treatment, but could also be due to the reduction of Felimazol. The observation that Daisy has begun chewing wool again is a good sign, as this is the resumption of an earlier habit that had ceased with the hyperthyroid disease. Another favourable sign is the return of her voice, which she had lost after a road traffic accident several years earlier.

Daisy after the third consultation on 7 January 2011

Prescription
Homeopathic treatment is continued and Felimazol reduced to 2.5 mg twice weekly.

Daisy's weight continues to increase and is now 3.4 kg. Her voice has fully returned and she is no longer hoarse. She eats well and likes her "raw food". Her nose is no longer dry and her eyes also seem better. Her breath smells better and she is no longer so jealous when the other cats sit on her owner's lap.

Interpretation
The improvement of all physical symptoms is encouraging. Daisy is better on a deeper level

better, as she seems less jealous. The improvement in the breath may be because the wool-chewing acts on her teeth like using dental floss.

Prescription
Thuja LM 2 is reduced to once every other day. Thyreoidinum LM 2 once daily is continued. Felimazol is discontinued.

Plan for the future
Review in one month. A change to Natrium muriaticum (instead of Thuja) will be considered if indicated. Thyreoidinum will probably need to be tapered slowly.

It is to be expected that Natrium muriaticum will probably at some point be indicated as a constitutional remedy for Daisy (for various reasons, mainly because of the psychological symptoms):

Sensitive

• sensitive to the feelings of the people around her
• to the rustle of aluminium foil >> repertorised as "rustling of paper" (most cats cannot stand the rustle of aluminium foil )
  
  
• Craves petting - but only on her own terms
• Likes being the centre of attention, but also wants to be alone sometimes
  

Like Thuja, Natrium muriaticum has strong sycotic symptoms that appear in patients. These include:

• Vaccine damage
• Hyper: overactive glandular activity
• Hydrogenoid: always drinks a lot (unusual in properly fed cats)
• Salt: craving for salt and seafood

Side effects of Felimazol:
It is worth recalling the known side effects of Felimazol, as some of them (e.g. vomiting, loss of appetite, lethargy etc.) could have contributed to Daisy's symptom picture:

• Vomiting of food, loss of appetite
• Itching of the face and neck (self-inflicted by scratching)
• Bone marrow suppression (red and white blood cells)
• Reduced hepatic oxidation of benzimidazole anthelmintics (caution when deworming!)
• Less effective when phenobarbital is given concurrently.
• Immunomodulation (caution with vaccinations!)

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*BID = twice daily.************************************************************************
Photos: Douglas Wilson
Categories: Cases
Keywords: Hyperthyroidism, rabies vaccination, "affection-seeking", weight loss, hoarseness
Remedies: Thuja, Thyreoidinum