At this point, your long-term plan with Miss Kitty is to leave her methimazole dose where it is, add a phosphate binder to her regimen, and, once her phosphorus concentration falls below 6 mg/dl, initiate calcitriol therapy. Her clinical condition will likely change over time, and we may need to consider changes in her methimazole dose if her renal disease worsens and she doesn’t feel well. Managing cats with hyperthyroidism and renal disease is like walking a tightrope, but with dedicated owners and close monitoring, it is possible to keep them happy with a good quality of life.
1. Milner RJ, Channell CD, Levy JK, et al. Survival times for cats with hyperthyroidism treated with iodine 131, methimazole, or both: 167 cases (1996-2003). J Am Vet Med Assoc 2006;228(4):559-563.
2. Nagode LA, Chew DJ, Podell M. Benefits of calcitriol therapy and serum phosphorus control in dogs and cats with chronic renal failure. Both are essential to prevent or suppress toxic hyperparathyroidism. Vet Clin North Am Small Anim Pract 1996;26(6):1293-1330.
3. Polzin DJ. Chronic kidney disease. In: Textbook of veterinary internal medicine. 7th ed. St. Louis, Mo: Elsevier Saunders, 2010.
4. Riensche MR, Graves TK, Schaeffer DJ. An investigation of predictors of renal insufficiency following treatment of hyperthyroidism in cats. J Feline Med Surg 2008;10(2):160-166.
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