Thank you for the update! Glad your kitty is still feeling ok after taking him off the meds. Hope everything goes smoothly for him at the clinic. Please let me know how he does, and how long it takes for him to forgive you for not cuddling with him for two weeks afterwards! 
My guy went in for his treatment today! He did so well. Hereās his scintigraphy:
I have so much peace of mind knowing this is what weāre dealing with (tumor size, location, no metastasis) vs just flying blind. This looked pretty sizable to me, but was actually smaller than the doctor was expecting!
He got 80% of his radiation dose today, and they monitor uptake, giving the remainder as necessary on Wednesday. Dr Peterson said heād likely need 3 millicuries based on his pre procedure labs, his ānormalā is 1.9, but many clinics give everyone 4. 
He also mentioned a couple papers he thought Iād find interesting. This one is fascinating! Especially the discussion about increased incidence and possible causes why:
https://sci-hub.se/10.1530/JOE-14-0461
And this one, too, I had no idea testing could be SO unclear, or vary so widely. Or that thereās no cat specific TSH test?! (How crazy is that, really.)
https://sci-hub.ru/10.1177/1098612X13500426
Anyway, I hope theyāre helpful for you, too.
Itās definitely been worth the āfancyā clinic here for us, the level of care and concern is amazing. Iām so glad we went this route instead of the more local āone size fits allā clinics. (Which I know work great for many, but Iāve loved the personalized treatment heās getting.)
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No fish. Ever. Iām surprised about the Tiki Cat. Most of the varieties are meat and vitamins and minerals. I wouldnāt feed many of the food your vet is recommending. Vets are notorious for having poor education in pet nutrition and are trying to sell you what they carry in the clinic.
I had the radiation treatment on a 10-year old cat. Tried the meds but his values grew more difficult to control over time. It was just too much of a hassle and doing the math, with vet visits, repeated testing, meds and special diets, the math just didnāt work out.
I donāt feed fish.
The issue with the foods on the ānoā list is they risk not containing the nutrients (iodine is a biggy) they claim.
āMy vetā here is THE expert in radioiodine therapy. Heās the guy who developed the therapy and has done a significant bulk of the research in it. I feel very lucky to have access to his clinic. Iāve linked a number of his papers in this thread. He also (literally) wrote the book.
The first paper I linked directly above your post has some of his research wrt diet. A good read if this is of interest to you.
Heard again from the clinic (they actually call every day with an update, and email a pic every night 
) and everything is right on track. Peterson monitors uptake and typically gives the small remainder of the dose on Wednesday, and that was given yesterday. Weāre on track to pick up on Saturday.
Iām honestly pretty stunned with how WELL this cat has done! Heās a total sweetheart, but very shy with new people, and while heās locked in the tack room overnight, itās not like heās an inside cat. But every report I get is just glowing with how sweet he is, and how chill he is, and how much they love him. I can pull him up on the cam in his kennel, and heās just lounging. I was so worried heād be really upset being kenneled, and with strangers.
Weāre really looking forward to having him home, but knowing heās doing okay and isnāt freaked out where he is helps SO much.
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Hi Simkie-
Was your kitty able to come home yesterday as planned? Howās he feeling, and is he holding a grudge?
Heās doing SO well
He was just a bitā¦ shell shocked immediately after getting home yesterday. Looked a little lost, and went and hid, but seemed a little confused about the whole thing. We gave him a few hours alone to decompress, and after that heās been his typical self, purring and looking for attention.
Heās our barn cat, so itās not like he sleeps with us, so itās a little easier to keep total snuggle time to 20 mins/day. He very much wants out of the tack roomāheās usually locked in only at nightāso weāll have to figure that out. While the vet wasnāt concerned out him pottying outside (as long as itās not in the neighborās vegetable garden!) we do have a dog that finds all sorts of poop quite tasty. I donāt know if she ever finds his spots, but that sounds like bad news if she does.
His total dose came in at 2.25 millicurie, so less than predicted with his intake bloodwork, but more than average. Heās a pretty big guy, so that might account for some of the increase? Overall, the experience was just fab, we heard from the clinic & got pics everyday, and he just did very well.
I know this sounds crazy cat lady bonkers, but I do think that some of his comfort with the whole thing is because I told him in advance what was going to be happening, and stressed that weād be back to get him. I really do think they can understand more than we give them credit for. So tell your girl what to expect, that sheās going to be meeting some nice people, and that youāll be back to bring her home in a few days. Worst case, you feel kinda silly, but truly, I think it makes a difference.
Oh, one thing I didnāt anticipate (I just didnāt think about it) is that Peterson has requested follow-up bloodwork & physical exam (with the local vet) at 1, 3, 6, and 12 months post treatment. That adds maybeā¦$1200? to the total treatment cost? which is fine, whatever, but I just didnāt think to ask about follow-up recommendations prior.
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Aww, Iām glad heās happy and home! I am a crazy cat lady who is bonkers, and since I live alone I talk to the cats all the time. 
So I definitely will be having conversations with CJ before she goes anywhere. Not that it seems to make any difference to her, but it makes me feel better. Lol.
Thanks for the additional information on the follow-up visits. Iāll have to really think again about the expenses on this now before committing to it. I figured there would be one round of follow up testing, I wasnāt planning on 4! Although she needs to go in twice a year now anyway to check on how her kidneys are doing but I still need to factor in the extra cost. Along with the pre-visit testing as well. If the recommendations are the same for the clinic here, those visits combined will put the treatment at over $4K which is a lot of money to spend on a cat that has other health issues.
Regardless of the money Iām still torn over her being my heart kitty and whether itās truly in her best interest to put her thru everything or whether Iām just being selfish and wanting to hold on to her as long as possible past what will be kind to her. She will be extremely stressed about the stay at the clinic along with the additional vet visits and will not be a cooperative patient when her kidney disease progresses to needing additional therapies. This is a cat who insists I build a tiger cave/pillow fort every day in my bed for her so she can sleep in seclusion and comfort. Lol. And one who has refused for 12 years to allow me to trim her nails, instead forcing me to take her to the vet to do it instead (at $28 freaking dollars a pop!). One would think she would be smart enough to realize its far less stressful for me to do it, but nope, Iām not allowed for ANY reason to touch her paws without being threatened with loss of limb. 
Thank you so much for all the information on your experience and how your guy did. I really appreciate it! I hope the treatment worked perfectly for him and he can go back to his regular happy barn cat life quickly.
My kitty only needed two follow ups with bloodwork so that seems to vary by vet. They did one month and 6 months. She was only 11 but it absolutely gave her her life back sheās so much healthier after treatment.
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I know, it IS a LOT of dollars. Sigh.
I was also really worried about the stress of it all. This guy is shy shy shy with people other than us. Having to be handled by anyone new is always hard on him.
And then I was worried about discontinuing methimazole, too. Heās always stuck very close to home, but would he be really anxious, and would heād leave? What a worst case scenario.
So that, plus just not feeling really sold on the radio clinic referrals I was getting from my local vets is really why we waited. He tolerated being pilled twice a day just fine. Overall, he looked pretty good although a little dull? I thought we might be over treating him, but his T4 was on the higher side when we checked this spring, so I guess not. But that red cell dyscrasia is what really pushed me to go look around and get him treated.
Thereās def nothing wrong with waiting and seeing. Have you looked through the IRIS kidney cat staging stuff? It might help provide some more info on where she is with her kidneys and what you might expect there.
There is a risk the longer you wait that some of those errant thyroid cells will become cancerous, and then metastasize. Methimazole doesnāt stop the thyroid tumors from growing, it just prevents the thyroid hormones from being produced. So that is something to weigh.
I know itās a tough decision. Overall, for us, the stress to the cat was about as minimal as it could be, despite not expecting it to go that way. Your kitty might surprise you in that regard, too. (The vets can trim her nails! Just because she says no at home, doesnāt mean she says no to them? This might be similar?) And this option does seem a lot kinder to them than surgery, which is something else my vet offered.
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My friend had it done about a year ago with her 18/19ish year old cat. I was surprised given the catās age. But her cat has thrived since then, looks so much better, and gained back a lot of the weight she had lost.
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She only lets the vet techs trim her nails because sheās too terrified to resist. 
She used to spike a stress fever on every vet visit but that seems to have finally stopped now in the past few years. But she tries to hide and just shakes in fear the entire time sheās there. Iāve considered at times whether she would be scared enough to let me trim her nails if I just put her in the car and took her to a friends house instead so I could get help pinning her down. Lol. It would save me a nice amount of money!
She is in stage 1 with her kidneys according to her last bloodwork. Certainly seems to still feel fine at the moment, which is good. Still doing wind sprints, playing with the dog toys and cleaning her plate like normal. Her coat has felt greasy to me the last two weeks or so at times which is something new, so Iām wondering if that means her thyroid or kidneys may be flaring up.
Her teeth are bothering her and she probably needs one or more pulled based on how sheās eating her food. And definitely needs them cleaned. But with the enlarged heart and murmur Iām not keen on knocking her out right now for that, and the vet wanted to get the thyroid medicated first.
I think Iām going to switch her to the cat only vet when itās time for her next round of bloodwork and go over everything in detail with them and see what they recommend with regards to her thyroid treatment and kidney disease. Hopefully theyāll be more helpful than the current vet.
Howās your kitty feeling now that heās had a few days to settle back into being home?
Iām sorry I missed replying here, Cammie! Weāre a month out, so wanted to update. My guy settled back into being home like a champ after a couple days. I kept him mostly in the tack room for the first two weeks to contain his radioactive waste. He was very happy when that period of incarceration ended, but it didnāt traumatize him 
Whatās surprised me the most about all this is itās clear he feels SO MUCH better. By maybe 7 or 10 days post treatment, he was very obviously brighter and more chipper, and his coat started feeling much better, too. His goopy eye cleared up. He was just much more clearly himself.
I didnāt expect that, because I thought treating with methimazole pretty much took care of the symptoms of being hyperthyroid. I didnāt realize that he would feel so much better. Iād definitely noticed that he was kind of dull, and was concerned we were over treating him, but that wasnāt the case looking at the bloodwork. Iād also noticed that I was doing more coat care, but heās just got a shit ton of hairā¦itās a lot to maintain.
Thereās really clearly a massive difference in how he feels now vs pre treatment. He goes in today for his first post procedure exam, and Iām eager to see what that shows.
But based on what Iāve seen in this guy, itās really worthwhile to go the iodine route vs maintaining with methimazole, even if thatās a stressful week. The change in QoL is massive.
Howās your girl been doing with the meds?
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So glad your guy is doing so well! I have noticed CJās coat feels greasy the past few weeks and figured it was probably because of her thyroid.
We had a major setback the past few days, she got sick on Sunday around mid-day. She was slow to come to lunch, and started looking uncomfortable later in the afternoon. Shifting positions, moving from different napping spots and in some discomfort. She had slightly elevated respiration as well. She came out very late for her dinner and wouldnāt eat her regular food but did eat a tube of tuna puree. Bedtime snack she would only eat a mouthful of the tuna, ordinarily she tries to rip the tube from my hand to scarf it. I kept an eye on her all night, she woke up at 1:30 and barfed up all the food along with her undigested evening thyroid pill. She wouldnāt eat at all at breakfast so off to the vet.
Vet thought maybe her thyroid meds were too high, they can cause IBD or gastro upset. Bloodwork came back fine other than one liver value that was high but she thought it was a result from her throwing up. Kidney numbers are still good. Did not test thyroid since it wouldnāt be accurate after missing two pills. Fluids, anti-nausea meds and they sent her home. No improvement by the next day, she wasnāt shifting around as much but was very lethargic and dull and wouldnāt eat anything. Still had the elevated respiration. I actually thought for a minute in the morning she had passed away, she was so still and didnāt respond at first when I called her and touched her. Nearly gave me a heart attack.
Regular vet didnāt have any openings until the next day, so I called the cat only clinic, which Iāve been thinking of switching the cats to anyway. Lucked into an appointment and they did a SNAP test which came back as abnormal, so she likely has pancreatitis. Her symptoms fit so we moved forward with that assumption. They did do x-rays which showed gallstones, which may or may not be bothering her. Iām waiting on a callback from previous vet to see if they saw any in previous x-ray in Feb. Apparently cats regularly can have gallstones that cause no issue. The good news is her enlarged heart is back to normal, although she still has the low-grade heart murmur. She does have Intervertebral Disc Disease, and a small collapsed section on one lung. Vet said they usually see that in cats that have had chronic bronchitis or asthma. She has had neither, so no clue where that is coming from. Vet said not a concern at the moment, but something to keep an eye on with future x-rays. They did more fluids, appetite-stimulant, pain meds, b-12 shot and said to keep her on the Cerenia longer. MUCH better vet than at the other clinic Iāve been using.
She didnāt eat dinner, and was high as a kite from the pain meds. She did start purring again and definitely felt some relief after she got home. No breakfast even after anti-nausea and pain meds, but you could see her thinking about it. Lunch she came out for like usual but only ate a small bite or two. By mid-afternoon she was hungry and ate a few cookies before I left for practice. When I got home she was waiting for dinner and inhaled it and wanted seconds. I gave her another dose of pain meds just in case, but she seemed to be feeling pretty good. Ended up not needing to use the appetite stimulant. I didnāt give her any pain meds or anti-nausea meds this morning and she inhaled her breakfast and is acting normal so it looks like sheās bounced back much quicker than the vet anticipated. 
She restarted the thyroid meds yesterday morning, so she only missed three doses. But will need to check her again in a month to see where sheās at. This vet also highly recommended the radiation treatment, so I will be trying to book an appointment assuming she keeps feeling fine before these current x-rays are too old to use in the hopes of at least saving a tiny bit of money in the required diagnostics. The two vets visits totaled a little over $1300. 
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Oh boy, pancreatitis is such a bitch, Iām so sorry youāre dealing with that. I have one (not my thyroid kitty) thatās been through a few rounds, too. Actually just wrapping one up, sigh. Glad your girl is on the upswing!
Yes, this is what I saw with my hyperthyroid cat. Itās just miraculous how much better they feel after curing the hyperthyroidism. And another benefit is that you wonāt have to give medicine twice a day every day forever.
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Ok, decided to move forward with the thyroid treatment since CJ bounced back so fast from the pancreatitis episode in May. Took her in last week for the last of the required diagnostics, and dropped her off yesterday afternoon for her nuclear scan. The thyroid vet called last night- CJ is NOT hyperthyroid and has no signs of any thyroid tumors. 
So, awesome? But what the hell?
The thyroid vet thought maybe she just runs a little high on her thyroid numbers, as she was just over the threshold when she was tested back in Feb. Her symptoms at the time seemed to match hyperthyroidism, with the weight loss, new heart murmur and enlarged heart so they put her on the meds and when retested in March her numbers were good. When she had her pancreatitis bout in May, another vet thought maybe the thyroid meds were slightly too high and maybe that was causing the GI upset. I had her thyroid tested last week in preparation for her visit, and her thyroid was now a little low. The new x-rays showed her enlarged heart is now normal, and she had put a little more weight on from May to last week.
So no more thyroid meds, and no idea what caused the weight loss and why her heart was enlarged and is now back to normal size. Spent $256 on unnecessary tests last week and $650 for her expensive slumber party last night. AAAARGH!
She is extremely relieved to be back home. I did like this vet and facility very much, and glad I went with the more expensive option that had the nuclear scintigraphy. If I had gone to the cheaper place they would have just dosed her based on her bloodwork and zapped her thyroid, potentially causing her to be hypothyroid afterwards. So bullet dodged there at least.
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