Saturday, October 26, 2013

Can a Special Diet be Formulated to Treat Hyperthyroidism in Cats?


I have a 13-year old female DSH cat that has recently been diagnosed with hyperthyroidism. Unfortunately found out that she is severely allergic to methimazole (severe vomiting and anorexia), so I cannot treat her with medication (even though I've read this medicine can cause other health issues).

My next option was to feed her the Hill's y/d diet, but she absolutely refuses to eat that food. I then began an online search to see if I could make my own low-sodium cat food that would mimic the Hill's diet. My online research brought me to your blogs about hyperthyroidism and diet.

After reading many of your blogs, I found where you say that a high protein/low carb diet is beneficial to the hyperthyroid cat (http://endocrinevet.blogspot.com/2011/09/best-diet-to-feed-hyperthyroid-cats.html), but it doesn't address sodium content.

Do you believe a diet referenced in your blog would be a life-long treatment for a cat with hyperthyroidism? Or should I pay a veterinary nutritionist to compose a diet for my cat with an iodine level at or below 0.32 ppm (www.2ndchance.info/lowIodine.htm), which Hill's y/d diet allows? I recently called the nutritionists at UC Davis about such a diet, but was told that they have never made a diet for hyperthyroidism in cats.

I've also read that too low of sodium in a cat's diet will cause the thyroid to once again over-produce hormones to compensate. To say the least, I'm confused. I'm at a crossroad wondering if I should try a diet or go ahead and have the I-131 treatment done for my cat. 

Thank you so much for your opinion and response.

My Response:

High protein, low-carbohydrate diet for hyperthyroid cats
First of all, my recommendation to feed hyperthyroid cats a diet higher in protein and lower in carbohydrates is based on what we know about the secondary complications of hyperthyroidism.

Hyperthyroidism is a hypermetabolic, catabolic state. Therefore, in hyperthyroidism, the body may be forced to use it's own muscle tissue to supply increased energy it needs. Because of these increased protein needs of the hyperthyroid cats, loss of lean body mass and muscle wasting is common. By adding more protein to the diet, this will help preserve or restore lost muscle mass, but feeding a high protein diet, by itself, will do nothing to lower thyroid hormone secretion or correct hyperthyroidism.

My recommendation for feeding hyperthyroid cats a low-carb diet is based on the fact that hyperthyroid cats commonly develop a form of prediabetes. Feeding a lower carb diet will help prevent the onset of overt diabetes in these cats. Even if this was not true, cats have absolutely no dietary requirement for carbohydrate and cats in the wild would normally ingest only 1-2% of their daily calories in the form of carbs (1).  But again, limiting the amount of carbohydrates in a hyperthyroid cat's diet would do nothing to treat the hyperthyroid condition.

Overall, a diet higher in protein and lower in carbs, is actually a more "natural" diet for cats (1,2). But this natural diet fed to hyperthyroid cats must be combined with another treatment directed specially at the thyroid gland (e.g., antithyroid drugs, surgical thyroidectomy, or radioiodine).

Salt and the thyroid
In cats, both sodium and chloride (i.e., salt) are required in relatively small amounts in the diet. Nutritional requirements for dietary salt in cats are available from regulation associations or scientific councils, mostly based on studies establishing sodium requirements in cats (3,4). Salt restriction has been historically advocated for cats in some disease states (mainly cardiovascular and kidney diseases) (5,6). No study has confirmed the benefit of such dietary intervention in cats.

However, feeding a cat a low sodium (or salt) diet will not do anything to lower thyroid hormone secretion from the thyroid gland. In other words, we have no evidence at all that a low salt diet can be used as a treatment for hyperthyroidism. Now, because iodine is commonly added to salt as a treatment for iodine deficiency (7,8), using a lower salt diet could lower iodine levels very slightly.

Iodine and the thyroid
The y/d diet made by Hill's (named, Prescription Diet y/d Feline –Thyroid Health) is an iodine deficient diet (9-11). Unlike sodium or chloride, iodine is one of the essential building blocks needed for thyroid hormone synthesis.

The main thyroid hormones secreted by the feline thyroid include thyroxine (T4) and triiodothyronine (T3).  If we look at the thyroxine molecule, it contains four atoms of iodine per molecule, and that's how the common abbreviation "T4" was derived. Triiodothyronine contains one less iodine atom, thus the common abbreviation "T3." Therefore, it's the number of iodine atoms in each of these thyroid hormones that determines the "number" in T4 or T3.

The basis for using a severely restricted iodine diet to treat hyperthyroid cats is that iodine is an essential component of both T4 and T3. With severe dietary iodine deficiency, the thyroid cannot produce adequate amounts of thyroid hormone (8,9).

Hill's y/d is clearly an iodine deficient diet, containing levels of approximately 0.2 mg/kg (0.2 ppm) on a dry matter basis, well below the minimum daily requirement for adult cats (0.46 mg/kg or 0.46 ppm) of food (9-11).  Our current data does indicate that feeding y/d, a diet severely restricted to overtly deficient in iodine, will result in normalization of T4 levels in most hyperthyroid cats. Since iodine is an essential nutrient and has other functions other than making T4 and T3 (12), the long-term effects of such iodine deficiency in cats remains unclear.

Can a low-iodine home-made diet be formulated?
I am well aware of the claim by some, including Dr. Hines, that it is possible to make your own low-iodine diet. However, if this were true, then why would we ever feed the Hill's y/d diet, which is very unnatural? 

You can certainly talk to a veterinary nutritionist about making an iodine-deficient diet for your cat (13). Unfortunately, it is just not that easy to formulate such a diet, and I do not know of anyone who has made one. That's especially true if we want to feed a higher protein, lower-carbohydrate diet (iodine is present is most meat, since iodine is a required nutrient in all animals, including cattle, chickens, and pigs). And remember, cats are meant to eat a low-carb, high-protein diet!

My Bottom Line:

At 13-years of age (a middle-aged senior cat), I would consider a definitive form of treatment of the hyperthyroidism to be ideal. I'd talk to your veterinarian about the possibility of the use of radioiodine or surgical thyroidectomy. Once your cat is cured, then we can concentrate on the use of nutrition to help restore any lost muscle mass and to improve glucose metabolism.

References:
  1. Eisert R. Hypercarnivory and the brain: protein requirements of cats reconsidered. J Comp Physiol B 2011;181:1-17.
  2. Zoran DL. The carnivore connection to nutrition in cats. Journal of the American Veterinary Medical Association 2002;221:1559-1567.
  3. AAFCO (Association of American Feed Control Officials). Official Publication, 2007. 
  4. NRC (National Research Council). Minerals. In: Nutrient Requirements of Dogs and Cats. Washington DC, The National Academy Press, 2006:145-192. 
  5. Xu H, Laflamme DP, Long GL. Effects of dietary sodium chloride on health parameters in mature cats. J Feline Med Surg 2009;11:435-441. 
  6. Reynolds B. Dietary salt and cats: evidence-based approach. Proceedings of the 21st ECVIM-CA Congress, 2011.
  7. Zimmermann MB. Iodine deficiency. Endocr Rev 2009;30:376-408. 
  8. Zimmermann MB, Andersson M. Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev 2012;70:553-570.  
  9. Melendez LM, Yamka RM, Forrester SD, et al. Titration of dietary iodine for reducing serum thyroxine concentrations in newly diagnosed hyperthyroid cats [abstract]. J Vet Intern Med 2011 2011;25:683. 
  10. Melendez LM, Yamka RM, Forrester SD, et al. Titration of dietary iodine for maintaining serum thyroxine concentrations in hyperthyroid cats [abstract]. J Vet Intern Med 2011;25:683. 
  11. Yu S, Wedekind KJ, Burris PA, et al. Controlled level of dietary iodine normalizes serum total thyroxine in cats with naturally occurring hyperthyroidism [abstract]. J Vet Intern Med 2011;25:683-684. 
  12. Patrick L. Iodine: deficiency and therapeutic considerations. Altern Med Rev 2008;13:116-127. 
  13. Fascetti AJ, Delaney SJ. Nutritional management of endocrine disease In: Fascetti AJ, Delaney SJ, eds. Applied Veterinary Clinical Nutrition. Chickester, West Sussex: Wiley-Blackwell, 2012;289-300.

5 comments:

Tails from the Foster Kittens said...

Beautiful (and informative) post! Thank you

Sharon Wallis said...

My 14 year old cat was diagnosed in May 2016 with Hyperthyroid. She was prescribed Methimazole 5 mg, ½ tablet every 12 hours. She reacted with self-excoriation, throwing up and acting bizarre, getting on furniture/tabletops/kitchen counters and places she would NEVER have gone before. We took her off after only a week and now are on the Science Diet Y/D. This has reduced her thyroid numbers. The problem is, she is still acting somewhat bizarre, still doing self-excoriation and only stops when she is on Temaril P, a quarter tablet daily. Once we start to take her off, she starts with the self-excoriation again.

Now we have done allergy testing….and are awaiting the results. She never had allergy issues prior to taking the methimazole. It doesn’t seem likely that the methimazole is still in her system, but could that have triggered her continued, on-going reaction? She was never ill prior to this, and I am just beside myself. Have you experienced this with any other cats? She is a totally different cat now. Thank you. Sharon Wallis 904-534-4940

Dr. Mark E. Peterson said...

I'd try stopping the y/d to see if that helps. Temaril P is definitely not a good idea, at least on a long term basis.

elissa may said...

Hi Dr. Mark,
My kitty is 11 & was recently diagnosed with a hyperthyroid. Her T-4 levels were at 15 a few weeks ago. We're currently feeding her the y/d formula, because I tried the transdermal methimazole and she would run from me. Then I tried the liquid, which at a low dose, gave her really bad diarrhea.
She's relatively healthy, although she's been through some things- she had diabetes for a couple of years that we treated with insulin. Her levels are now normal & has been off insulin for almost a year. Last year, she had a tumor in her eye & had to have it removed.
I live in Hawaii so I don't have access to the radioiodine treatment and I don't like the idea of feeding her the y/d diet forever, it just seems wrong to feed her such high carbs, especially since she's prone to being diabetic.
My question is would a high protein/low-carb, bpa free, canned food diet, along with L-Carnitine, and a low dose of methimazole be worth trying/be effective? Or is it worth getting the surgery?
I'm just worried about putting her through a complicated surgery, especially in Hawaii where the Dr.s might not have the most experience.
And thank you, you and this website have been so helpful. I really appreciate it!!
Take care,
Melissa

Dr. Mark E. Peterson said...

Yes, you can try a combo treatment of low-dose methimazole and L-carnitine. In a 11-year old cat, however, radioiodine or surgery would be ideal.