Plus-Hex CLINICAL
VNs are well placed to educate clients about the treatment process and its risks and benefits , and about maintaining their cat ' s quality of life , irrespective of the treatment modality .
As with all patients , it is crucial that cats with FHT are handled with care and consideration , following established cat-friendly principles . The isolation process during RAIT can be traumatic for both cats and clients ; VNs can ease some of this stress with appropriate housing and interactions with the cats and through informative , empathetic communication with their owners .
Acknowledgements
Many thanks to Dr Amanda Gross at The Hyperthyroid Cat Clinic for her time and assistance with these articles .
Figure 4 . Discharge day for Montana , 6 days post treatment . A reading of 1.5 μSv / hour from a distance of 1 metre is well within the acceptable range for discharge (< 25 μSv / hour ). Photo courtesy of A . Gross .
The risk to the cat ' s human family following discharge is very low but it is important to adhere to radiation safety protocols for at least 2 weeks .
Post-treatment monitoring
Measurement of TT4 is recommended 1 month after discharge . It is common to see cats with transient hypothyroidism at this time . It is advisable to repeat TT4 ( and thyroid-simulating hormone ( cTSH ), if indicated ) at 3 , 6 and 12 months [ 3 ] . After 3 months , most cats ( ̴95 %) have achieved euthyroidism .
Cats that remain hypothyroid after 3 months ( ̴2 %) need to commence lifelong thyroid replacement therapy ( thyroxine ), particularly to prevent or slow the progression of CKD caused by a reduced glomerular filtration rate , which can occur as a consequence of hypothyroidism . This will be a disappointing outcome for clients , but all clients are informed in advance that this a potential outcome of RAIT .
Approximately 4 % of cats remain hyperthyroid after a single treatment and require a second dose . Such cats are often chronically hyperthyroid prior to RAIT , even if the condition was managed with medication or diet [ 3 ] .
Conclusions
Owners of hyperthyroid cats are often highly committed to their cat ' s welfare and keen to pursue a curative treatment . However , there are many issues to consider when determining whether RAIT is the optimal treatment for their cat .
Assessment of learning
1 . For which of the following cats would RAIT not be suitable ?
( a ) A cat with uncontrolled diabetes mellitus ( b ) A cat aged > 15 years ( c ) A cat with IRIS stage I – II CKD ( d ) A cat with a thyroid carcinoma
2 . Prior to RAIT , all cats need :
( a ) At least 3 months of medical treatment to assess the response
( b ) Thoracic ultrasound to identify ectopic thyroid tissue ( c ) Scintigraphy and biopsy of the thyroid gland ( d ) A full blood panel , TT4 , SDMA and full urinalysis
3 . A cat ' s RAI dose is determined by : ( a ) The cat ' s bodyweight
( b ) TT4 , time since diagnosis , presence / absence of thyroid carcinoma , response to previous treatment
( c ) The amount of I-131 the client can afford ( d ) The type of treatment the cat has previously received
4 . Which two of the following are examples of cat-friendly practices ?
( a ) Positioning cages so cats cannot see one another ( b ) Staying as far as possible from RAIT cats at all times ( c ) Providing a hide and shelving within the enclosure ( d ) Leaving a television in the room for the cats to watch
Volume 38 ( 5 ) • October 2023
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