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2016 AAFP Guidelines for the Management of Feline Hyperthyroidism

Clinician's Brief (Capsule)

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Today, primary clinicians manage hyperthyroidism cases on a regular basis. To better equip practitioners, the Journal of Feline Medicine and Surgery published the updated American Association of Feline Practitioners’ guidelines on management of feline hyperthyroidism (FHT).

The updated guidelines: 

  • Provide recommendations on best diagnostic testing protocols to help avoid misdiagnosis. 
  • Separate FHT diagnosis into 6 categories. 
  • Underscore the importance of treating all hyperthyroidism cases (regardless of comorbidities). 
  • Outline current treatment methods. 
  • Detail monitoring methods. 
  • Give a communication script for veterinary teams to use with these patients and their owners. 

Related Article:Feline Hyperthyroidism 

Recommendations that may impact the practice include: 

  • Serum T4 assay should be included with routine screening panels for geriatric cats. 
  • All hyperthyroid cats should be treated and comorbidities concurrently managed.
  • Signalment, history, physical examination, and a minimum database (CBC, serum chemistry profile, urinalysis, T4 assay) should be used to identify suspected FHT cases. 
  • Suspected cases should be placed into one of the following categories for diagnosis and optimum management:
    • Classic clinical disease
    • Possible FHT with possible nonthyroidal disease
    • Enlarged thyroid without clinical FHT
    • Subclinical FHT 
    • Clinical FHT with confirmed nonthyroidal disease
    • Clinically normal
  • Diagnostic testing for nonthyroidal disease should include: thoracic radiography, echocardiography, abdominal imaging.
  • Identification of hypertension in suspected or confirmed FHT cases is essential.
    • Blood pressure should be monitored at every visit.
    • Patients should be routinely assessed for hypertensive retinopathy via fundic examination.
    • If hypertension does not resolve with control of FHT, further diagnostics are warranted.
  • Hypothyroidism secondary to FHT treatment should be avoided in cats with concurrent chronic kidney disease (CKD). 
    • Full staging of CKD is indicated as FHT treatment recommendations vary with IRIS stage.
    • Careful, frequent monitoring of T4 and TSH is essential.
  • Cats with concurrent cardiac disease should first have FHT corrected, and then have heart disease assessed.
    • Exception: Congestive heart failure (CHF) should be treated simultaneously with FHT.
  • Four main treatment options include radioactive iodine, oral/transdermal medication, surgical thyroidectomy, and dietary therapy.
    • All treatments have advantages and disadvantages that should be considered.
    • Total cost of treatment is similar among all options for uncomplicated FHT cases.
  • Routine monitoring of FHT cases is important to determine response to therapy, iatrogenic hypothyroidism, and comorbidities unmasked by treatment of FHT.
    • Physical examination, T4 assay, CBC, renal values, +/- TSH and other diagnostics for comorbidities. 
  • Median survival for hyperthyroid cats without CKD is up to 5.3 years.

Related Article: Weight Loss, Polyphagia, & Ataxia in a Cat

Practice Changers is a new column intended to brief readers on the release of new best practices; readers are encouraged to view the guidelines or statements in full at their respective publisher’s sources. 

Related Article: Chronic Kidney Disease in Cats with Hyperthyroidism

The updated FHT guidelines can be accessed at http://jfm.sagepub.com/content/18/5/400.full.pdf+html

CHF = congestive heart failure, CKD = chronic kidney disease, FHT = feline hyperthyroidism

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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