Content continues after advertisement

2016 AAFP Guidelines for the Management of Feline Hyperthyroidism

Clinician's Brief (Capsule)

Sign in to Print/View PDF

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

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


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

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Clinician's Brief:
The Podcast
Listen as host Alyssa Watson, DVM, talks with the authors of your favorite Clinician’s Brief articles. Dig deeper and explore the conversations behind the content here.
Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*

*2007-2017 PERQ and Essential Media Studies

© 2023 Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Terms & Conditions | DMCA Copyright | Privacy Policy | Acceptable Use Policy