A well known endocrine disease characterized by an increased secretion of thyroid hormone. In cats the disease can be due to multinodular adenomatous hyperplasia ( MNAH ), adenomas, adenocarcinoma and fair to mention that there may be genetic and immunologic reactions at play here along with other causes of unknown etiology.

 Clinical features and symptoms

Most symptoms may be associated with a sympathetic system excess.
1. Altered appetite( ravenous)
2. Restlessness
3. Pacing
4. Tachycardia 5. Low grade fever
6. Possible arrythmias
7. Anorexia ( on occasion )
8. Fatigue and vomiting ( on occasion )

 Thyroid enlargement may on occasion be difficult to palpate and in this sense it may be necessary to shave the area and palpate under sedation.

 Diagnosis

 TSH ( thyroid stimulating hormone )
T3T4 test
RAIU ( radioactive uptake ) to detect the functional status of thyroid tissue and of ectopic or metastatic masses.

 Differential diagnosis

 1. Enlargement of the thyroid gland without an increase in TSH,T3T4 and no signs or symptoms of hyperthyroidism

2.Diabetes

3. Emotional and psychological causes which show a disturbance in weight, appetite and irritability.

Traditional Chinese Medicine ( TCM ) Diagnosis

 1.Liver fire uprising 
due to elevated thyroid hormone noted by increased appetite, palpitations, red tongue with a thin yellow coat and a rapid wiry pulse.

 2.Qi and yin deficiency 
presented in a state of fatigue, palpitations, red tongue with a thin coating, abnormal sleep, and a deep, thready and rapid pulse.

 3.Qi and phlegm stagnation 
present with irritability, restlessness, thyroid gland enlargement, red tongue with a thin and greasy tongue coating and a wiry and/or slippery pulse.

Treatment and management

 1. Surgery ( pre-op ) scan may be performed to determine whether 1 or both lobes need to be removed.

 2.Radioactive Iodine ( destruction of the thyroid gland )

 3. Antithyroid medicine 
PTU ( propylthiouracil )
Tapazole ( methimazole )

 4. Beta blockers
Inderal ( propranolol ) to block the sympathetic effect of excess thyroid hormone.

 Herbal Treatment

 Treatment principle: Clear and soothe the liver, purge fire, tonify Qi and yin, resolve phlegm and regulate Qi circulation.

 1.Liver Fire uprising: Gardenia decoction to clear the liver( zhi zi qing gan tang)

 2.Qi and yin deficiency: Ginseng and Ophiopogon formula ( sheng mai san ) Liver reinforcing decoction ( yi guan jian )

 3.Qi and phlegm stagnation : Bupleurum and Cyperus combination ( chai hu shu gan tang ) White metal pills ( bai jin wan ) alumen ( ming fan ) and curcuma ( yu jin )

 Acupuncture treatment

 Point selection will vary but treatment principle again is to a. Tonify Qi and yin
b. Clear the liver and drain the fire
c. Transform the phlegm, open the vessels and remove stasis.

 Important to note that the root cause of the hyperthyroid state is one of deficiency but the symptoms are those of excess.

 Some useful points include:
TH 10,LI 11, ST 40, SP 10, BL 17 ( Transform phlegm, open the vessels and remove stasis)

 GB 34, LV2-LV3 ( thru and thru ), Bl 18, SP 6, SP 9 ( Clear the liver and drain the fire )

 Points to tonify Qi and yin vary and can be used accordingly.

 The conventional treatment of hyperthyroidism in cats, in many occasions ,works quite well. There are those cats that do not tolerate the thionamides well ( PTU and Tapazole ) and for some owners the costs of radioactive iodine treatment is excessive.