Your older kitty seems to get skinnier every day—but his appetite? It’s better than ever! Somehow, the early signs of weight loss in the face of a good appetite seem to go largely unreported. Mostly because cat people are happy to see their kitty eat so well, but also because they know all those extra pounds were making him sluggish and slow.

But by the time owners notice their kitty’s gone beyond “healthy” skinny, she looks like death warmed over.

Cancers, diabetes and other disorders manifest this way commonly in cats. But none in such splendid fashion as when they’re suffering from feline hyperthyroidism. The hallmarks of the disease are rapid weight loss, an increased appetite and often an increased activity level.

Hyperthyroidism is the most common hormone–related illness in cats, usually affecting just our geriatrics. Because the most common age of diagnosis is around thirteen (and because by the time they’re diagnosed they’re looking like sickly skeletons) most owners assume the end is near and often choose not to treat the disorder.

But hyperthyroidism, a disease where the thyroid gland becomes enlarged and overactive, is eminently treatable. For vets who know how easy a cure can be, thyroid disease can be incredibly frustrating when owners choose “to let my pet go instead of putting her through the hardship of treatment.”

Sure, there are times when other factors compete with their candidacy for treatment, but usually, it’s the price that makes owners balk.

“$1,200 for a dying, withered-out cat? Who does this vet think she is? Sure, if I had her salary…”

The thousand-plus bucks in this case is for a treatment called radioactive iodide therapy (I131). Giving an injection of radioactive stuff, should kitty be basically sound (for a geriatric cat), is almost always 100% curative. Although they have to stay in a special hospital facility for a few days to get rid of their radioactive waste (hence the cost), they tend to respond almost immediately to the treatment.

Problem is, this [often prohibitively expensive] approach is the only one that seems truly effective. The most common approach, an oral chemotherapeutic called methimazole (Tapazole) is expensive (rivaling the iodide treatment—penny for penny—within two years), difficult (requires daily pilling), is fraught with numerous side-effects (vomiting and diarrhea), requires regular bloodwork to ensure the appropriate level of medication is maintained and sometimes isn’t even effective at controlling the symptoms.

The next most common alternative approach? Surgery. Again, it’s usually an incomplete approach that requires lots of follow-ups as well as medication, in many cases. It, too, carries all the side effects of any anesthetic procedure carried out on a sick geriatric (not the best odds, IMHO). And it’s only slightly less expensive, up-front, than the iodide approach. After a year, what’s the difference?

With all those strikes, you’d think the iodide treatment would win, hands down. But it doesn’t. People still freak when you say “one-thousand-two-hundred.”

I guess I can understand why a cat that looks like he’s dying (because he is) makes people reluctant to shell out big cash on his behalf. And I guess the modest improvements they see with the “next best” therapies seem like an appropriately frugal approach. But they’re not.

Why is it that when older cats get hit by a car or attacked by a dog that people tend to fish out their wallets but when we offer a complete cure they run screaming away? I don’t quite get it. If we had no option but the best then perhaps then we’d see better treatment.

I know I’m not the only vet with this problem. I know others who complain of the very same thing. That’s why researchers are moving quickly to devise tests to detect the disease earlier. This way we can screen a cat for the disease before she looks like a ghost of herself.

Interestingly, this research has also led us to conclude that diet and other environmental factors may be at least partly to blame for hyperthyroidism. Wet diets high in liver and fish may well contribute (but we’re not completely sure yet). Some plastic collars may also put cats at risk (but, again, we’re not sure). Stay tuned for more…

For my part, I’m going to start offering iodide therapy as the one and only treatment, describing the other approaches as potentially doable for mere management of symptoms (in serious money cases). Because when it comes right down to it, properly treated cats live much longer, healthier, more comfortable lives than anyone ever expects from the dying cat I see on that first visit.