Methimazole

From Cat

In the United States, Methimazole is the mainstay of medical treatment for hyperthyroidism in cats[1].

Oral as well as topical administration has been shown to be effective in normalizing serum thyroid hormone levels in hyperthyroid cats[2]. After normalization of thyroid hormone concentrations, glomerular filtration rate may decrease, potentially exacerbating or 'unmasking' underlying renal disease[3]. If renal parameters improve or remain static after a methimazole treatment trial, a more permanent treatment option may be pursued safely. Additionally, even if renal parameters worsen slightly but the clinical status of the cat improves because of remission of the hyperthyroidism and no clinical signs of renal disease/failure develop, definitive therapy can be sought[4].

In cats, the plasma half-life of methimazole ranges from less than 3 hours to approximately 6 hours[5]. Methimazole's activity correlates with intrathyroidal drug concentrations, not the plasma half-life. Because methimazole, like other thioureylenes, is concentrated in thyroidal tissue, the biological effect of the drug exceeds its plasma half-life[6].

Dosages

Various recommendations have been made regarding initial dosing of methimazole, ranging from 2.5 mg to 15 mg/day in divided doses of every 8-12 hours[7]. Most cats require between 5 and 10 mg/day of methimazole to control their disease; twice or three times daily administration is the most effective[8]. Once an effective dose has been reached, T4 levels usually fall within the low normal reference range.

Side effects

While effective in most cases, methimazole administration is associated with side effects in up to 18% of treated cats (Peterson et al, 1988). The most common side effects are vomiting and anorexia, but more serious side effects necessitating discontinuation of the drug occur in up to 10% of cats. These include self-induced excoriation, hepatotoxicity, thrombocytopenia and agranulocytosis. In cats that cannot undergo surgical thyroidectomy or radioiodine therapy, there are limited options[9].

References

  1. Rutland, BE (2009) Optimal testing for thyroid hormone concentration after treatment with methimazole in healthy and hyperthyroid cats. J Vet Intern Med 23:1025-1030
  2. Feldman, EC & Nelson, RW (2004) Feline hyperthyroidism. In Feldman, EC Nelson, RW, eds: Canine and feline endocrinology and reproduction. 3rd edition. WB Saunders, Philadelphia. pp:152-218
  3. Peterson, ME, Kintzner, PP & Hurvitz, AI (1988) Methimazole treatment of 262 cats with hyperthyroidism. J Vet Intern Med 2:150-157
  4. August, JR (2006) Consultations in feline internal medicine. Elsevier Saunders, USA
  5. Takami, H et al (2004) Radiological and surgical management of thyroid neoplasms. Biomed Pharmacother 58:360-364
  6. Cooper, DS (2005) Antithyroid drugs. N Eng J Med 352:905-917
  7. Feldman, EC & Nelson, RW (2004) Feline hyperthyroidism. In Feldman, BC & Nelson RW (Eds): Canine and feline endocrinology and reproduction. WB Saunders, St Louis. pp:152-218
  8. Hunter, AN Meinhold, H & Hurvitz, AI (1982) Alterations in thyroid function after cholecystographic contrast agents. Aust N Z J Med 12:192-195
  9. Petersen, ME et al (1988) Methimazole treatment of 262 cats with hyperthyroidism. J Vet Int Med 2:150-157