Vet AI Scribe for Feline Only

Mochi

Wednesday, July 9, 2025 at 8:55 AM

Subjective

Chief Complaint

Owner reports steady weight loss over the past year despite a good and possibly increased appetite, night-time vocalisation, and vomiting once or twice a week.

History

• 13-year-old spayed female domestic shorthair; indoor only; sole cat in the household.
• Dry food offered free-choice; owner notes the bowl empties faster than it used to.
• Recorded weights: 4.9 kg two years ago, 4.4 kg one year ago, 3.8 kg today.
• Water bowl refilled more often over the past several months.
• No diarrhoea. Litter box output described as unchanged in frequency, larger in volume.
• No current medications.

Objective

Vitals

• Weight: 3.8 kg (down 13.6% over 12 months)
• Body condition: 3/9
• Temperature: 102.8°F
• Heart rate: 220 bpm
• Respiratory rate: 36 breaths/min
• Blood pressure: 178 mmHg systolic (Doppler, mean of five readings, acclimatised)

Physical Exam

• General: Thin; unkempt coat with dandruff over the dorsum
• Cervical: Palpable mobile thyroid nodule, left
• Cardiac: Gallop rhythm; grade II/VI left parasternal systolic murmur
• Renal: Both kidneys small and irregular on palpation
• Ophthalmic: Fundic exam performed given the blood pressure; no retinal detachment, haemorrhage or tortuosity
• Oral: Moderate calculus; no resorptive lesions visible on conscious exam
• Abdomen: No masses; no pain

Assessment

Primary Problem List

1. Hyperthyroidism — clinical signs, palpable nodule, tachycardia
2. Systemic hypertension — 178 mmHg, target organ screening negative so far
3. Suspected concurrent chronic kidney disease — small irregular kidneys, likely masked by thyrotoxic increase in glomerular filtration
4. Murmur with gallop — thyrotoxic cardiomyopathy versus hypertrophic cardiomyopathy

Differentials

• Hyperthyroidism (most consistent)
• Diabetes mellitus
• Gastrointestinal lymphoma or chronic enteropathy
• Primary chronic kidney disease
• Exocrine pancreatic insufficiency (uncommon in cats but reported)

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Plan

Diagnostics

• CBC, serum biochemistry, total T4
• Free T4 by equilibrium dialysis if total T4 is equivocal
• SDMA alongside creatinine, given the expectation that renal values are falsely reassuring
• Urinalysis with specific gravity and urine protein:creatinine ratio
• Echocardiogram to distinguish thyrotoxic changes from primary hypertrophic cardiomyopathy
• Repeat blood pressure at the recheck before committing to lifelong antihypertensive therapy

Treatment / Management

• Antithyroid: Methimazole 1.25 mg PO q12h to start; dose titrated by T4 at recheck
• Antihypertensive: Amlodipine 0.625 mg PO q24h
• Diet: Transition from free-choice dry to measured meals; defer any renal diet decision until the renal picture is clear after the thyroid is controlled
• Monitoring: Owner to weigh weekly on a digital kitchen scale and record

Follow-Up

• Recheck T4, renal values and blood pressure at 2-3 weeks
• Discuss definitive options — radioiodine, thyroidectomy, or lifelong medical management — once the renal picture is established
• Dental treatment deferred until thyroid and blood pressure are controlled

Client Communication:
Explained that an overactive thyroid pushes blood through the kidneys faster, which can make kidney values look normal, and that treating the thyroid may reveal kidney disease that was already present. That is the disease becoming visible, not the treatment failing. Reviewed why the recheck at two to three weeks matters more than the starting dose, and set the expectation that the first few months involve adjustment rather than a single fix.

— Dr. Naomi Feldt, DVM