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Hyperthyroid cats seem to have increased renal loss of cobalamin and compromised intestinal absorption due to increased intestinal motility

Rexach JE, Clark PM, Mason DE, Neve RL, Peters EC, Hsieh-Wilson LC

These catechol estrogen metabolites can be further changed by the COMT (catechol-O-methyltransferase) enzyme or through glucuronidation ( UGT genes)

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To balance efficacy and safety, individualized dose adjustments, regular monitoring (including urine protein, liver, and kidney function tests), and avoidance of high-risk combination regimens are necessary (Koraishy et al., 2013)