CLINICAL

ENDOCRINOLOGY
 INTRODUCTION
• The endocrine system is unique in that it has diseases that cause hyperfunction as well as
hypofunction.
• For most systems we try to recognize failure of an organ, but in the endocrine system
many diseases are due to hyperfunctional states.
• The approach used to solve or diagnose endocrine diseases should involve the following
sequential steps:
• Determine the historical and physical exam findings that may suggest an endocrine disease.
• Determine the routine lab results (CBC, chemistry profile, urinalysis) that may be characteristic of
the suspected endocrine disease.
• Lastly, utilize appropriate screening and confirmatory tests that rule in or rule out, the suspected
endocrine disease.
 THYROXINE
• Measurement of serum thyroxine (T4) concentration is performed:
• to diagnose hypothyroidism and hyperthyroidism
• to monitor sodium levothyroxine therapy for hypothyroidism and methimazole
therapy for hyperthyroidism
• T4 is a stable hormone and the primary hormone secreted by the thyroid gland.
 THYROXINE
• T4 concentration is measured in serum by RIA or in-house ELISA.
• T4 concentration in serum is stable for at least 8 days at room temperature.
• Hemolysis, freezing, and thawing does not affect serum T4 concentrations.
• Normal Values • Dogs, 1.0 to 3.5 μg/dl; cats, 1.0 to 4.0 μg/dl.
 THYROXINE
• Interpretation for hypothyroidism in dogs: • Interpretation for hyperthyroidism in cats:
• Greater than 2.0 μg/dl: hypothyroidism very • Greater than 4.0 μg/dl, hyperthyroidism very
unlikely likely
• 1.5 to 2.0 μg/dl, hypothyroidism unlikely • 3.0 to 4.0 μg/dl, hyperthyroidism possible
• 1.0 to 1.5 μg/dl, unknown • 2.5 to 3.0 μg/dl, unknown
• 0.5 to 1.0 μg/dl, hypothyroidism possible • 2.0 to 2.5 μg/dl, hyperthyroidism unlikely
• Less than 0.5 μg/dl, hypothyroidism very • Less than 2.0 μg/dl, hyperthyroidism very
likely unlikely
 HYPOTHYROIDISM
• In the dog, lymphocytic thyroiditis, idiopathic atrophy, or neoplastic
destruction of the thyroid gland may cause primary hypothyroidism.
• Secondary hypothyroidism results from a deficiency of pituitary gland
thyrotropin (thyroid-stimulating hormone [TSH]) and may be caused by
pituitary malformation, destruction, or suppression (e.g., glucocorticoid
therapy).
 HYPOTHYROIDISM
• Fasting lipemia, hypercholesterolemia and, less commonly, mild normocytic
normochromic anemia (i.e., hematocrit 30% to 35%) are the most common
abnormalities identified on routine clinical pathologic assessments.
• A mild-to-moderate increase in lactate dehydrogenase, aspartate
aminotransferase, alanine transaminase, alkaline phosphatase and, rarely,
creatine kinase activity may also occur.
 HYPOTHYROIDISM
• Additional diagnostic tests, including baseline serum free thyroxine (fT4) and
endogenous TSH concentration, TSH or thyroid-releasing hormone (TRH)
stimulation test, or clinical response to trial therapy with sodium
levothyroxine, are usually required to establish the diagnosis.
 HYPERTHYROIDISM
• Spontaneous feline hyperthyroidism is usually caused by multinodular
adenomatous goiter.