Diagnosis of Canine Hypothyroidism

W S A V A W C P , 2006
Sylvie Daminet, DVM, PhD, DACVIM, DECVIM-CA
Profe ssor, Inte rnal Me dic ine , De pt. S m all Anim al Me dic ine , Ghe nt Unive rsity, Me re lbe ke , Be lgium

The image we have of canine hypot hyroidism has changed during t he last decade.
We use t o consider it as t he most common endocrinopat hy in dogs. Most
endocrinologist s will agree t hat nowadays, ot her endocrine diseases such as
hypercort isolism, are more frequent ly observed. In t he past , many dogs have been
erroneously diagnosed wit h hypot hyroidism. Indeed, evaluat ion of t hyroid funct ion
in dogs is not always st raight forward. The vague and non-specific clinical signs of
hypot hyroidism and t he fact t hat numerous fact ors can influence t hyroid funct ion
t est result s are major cont ribut ors t o t he difficult y in diagnosing t his disease.
Test s Available to Assess t he T hyroid Gland in Dogs

Table. Advant ages and disadvant ages of t he most commonly used t est s t o
evaluat e t hyroid funct ion in dogs.

Te st Adva nt a ge s D isa dva nt a ge s

TT4 Easy Decreased with SNTD

Not expensive Decreased after administration of certain drugs
Readily available A decreased T4 alone does not allow a reliable
Normal values allow 'exclusion' of diagnosis of hypothyroidism (low specificity)
hypothyroidism

T SH Easy 1/4 of hypothyroid dogs have TSH values within

Not expensive the reference range (low sensitivity)
Available Always use in combination with T4

FT 4 Is less influenced by SNTD or through The only reliable method includes equilibrium
drug administration than TT4 dialysis Not readily available in all countries

T SH Was and still is considered as the Bovine TSH is not easily available anymore
st imula t ion gold standard rhTSH
t e st Expensive 4 to 6 hours lasting test
Anaphylactic reactions were described with bTSH

SNTD: systemic non-thyroid disease

Tot al T hyroxine (T T 4)
It is import ant t o realise t he limit at ions of a TT4 measurement . Indeed, numerous
fact ors such as syst emic diseases (eut hyroid sick syndrome) or t he
administ rat ion of medicat ions can influence t he TT4 serum concent rat ions.
Therefore, when TT4 serum concent rat ion is below t he reference range, furt her
t est ing is indicat ed.
Endogenous T hyrot ropin

Wit h primary hypot hyroidism, an increase in TSH serum concent rat ions would be
expect ed because of t he lack of negat ive feed back mechanism of t he t hyroid
hormones on t he pit uit ary. However, about one fourt h of t he dogs wit h
hypot hyroidism show TSH serum concent rat ions wit hin t he reference range.
Because of t he weak sensit ivit y of t he TSH measurement for t he diagnosis of
hypot hyroidism, t his t est cannot be recommended solely. To reliably evaluat e
canine t hyroid funct ion, a T4 measurement (FT4 or TT4) is always combined wit h
a TSH measurement . A serum sample wit h decreased T4 and increased TSH
serum concent rat ions (>0,6 ng/ml) will confirm wit h confidence t he diagnosis of
primary hypot hyroidism. When t he measurement s of T4 and TSH give
cont radict ory result s, it is recommended t o repeat measurement s 4-8 weeks
lat er or t o perform furt her t est ing (i.e., FT4 measurement , rhTSH st imulat ion,
scint igraphy).
Free T hyroxine (FT 4)

In t heory, t he measurement of FT4 should reflect more precisely t hyroid funct ion.
The most reliable t echnique used t o measure FT4 involves equilibrium dialysis,
only available in some laborat ories and more expensive t han measurement of a
TT4. Free T4 serum concent rat ions seem less influenced by non-t hyroidal
illnesses t han TT4. Measuring FT4 seems t herefore more int erest ing t o evaluat e
t hyroid funct ion, if measurement is performed aft er equilibrium dialysis.
T hyrot ropin St imulat ion Test

Canine t hyroid st imulat ion wit h bovine TSH is less affect ed by t he presence of
non-syst emic t hyroid diseases t han is a baseline TT4 measurement . Therefore
t he bovine TSH st imulat ion t est has long been considered as t he gold st andard
for t hyroid evaluat ion in dogs. Today, t he bovine TSH st imulat ion t est is less used
for several reasons: expense, 4-6 hour t est , bovine TSH is difficult t o obt ain and
FT4 and TSH measurement s are available. However, in non-infrequent cases wit h
cont roversial result s, performing a TSH st imulat ion t est would st ill be very
int erest ing. Sauvé and Paradis showed t hat recombinant human TSH (rhTSH) will
st imulat e t he t hyroid gland of eut hyroid beagle dogs. Major limit ing fact ors for
t he use of rhTSH in dogs resided in t he cost of t he product and some pract ical
aspect s: one vial cont ains 1.1 mg of lyophilized rhTSH, while t he amount needed
t o perform a TSH st imulat ion t est in dogs varies from 50 t o 100 µg. We showed
t hat rhTSH can be st ored in aliquot s at 4°C for 4 weeks and at -20°C for 8 weeks
wit hout loss of biological act ivit y. This allows clinicians t o perform more TSH
response t est s per vial.
A st udy performed at t he Universit y of Mont real (Daminet et al., submit t ed),
showed t he abilit y of t he rhTSH st imulat ion t est t o different iat e eut hyroid dogs,
dogs wit h hypot hyroidism and eut hyroid dogs wit h nont hyroidal illnesses.
We have used t he rhTSH st imulat ion t est in our clinic almost exclusively in dogs
wit h ambiguous t hyroid funct ion t est result s, especially in dogs suspect ed of
having hypot hyroidism wit h decreased TT4 serum concent rat ions and TSH levels
wit hin t he reference range, but also in dogs wit h TT4 values wit hin t he reference
range accompanied wit h an increased TSH concent rat ion.
Ant ibodies Against T hyroid Hormones
Ant i-t hyroglobulin ant ibodies (ATG) are found in only 36 t o 60% of hypot hyroid
dogs. The presence of ATG in eut hyroid dogs (false posit ives) is now only
observed in less t han 5% of dogs. Epidemiological analysis of t he prevalence of
ATG has shown considerable breed and age variat ion. The presence of ATG does
not necessarily reflect t hyroid abilit y t o synt hesise t hyroid hormones. The
presence of ant ibodies in combinat ion wit h normal t hyroid hormone values can be
an indicat ion t hat hypot hyroidism might develop.
Rarely, ant i-T3 and ant i-T4 ant ibodies are observed in hypot hyroid dogs.
Therefore t heir clinical use is limit ed. These ant ibodies can however int erfere wit h
radio immunoassay det erminat ion of T3 or T4, and lead t o falsely increased values
as a consequence.
Medical Imaging
Scint igraphy is a very useful met hod for evaluat ion of t hyroid funct ion. When
available, it can be used t o different iat e dogs wit h t he eut hyroid sick syndrome
from t ruly hypot hyroid dogs.
Ult rasonographic changes observed in hypot hyroid dogs were recent ly described
and include a decrease in t hyroid volume and a decreased echogenicit y compared
t o normal dogs. Qualit y of t he ult rasonographic equipment and experience of t he
ult rasonographer may negat ively impact accurat e measurement of t hyroid size and
will most likely limit t he use of ult rasonography for t he diagnosis of
hypot hyroidism in current vet erinary pract ice.
Influences on T hyroid Funct ion Test s
Numerous diseases and drugs can influence t hyroid funct ion. Besides t his many
ot her physiological fact ors such as, age, breed and fluct uat ing serum
concent rat ions, can influence t he result s. Some dog breeds clearly have t hyroid
hormone concent rat ions lower t han values observed in most breeds. For example,
Greyhounds have TT4 values t hat are markedly lower (half) t han in ot her breeds.
Recent ly we invest igat ed t hyroid hormone values in Whippet dogs and also
demonst rat ed t hat caut ion is also advised in t his breed as lower TT4 values were
found when compared t o cont rol dogs.
Summary of t he effect s of some drugs on canine t hyroid funct ion t est result s.

Drugs TT4 FT4 TSH TSH st imulat ion t est

Glucocorticoids = or = Blunt ed at high dose

(immunosuppressive dosage) and durat ion

Potassium bromide = = = =
 
Phenobarbital = or = or

Sulfonamides

Propranolol = = = =

Carprofen = or = ( ) = or Not st udied

Aspirin = = Not st udied

Meloxicam = = = Not st udied

Ketoprofen = = = Not st udied

Etodolac = = = Not st udied

Clomipramine = Not st udied

Conclusion
Treat ment of hypot hyroidism is relat ively simple, but obt aining a reliable diagnosis
can somet imes be more difficult . Numerous fact ors can influence t hyroid
homeost asis. Knowledge of t hese fact ors can cont ribut e t o decreasing t he
misdiagnosis of hypot hyroidism. Non-t hyroidal diseases and t he administ rat ion of
medicat ions can lead t o decreased t hyroid hormone concent rat ions. As always,
laborat ory result s should be int erpret ed in light of hist ory and physical
examinat ion findings.
References
References are available upon request .
S I
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Sylvie Daminet, DVM, PhD, DACVIM, DECVIM-CA

Dept . Small Animal Medicine
Ghent Universit y
Merelbeke, Oost -Vlaanderen, Belgium

URL: https ://www.vin.com/doc/?id=3859000