SAD - Chapter 10 - Endocrine Flashcards
What is the chemical name of T3?
3,5,3’-triiodothyronine
What is the chemical name of T4?
thyroxine
Both T3 and T4 are derived from what reservoir?
thyroglobulin
Which thyroid hormone primarily inhibits TSH secretion?
T3 (3,5,3’-triiodothyronine)
What are the main thyroid binding proteins in the dog? In the cat?
Dog: thyroxine-binding globulin, thyroxine-binding prealbumin, albumin, plasma lipoproteins; Cat: lacks thyroxine-binding globulin
Which is more potent: T3 or T4?
T3 - enters cells more rapidly, more rapid onset of action, 3-5X more potent than T4
Where in the cell do thyroid hormones principally bind?
receptors in the nuclei => hormone receptor complex then binds to DNA => influences of genes coding for regulatory enzymes
What is the major metabolically active thyroid hormone in dogs?
T3 (3,5,3’-triiodothyronine) - T4 serves mainly as a prohormone
T/F: The thyroid gland secretes all of the T4 and T3.
False - secretes all of T4, but up to 60% of T3 is formed via monodeiodination from T4 in peripheral tissues
Secretion of TSH is inhibited by what?
somatostatin (from hypothalamus), thyroid hormones, glucocorticoids, dopamine, stress
What organ produces TSH?
adenohypophysis (pituitary gland)
What organ produces TRH?
hypothalamus
TRH stimulates release of what?
TSH and prolactin
Secretion of TRH is enhanced by what?
norepinephrine, histamine, serotonin, dopamine
What is primary hypothyroidism? Where is the problem?
abnormality at the level of the thyroid gland
Where is the problem with secondary hypothyroidism?
decreased TSH secretion (problem at level of pituitary)
Where is the problem with tertiary hypothyroidism?
decreased TRH (problem at level of hypothalamus)
What are the two forms of primary hypothyroidism in the dog?
lymphocytic thyroiditis and idiopathic atrophy
Other than lymphocytic thyroiditis and idiopathic atrophy, what are other possible causes for primary hypothyroidism?
Iodine deficiency, goitrogen ingestion, congenital hypothyroidism, thyroid gland destruction by neoplasia, drug therapy, surgical removal, radioactive iodine tx
Clinical signs of hypothyroidism occur with lymphocytic thyroiditis after what percentage of the thyroid gland has been destroyed?
80%
What is the main target antigen of lymphocytic thyroiditis?
thyroglobulin, smaller percentage is due to anti-TPO antibodies (thyroid peroxidase)
T/F: Animals with idiopathic thyroid atrophy have negative anti-thyroglobulin antibiodies and negative anti-thyroid hormone antibodies.
TRUE
What cells in the pituitary gland produce TSH?
thyrotrophs
Would TSH be low or high with secondary hypothyroidism?
low to undetectable – pituitary gland is not producing enough TSH => hypothyroidism
Other than TSH, what hormones are deficient in congential abnormalities of the pituitary gland?
growth hormone, TSH, prolactin, gonadotrophins
What breeds are most commonly reported to be at an increased risk for hypothyroidism?
Golden Retriever, Doberman Pinscher
Why are seborrheic changes common in hypothyroid dogs?
thyroid hormones influence serum and cutaneous fatty acid concentrations, influence sebaceous gland function – abnormal lipogenesis and decreased sterol synthesis by keratinocytes, sebaceous gland atrophy (w/ reduced sebum excretion)
Why can cutaneous mucinosis occur with hypothyroidism?
thyroid hormones help regulate the production of dermal glycosaminoglycans => accumulation of hyaluronic acid in the dermis
T/F: Neurologic disorders can occur with or without cutaneous signs of hypothyroidism.
True - both peripheral and CNS signs
What cardiovascular signs are possible with hypothyroidism?
bradycardia, weak apex beat, atherosclerosis, functional abnormalities on ECG or echo
What ocular abnormalities can occur with hypothyroidism?
corneal lipidosis, corneal ulceration, anterior uveitis – usually all secondary to hyperlipidemia
What coagulation abnormalities can occur with hypothyroidism? Why?
increased bleeding tendency, due to platelet dysfunction or clotting factor defects; T4 amplifies production of factor VIII and factor VIII-related antigen
What is the proposed mechanism for inappropriate galactorrhea or gynectomastia associated with hypothyroidism?
thought to be due to hyperprolactinemia induced by elevated levels of TRH
What changes can be seen on a CBC with hypothyroidism?
normocytic, normochromic, nonregenerative anemia; increased leptocytes (target cells) => increased erythrocyte membrane cholesterol loading
What change is commonly seen on a biochemical profile with hypothyroidism?
hypercholesterolemia +/- hypertriglyceridemia
What changes on a biochemical profile would be expected with a hypothyroid myopathy?
increase in lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase
What changes are seen on histopathology with hypothyroidism?
orthokeratotic hyperkeratosis, epidermal melanosis, follicular keratosis, follicular dilatation, follicular atrophy, telogenization of hair follicles, excessive trichilemmal keratinization (flame follicles), sebaceous gland atrophy; vacuolated, hypertrophied arrector pili muscles, increased dermal mucin, thick dermis, hyperplastic epidermis
Why is T3 a poor indicator of thyroid gland function in the dog?
most TT3 is produced by peripheral conversion of T4 - minimal amount originating from thyroid gland; T3 is conserved with early thyroid gland dysfunction => results in normal T3 in the face of low T4
What percentage of T4 is bound to plasma proteins?
99% - rest is the free T4 (the biologically active form)
When free T4 enters the cell, what is it converted to?
freeT4 is de-iodinatd to form either T3 or rT3
When is rT3 produced instead of T3?
T3 - preferentially produce during normal metabolic states; rT3 - biologically inactive, produced during illness, starvation, etc.
T/F: Serum total T4 concentration is the sum of both protein-bound and free hormone circulating in the blood.
TRUE
T/F: Baseline serum T4 concentrations are lower in healthy dogs than humans. Why or why not?
True - weaker protein binding in dogs compared to people
Anti-thyroid antibiodies are estimated to be present in what percentage of animals with clinical hypothyroidism?
2%
What breed(s) of dog has/have lower normal T4 levels?
Sighthounds
Which test of thyroid hormones has the lowest sensitivity and specificity: TT4, fT4, cTSH?
cTSH
T/F: A TSH stimulation test can be used to differentiate primary hypothyroidism from drug-induced hypothryoidism.
True - EXCEPT hypothyroidism due to sulfonamides– sulfonamides block production of all thyroid hormones
What is the utility of a TRH stimulation test?
Can be used to differentiate betweeen primary, secondary, and tertiary hypothyroidism
What is the typical response to a TRH stimulation test with primary hypothyroidism?
low basal TT4, high basal TSH, neither of which respond to TRH stimulation
What is the typical response to a TRH stimulation test with secondary hypothyroidism?
low basal TT4, low basal TSH, neither of which respond to TRH stimulation
What is the typical response to a TRH stimulation test with tertiary hypothyroidism?
low basal TT4 and low TSH => both of which should respond to TRH stimulation
What drugs can affect TT4 levels?
anticonvulsants (phenobarbital, phenytoin, diazepam), glucocorticoids, salicylates, phenylbutazone, sulfonamides, radiocontrast agents, mitotane, furosemide, cardiac drugs, androgens, estrogens
What effect do glucocorticoids have on thyroid values? Why?
decreased TT4, fT4, T3; decreased binding of T4 to carrier proteins, alterations in clearance and metabolism of thyroid hormones, decreased conversion of T4 to T3, suppressed pituitary TSH secretion
What test can be helpful in differentiating primary hypothyroidism from hypothyroidism secondary to glucocorticoids?
TSH – increased TSH is more consistent with hypothyroidism, usually normal with glucocorticoids (exogenous or endogenous)
How long after discontinuation of glucocorticoids should you wait to assess TT4 and TSH?
4-8 weeks
With phenobarbital administration, what changes would you expect in the following values: TT4, freeT4, TSH?
TT4 - low, free T4 - low, TSH - within reference range
How do sulfonamide antibiotics interfere with thyroid hormone synthesis?
inhibition of thyroid peroxidase activity
With sulfonamide administration, what changes would you expect in the following values: TT4, freeT4, TSH?
Low TT4, low freeT4, elevated TSH
With aspirin administration, what changes would you expect in the following values: TT4, freeT4, TSH?
low TT4, low freeT4, normal TSH
How can thyroid supplementation improve the hair coat, even in euthyroid dogs?
thyroid hormone supplementation stimulates telogen hair follicles to become anagen hair follicles
Why must testing be delayed for 4-8 weeks after stopping thyroid supplementation to confirm a diagnosis of hypothyroidism?
exogenous supplementation suppresses pituitary TSH secretion –> pituitary thyrotroph atrophy –> thyroid gland atrophy
Why is the dosenof thyroid hormone used for dogs higher than that of humans?
poorer gastrointestinal absorption and shorter serum half-life of T4 in dogs compared to humans
Why are dogs relatively resistant to iatrogenic hyperthyroidism?
short half-life of T4
What unique precautions need to be taken when treating hypothyroidism in dogs with cardiac disease?
start at 25-50% of the usual starting dose because thyroid supplementation will increase myocardial oxygen demand, increase heart rate, and may reduce ventricular filling time
T/F: Congenital hypothyroidism is more common in cats than adult-onset hypothyroidism
TRUE