Disorders of the Equine Thyroid Gland

Hair loss and endocrine dermatosis on horses raised in a Mimosa pudica var. unijuga-invaded area

A Mimosa pudica var. unijuga-associated toxicity affecting horses occurred in Araguari, Triângulo Mineiro, Southeast Brazil. Affected horses had gradual hair loss of the mane and tail and endocrine dermatosis after grazing for three months during the dry season on a paddock invaded by the plant. The main histological lesions include compact ortho-keratotic hyperkeratosis and numerous flame follicles. Toxicological analysis by HPLC-UV demonstrated 0.8 mg/g of mimosine in the leaves.

Diagnosis and management of thyroid disorders and thyroid hormone supplementation in adult horses and foals

Equine thyroid disorders pose a diagnostic challenge in clinical practice because of the effects of nonthyroidal factors on the hypothalamic-pituitary-thyroid axis, and the horse's ability to tolerate wide fluctuations in thyroid hormone concentrations and survive without a thyroid gland. While benign thyroid tumours are common in older horses, other disorders like primary hypothyroidism or hyperthyroidism in adult horses and congenital hypothyroidism in foals are rare. There is a common misunderstanding regarding hypothyroidism in adult horses, especially when associated with the clinical profile of obesity, lethargy, and poor performance observed in dogs and humans. Low blood thyroid hormone concentrations are often detected in horses as a secondary response to metabolic and disease states, including with the nonthyroidal illness syndrome; however, it is important to note that low thyroid hormone concentrations in these cases do not necessarily indicate hypothyroidism. Assessing equine thyroid function involves measuring thyroid hormone concentrations, including total and free fractions of thyroxine (T4) and triiodothyronine (T3); however, interpreting these results can be challenging due to the pulsatile secretion of thyroid hormones and the many factors that can affect their concentrations. Dynamic testing, such as the thyrotropin-releasing hormone stimulation test, can help assess the thyroid gland response to stimulation. Although true hypothyroidism is extremely rare, thyroid hormone supplementation is commonly used in equine practice to help manage obesity and poor performance. This review focuses on thyroid gland pathophysiology in adult horses and foals, interpretation of blood thyroid hormone concentrations, and evaluation of horses with thyroid disorders. It also discusses the use of T4 supplementation in equine practice.

A one-health lens offers new perspectives on the importance of endocrine disorders in the equine athlete

Endocrine disorders are associated with joint pain and tendon injury in humans, but the effects in the horse are only starting to be understood. Similar patterns of clinical signs and injury appear to affect horses and humans for both orthopedic and endocrine disorders, supporting the use of a one-health approach to tackle these issues. In this Currents in One Health, we will discuss common equine endocrinopathies, current testing recommendations, dietary management, genetic predispositions, and endocrine disorders' effects on performance. Our aim is to use a one-health lens to describe current comparative research so that veterinarians can employ cutting-edge preventative, diagnostic, and therapeutic recommendations. Identified key gaps in knowledge include whether equine metabolic osteoarthritis exists, if steroid joint injections are safe in horses with endocrine disorders, and if the return to performance percentage improves with concurrent treatment of endocrine and musculoskeletal disorders. Key takeaways include that the relationship between endocrine disorders and musculoskeletal disease in the horse goes beyond laminitis to include lameness, muscle atrophy, suspensory ligament degeneration, osteochondritis dissecans, and potentially metabolic osteoarthritis. Approaches learned from human and equine comparative studies can offer insight into injury recognition and management, thus mitigating the impact of endocrine disorders on performance in both species. Readers interested in an in-depth description of current and future research involving pathophysiology, novel interventions, and multiomic approaches to identify individuals with athletic limitations induced by endocrine disorders are invited to read the companion Currents in One Health by Manfredi et al, AJVR, February 2023.

Calcification and osseous metaplasia of the meibomian glands of a horse

OBJECTIVE

To report the clinical history, surgical management, and histologic findings of meibomian gland calcification and osseous metaplasia in a horse.

ANIMAL STUDIED

A 21-year-old Selle Français gelding presented with a 9 months history of blepharitis, blepharospasm, and epiphora affecting the right eye. The horse was diagnosed with meibomianitis and impaction with associated granulomas, but not treated surgically for 6 years.

PROCEDURES

Physical and ophthalmic examinations, and systemic bloodwork were performed. A diamond burr debridement was performed on a corneal ulceration, and meibomian gland nodules were excised and examined histologically.

RESULTS

Multiple firm concretions were associated with the palpebral conjunctiva of each eyelid. The largest nodule (5 × 4 × 10 mm) was excised from the lower right eyelid. Histology revealed dilated meibomian ducts with mineralized inspissated secretions surrounded by fibrosis and osseous metaplasia. Following nodule excision and corneal ulcer resolution, no blepharospasm or epiphora recurred for a follow-up period of 15 months.

CONCLUSION

Calcification and osseous metaplasia of the meibomian glands was identified in a Selle Français gelding. It is suspected that inspissated meibomian secretions led to a local granulomatous reaction with secondary dystrophic calcification and osseous metaplasia.

Measurement of oxidative stress and total antioxidant capacity in hyperthyroid patients following treatment with carbimazole and antioxidant

Hyperthyroidism is a common endocrine disorder in which the thyroid produces too many hormones, resulting in the metabolism speed up. The present study was designed to measure oxidative stress and total antioxidant capacity in hyperthyroid patients following treatment with carbimazole and antioxidants supplements. This randomized clinical trial study was conducted to compare Malondialdehyde (MDA) and total antioxidant capacity (TAC) among 25 newly diagnosed hyperthyroid patients (Group A), 25 hyperthyroid patients treated with carbimazole (Group B) and 25 hyperthyroid patients treated with carbimazole and antioxidants supplement (Group C) of both sexes. In this study, the mean serum malondialdehyde (MDA) of the three groups were 4.60 ± 1.08 μmol/L (Group A), 2.79 ± 0.58 μmol/L (Group B), and 1.57 ± 0.29 μmol/L (Group C). We found the mean MDA level was significantly higher in Group A than Group B and Group C. This study found the MDA level was significantly higher in hyperthyroid patients treated with carbimazole alone (Group B, 2.79 ± 0.58 umol/L) than hyperthyroid patients treated with carbimazole and antioxidant combined (Group C, 1.57 ± 0.29 umol/L) among the study groups (p < 0.001). The results showed that the mean serum TAC was significantly lower in newly diagnosed hyperthyroid (Group A, 527.8 ± 78.44 umol/L] patients compared to carbimazole treated alone (Group B, 951.80 ± 99.67 umol/L) and combination with the antithyroid drug (carbimazole) and antioxidant treated (Group C, 1113.56 ± 121.69 umol/L). There was more improvement found in the treatment combined with the antithyroid drug (carbimazole) and antioxidant (Group C).

Conventional treatment of hyperthyroid patients significantly reduced oxidative stress and elevated serum TAC but not up to normal level. Therefore, the supplementation of antioxidants could be utilized to improve thyroid function in hyperthyroid patients by boosting antioxidants and restoring oxidant-antioxidant balance. However, further studies are required to determine the optimal dosage, route of administration, and timing of antioxidant therapy needed before this supplementation could be officially recommended as adjuvant therapy.

•

Antioxidant boosting with conventional treatment enhanced of thyroid function in hyperthyroidism.

•

Treating antioxidants and carbimazole enhanced thyroid function more than carbimazole alone.

•

MDA level was normalized along with improved TAC by treating antioxidants with the antithyroid drug.

•

Serum T4 significantly reduces and TSH significantly improves boosting antioxidant with carbimazole.

•

Antioxidant adding helps to improve thyroid hormone and oxidative damage of hyperthyroidism.

The effect of neonatal dysphagia on subsequent racing performance in Standardbred horses

BACKGROUND

Previously we described a clustering of dysphagic foal cases on a Pennsylvania (PA) Standardbred farm which was associated with exposure of pregnant mares to high concentrations of polycyclic aromatic hydrocarbons (PAHs) in the well water. The effect of dysphagia on future athleticism was uncertain.

OBJECTIVES

To determine if, as adults, dysphagic foals were less likely to race and if athleticism (age of first race, Speed Index and Earnings Per Start Index) differed from that of healthy foals that raced as adults.

STUDY DESIGN

Prospective cohort study.

METHODS

All foals born during the study period (2014-2017) on the affected PA or an unaffected New York (NY) farm with the same proprietor were eligible for inclusion in the study. Foals with dysphagia attributed to causes other than PAH environmental exposure were excluded. The proportion of foals from both farms that raced, their age of first race, Earnings Per Start Index and Speed Index were compared between the dysphagic and normal foals using Chi-Square and Wilcoxon Rank Sum Tests. Significance level was P < .05.

RESULTS

A total of 116 foals met the inclusion criteria. No significant difference was found in the percentages of foals that raced from each farm: On the PA farm, 54% of healthy and 72% of dysphagic foals raced; 70% of healthy NY farm foals raced. Median (interquartile range) age of first race, Earnings Per Start Index or Speed Index for dysphagic foals (2 years (2, 2); 57 (49, 60); 60 (45, 66) was not different from those of healthy foals from both farms (2 years (2, 3); 55 (39, 78)) or the PA farm (2 years (2, 2); 61(24, 73); 68 (57, 85)). All P > .05.

MAIN LIMITATIONS

Small sample size and unique type of dysphagia.

CONCLUSIONS

The athleticism of formerly dysphagic foals does not appear to be negatively impacted compared with normal foals as measured by age of first race, Earnings Per Start Index and Speed Index.

Improvement of the clinical signs of gait abnormality after treatment with levothyroxine in a horse with shivering and hypothyroidism

An 11-year-old Hanoverian gelding used for jumping was evaluated for gait abnormalities and hoof problems in the hindlimbs. Clinical examinations revealed signs consistent with shivers. A thyroid gland enlargement was noticed, baseline serum thyroid hormone (TH) concentrations were low, and a low response to thyrotropin-releasing hormone administration was observed. Hypothyroidism was suspected. The horse was treated with levothyroxine for 1 year. TH concentrations returned to the normal range by week 4 of treatment. Thirty weeks after the initiation of levothyroxine therapy, the gait abnormality improved. Our findings suggest that the assessment of thyroid status and especially of the subclinical thyroid gland disorders in horses affected with shivering, as well as evaluation of the effects of levothyroxine on the improvement of clinical signs could be promising in establishing the aetiopathogenesis and/or treatment of shivering in horses.

Effects of the Glucosinolate Sinigrin in Combination With a Noniodine Supplemented Diet on Serum Iodine and Thyroid Hormone Concentrations in Nonpregnant Mares

Exposure to plants containing glucosinolates (GSLs) affects thyroid function in many species, in horses is implicated in the birth of foals with congenital hypothyroidism. The present study was performed to determine the effect of feeding a GSL (sinigrin) in combination with a low-iodine diet for 12 weeks on thyroid hormones and serum iodine concentrations in nonpregnant mares. Nineteen mares aged 2-14 years were divided into control (n = 6), low (20 mmol/day) (n = 7) and high GSL (35 mmol/day) (n = 6) groups. Thyrotropin-releasing hormone (TRH) stimulation tests and serum iodine measurements were performed at 0 and 12 weeks. Total triiodothyronine (TT3), total thyroxine (TT4), and thyroid-stimulating hormone (TSH) concentrations were measured at the baseline and in post-TRH samples. The post-TRH value minus the basal value (Delta Δ) and fold change (FC) were calculated for TSH, TT3, and TT4. Data were analyzed at P < .05. Highlights included Delta Δ and FC TT4 and TT3 concentrations having a group and week interaction (P < .001) with week 12 control mares having higher values than mares in week 12 low and high GSL groups. TT4 FC values had a group (P < .001) and group by week interaction (P < .001) with week 12 control concentrations higher (P < .006) than all groups. Iodine concentrations decreased (P < .002) over time in GSL mares. In conclusion, feeding mares a low-iodine diet with 20 and 35 mmol sinigrin/day resulted in lower serum iodine concentrations.

The contribution of total and free iodothyronines to welfare maintenance and management stress coping in Ruminants and Equines: Physiological ranges and reference values

In order to acquire a pattern of thyroid involvement in welfare maintenance in Ruminants and Equines, this review summarizes data concerning the reference values of total and free iodothyronines and their modifications in physiological conditions and in different management conditions (pregnancy, lactation, weaning, growth, isolation, restraint, shearing, confinement and transportation). Thyroidal and extrathyroidal tissues efficiently respond to management practices, giving a differentiated contribution to circulating iodothyronine changes. The hormonal response could be mainly attributed to the intracellular deiodination of T₄ to T_3. Triiodothyronine (T₃) and free iodothyronines (fT₃ and fT₄) result more responsive to management stress, showing different pattern with species and to various conditions, as to environmental conditions in which activities are performed. Intrinsic seasonal changes of iodothyronines and a significant pregnancy effect for T₃ were recorded in mares. Higher, although not significant, T₃ and T₄ concentrations in barren than pregnant mares were observed in donkeys. A positive significant correlation between T₃ and T₄ was described only in pregnant donkeys. Moreover, a significant effect of season on T₃ and fT₃ changes was observed both in pregnant and barren donkeys. A significant lactating effect compared with nonlactating stage for T₃ and T₄ was recorded in mares. In growing foals, body weight (BW) and age were positively correlated with T₃ and negatively correlated with T₄, fT₄ and fT₃. Weaning effects were shown for T₃ and fT₄ concentrations, indicating that weaning represents a severe stress and the presence of conspecific does not reduce psychological stress in this phase. Lambs showed significant decreased T₃ and elevated T₄ concentrations two weeks after weaning, with higher concentrations in both males and females compared to 24 h. Significant positive correlations were observed between BW and T₄, fT₃ and fT₄ concentrations in lambs. A T₃ decrease was detected after isolation, such as induced by confinement and weaning in lambs. Higher T₃ concentration after restraint and shearing than after isolation and significant increases in T₄, fT₃ and fT₄ values after restraint and shearing were recorded. The basal concentrations of fT₃ in both the inexperienced and experienced transported horses were significantly higher than in untransported experienced horses. Moreover, increases of T_3, T₄ and fT₄ after short road transportation, and significant correlations between T₃ and rectal temperature (RT), body weight (BW) and heart rate (HR), confirmed their important role in coping strategy. Thyroid responsiveness to short transport is similar in domestic donkeys and horses, with a preferential release of T₃ in horses. A greatest and constant release of T₃ and T₄, although differentiated, after simulated transportation and after conventional transport of horses confirmed that the degree of stress induced by confinement and additional stressful stimuli associated to road transportation could differently influence the iodothyronine release. Temperamental Limousin young beef bulls showed lower T₄ and fT₄ concentrations after prolonged transportation than calm subjects, and a concomitant decrease of circulating ACTH, cortisol, T₃ and fT₃ concentrations, probably induced by down regulation of HPA axis and cortisol negative feedback. These data reinforce the importance of taking into account the evaluation of iodothyronines, and notably of T₃, as markers of welfare and stress and their role in ensuring energy homeostasis and productive and reproductive performances in Ruminants and Equines.

Concurrent thoracic mesothelioma and thyroid C-cell adenoma with amyloid deposition in an aged horse

A 21‐year‐old American Saddlebred mare died with a history of weight loss and breathing difficulties of 1 month duration. Post‐mortem examination revealed a copious pleural effusion with multifocal to coalescing numerous white to grey nodular masses on the serosal surface of the pericardium, lungs and thoracic cavity. In addition, the left thyroid gland was markedly enlarged. A thoracic mesothelioma and C‐cell adenoma with amyloid deposits of the left thyroid gland were diagnosed by histopathology and confirmed by immunohistochemistry employing antibodies against cytokeratin (CK), vimentin and calcitonin. Amyloid deposits in the thyroid tumour were confirmed by Congo red staining with apple‐green birefringence under polarized light. Mesothelioma remains an uncommon neoplasm encountered in aged horses. Discussion includes the diagnostic challenge of differentiating carcinomatosis from mesothelioma by histology and differentiating reactive and neoplastic mesothelial cells by cytology.

Therapeutics for Equine Endocrine Disorders

Equine endocrine disease is commonly encountered by equine practitioners. Pituitary pars intermedia dysfunction (PPID) and equine metabolic syndrome (EMS) predominate. The most logical therapeutic approach in PPID uses dopamine agonists; pergolide mesylate is the most common. Bromocryptine and cabergoline are alternative drugs with similar actions. Drugs from other classes have a poor evidence basis, although cyproheptadine and trilostane might be considered. EMS requires management changes as the primary approach; reasonable justification for use of drugs such as levothyroxine and metformin may apply. Therapeutic options exist in rare cases of diabetes mellitus, diabetes insipidus, hyperthyroidism, and critical illness-related corticosteroid insufficiency.

Nonthyroidal illness syndrome in adult horses

BACKGROUND

This study was performed to determine whether sick horses have thyroid hormone (TH) alterations similar to those observed in nonthyroidal illness syndrome in other species.

HYPOTHESIS

Horses suffering from systemic diseases have decreased THs and inappropriately low thyroid-stimulating hormone (TSH).

ANIMALS

Seventy-one clinically normal horses; 380 hospitalized horses.

METHODS

Total thyroxine (TT4), free thyroxine by equilibrium dialysis (fT4D), total triiodothyronine (TT3), free triiodothyronine (fT3), and TSH were measured in normal and hospitalized horses. Disease severity was categorized as mild, moderate, or severe by both subjective and objective criteria.

RESULTS

Negative correlations existed between all THs, except TSH, and objective illness severity scores. These scores also increased with each subjective disease severity category. TT3 and fT3 were decreased with mild disease. TT3 progressively decreased more with moderate and severe disease. TT4 and fT4D remained normal with mild disease, but decreased progressively with disease severity. TSH increased with mild disease, but remained normal with moderate or severe disease. Horses that died or were euthanized had lower concentrations of all THs, except TSH, when compared with those that lived. In horses that received >3 doses of NSAIDs, corticosteroids, or heparin compared to 0-3 doses, TT3 and TT4 were decreased, whereas fT4D and TSH remained normal. There were minimal TH changes in horses that were not eating.

CONCLUSIONS AND CLINICAL IMPORTANCE

Thyroid hormones decrease in horses with systemic disease. TT3 decreases first, followed by TT4 and fT4D. TSH fails to increase proportionally to the changes in THs, indicating hypothalamic-pituitary axis dysregulation. NSAIDs, corticosteroids, heparin, and fasting have less effect on THs compared with disease severity.

Thyroid hormone concentrations in foals affected by perinatal asphyxia syndrome

The hypothalamus-pituitary-thyroid axis has specific functions, mostly related to metabolic activities, cell differentiation, and development. To the authors' knowledge, there are no studies about thyroid hormone (TH) concentrations in foals affected by perinatal asphyxia syndrome (PAS). Hence, the aims of the study are (1) to evaluate plasma TH concentrations (T3 and T4) in healthy foals during the first 7 days of life; (2) to evaluate plasma TH concentration (T3 and T4) in critically ill foals affected by PAS during the first 7 days of hospitalization; and (3) to compare TH concentrations between surviving and nonsurviving critically ill foals. Forty-five Standardbred foals were enrolled in this prospective observational study: 21 healthy foals (group 1) and 24 foals affected by PAS (group 2). Jugular blood samples were collected within 10 minutes from birth/admission and every 24 hours for 7 days (t0-t7). TH concentrations were analyzed by RIA. In both groups, T3 concentration was significantly lower at t4, t5, t6, and t7 compared with t1 (P < 0.05), and T4 concentration was significantly higher at birth than at all other time points (P < 0.01). No differences were found in TH concentrations at admission between surviving (n = 20) and nonsurviving (n = 4) foals. Statistical comparison between healthy and PAS foals divided into age groups showed significantly lower TH concentrations at t0 in PAS foals <12 hours old at admission (P < 0.01). In conclusion, PAS may cause lower T3 and T4 concentrations in affected foals than in age-matched healthy foals, as reported for other systemic illnesses, such as sepsis and prematurity. TH concentrations showed no prognostic value, which maybe due to the small number of nonsurviving foals in this study. Further studies are needed to find out if thyroid replacement therapy could be useful in the treatment of critically ill foals affected by PAS.

Thyroid hormone concentrations differ between donkeys and horses

REASONS FOR PERFORMING STUDY

Reference intervals for thyroid hormones (TH) concentrations have not been previously established for donkeys, leading to potential misdiagnosis of thyroid disease.

OBJECTIVES

To determine the normal values of TH in healthy adult donkeys and compare them to TH values from healthy adult horses.

METHODS

Thirty-eight healthy Andalusian donkeys and 19 healthy Andalusian horses from 2 different farms were used. Donkeys were divided into 3 age groups: <5, 5-10 and >11 years and into 2 gender groups. Serum concentrations of fT3, tT3, rT3, fT4 and tT4 were quantified by radioimmunoassay. All blood samples were collected the same day in the morning. None of the animals had received any treatment for 30 days prior to sampling or had any history of disease. Both farms were in close proximity and under similar management. Differences between groups were determined using a one-way ANOVA analysis followed by Fisher's LSD test. P<0.05 was considered significant.

RESULTS

Serum TH concentrations were higher in donkeys than in horses (P<0.01). Donkeys <5 years had higher serum rT3, fT4 and tT4 concentrations than donkeys >5 years (P<0.05). Furthermore, older donkeys (>11 years) had lower serum fT3 and tT3 concentrations than younger donkeys' groups (<5 and 5-10 years, P<0.05). TH concentrations were not different between genders (fT3: P = 0.06; tT3: P = 0.08; rT3: P = 0.15; fT4: P = 0.89; and tT4: P = 0.19).

CONCLUSIONS

Thyroid hormone concentrations are different between healthy adult donkeys and horses.

POTENTIAL RELEVANCE

Establishing species-specific TH reference ranges is important when evaluating clinicopathologic data in equids in order to avoid the misdiagnosis of thyroid gland dysfunction. Further studies to elucidate the physiological mechanisms leading to these differences are warranted.