Thursday, March 27, 2014

When Is Hypothyroidism not Hypothyroidism?

by Jennifer Coates, DVM

Hypothyroidism is one of the most common endocrine (hormonal) diseases I see in dogs. 

Doberman Pinscher

It occurs most frequently in middle-aged (4-10 years old) medium to large-breed dogs. Breeds that are commonly affected include Doberman Pinschers, Golden Retrievers, Irish Setters, Miniature Schnauzers, Dachshunds, Cocker Spaniels, and Airedale Terriers.

Hypothyroidism occurs when the thyroid gland secretes less thyroid hormone than normal. 

It usually is caused either by inflammation that destroys the normal thyroid tissue or the replacement of normal thyroid tissue with fatty tissue.

Because thyroid hormone has an effect on many parts of the body and the disease is slowly-progressive, the signs may be variable and non-specific at first.

Owners may notice weight gain, lethargy, intolerance of exercise, and heat-seeking behavior due to a lowered metabolism. Skin and hair coat changes (e.g., dull hair coat, hair loss, increased skin pigmentation and skin infections) may be evident also. Other possible signs include neurologic and/or reproductive abnormalities.

However, these symptoms are not specific for hypothyroidism and can be caused by a variety of diseases.

Diagnosing hypothyroidism is not straight- forward. 

The supporting signs and symptoms must be backed up by laboratory tests. Routine testing (such as a complete blood count and a biochemical analysis) may provide only supportive evidence of thyroid disease or may reveal another disease that is mimicking thyroid disease.

More specific thyroid function tests (measurements of total T4, free T4 and Thyroid Stimulating Hormone or TSH) can show that the thyroid gland is normal but do not conclusively prove that a dog’s illness is due to thyroid gland dysfunction.

Many non-thyroidal diseases and medications can cause a syndrome known as Euthyroid Sick Syndrome

This syndrome results in reduced total T4 concentrations and mimics a hypothyroid condition - thyroid levels are low, the dog may have some of the symptoms commonly seen with hypothyroidism, and clinical improvement may be seen following administration of thyroid medication (which is the treatment for hypothyroidism).

However, the thyroid gland is actually functioning normally.

Any severe systemic disease can cause low thyroid concentrations including neurologic diseases, heart failure, renal disease, and cancer. Some medications that can cause Euthyroid Sick Syndrome include
  • phenobarbital
  • zonisamide
  • sulfa antibiotics
  • clomipramine
  • aspirin
  • corticosteroids (including topical formulations)

To complicate matters further, some breeds of dogs normally have low serum total T4 and free T4 concentrations including
  • Greyhounds
  • Scottish Deerhounds
  • Other sight hounds
  • Alaskan sled dogs (particularly during intense training or racing)

The most specific test that is currently available for differentiating hypothyroidism from the Euthyroid Sick Syndrome is the measurement of free T4 by equilibrium dialysis

It has the greatest diagnostic sensitivity and specificity – meaning that when thyroid disease is present, the free T4 is most likely low and when the free T4 is low, thyroid disease is likely to blame.

Ultrasound of the thyroid gland by an experienced radiologist and scintigraphy (a thyroid scan) can also provide useful information, but due to cost and limited availability, these tests are not commonly used.

Veterinarians must be careful when evaluating a dog that looks like he has hypothyroidism.

An accurate diagnosis must be reached before proper treatment can start and the patient starts down the road to recovery.


Jennifer Coates, DVM graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999.  In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado.  She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-speak Deciphered for the Non-veterinarian

Dr. Coates has recently joined the PetMD team and she is now writing for the Fully Vetted column; great blog, do check it out.

Jennifer also writes short stories that focus on the strength and importance of the human-animal bond and freelance articles relating to a variety of animal care and veterinary topics.  Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and pets.

Articles by Dr. Coates:
Kidney Disease – Say What? 
What Happens In The Dog's Body When The Kidneys Fail To Function Properly? 
Heat Stroke: What Happens In The Dog's Body?  
The Perplexities of Pancreatitis
The Other Side Of The Coin: The Cost Of Defensive Medicine
To Neuter Or Not To Neuter… That Is The Question
Don’t Forget the Physical Therapy
Common Misdiagnoses (Part 1)
Common Misdiagnoses (Part 2)
Picking the Right Dog to Breed
When Is It An Emergency?
Dog Allergies: Common, Commonly Misdiagnosed, or Both? 
Why Does The Spleen Get No Respect?
Protect Your Dog From Snake Bites 
More Creepy Crawlies
Why I Dislike Inflammatory Bowel Disease
Salmonella – A Significant Problem, Or Not? 
What’s In the Vomit?
Cortisol: What Happens In A Dog’s Body When It Goes Awry?
What Happens In The Dog's Body With Zinc Toxicity? 
What Happens In The Dog’s Body: Xylitol Poisoning 
What Happens In The Dog's Body: Insulin 

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