Duration of effects of phenylbutazone on serum total thyroxine and free thyroxine concentrations in horses

The occurrence of low thyroxine concentrations and response to thyrotropin-releasing hormone using equine and canine assays in a population of Standardbred racehorses in Prince Edward Island, Canada

Decreased total T4 (tT4) concentrations are frequently observed in racing Standardbred horses lacking clinical evidence of hypothyroidism. This poses a diagnostic challenge as primary hypothyroidism is reported to be rare in adult horses. Despite this, owners frequently wish to administer thyroid supplementation to horses having low tT4 concentrations. Forty racing Standardbred horses were sampled. Baseline tT4 concentrations were determined using human-based (equine) and canine-based chemiluminescent assays. Dynamic evaluation of tT4 was performed using a thyrotropin-releasing hormone (TRH) stimulation test using both assays. Variability between tests was assessed with correlation coefficients and Bland-Altman plots. Mean baseline tT4 concentration using the equine assay was 15.1 nmol/L with 31/40 (77.5 %) concentrations falling below the reference interval. Those 31 horses had a mean post-TRH tT4 concentration of 27.5 nmol/L (SD = 6.1), and mean percentage increase of 113.6 % (SD = 47.4). Although all horses had post-TRH tT4 concentration higher than baseline indicating normal thyroid function, 3 horses did not reach a 50 % increase. Mean baseline tT4 concentration using the canine assay was 17.9 nmol/L with 12 of 40 (30 %) concentrations falling below the reference interval. Those 12 horses had a mean post-TRH tT4 concentration of 36.7 nmol/L (SD = 5.8), and a mean percentage increase of 242.7 % (SD = 91.7). The 31 horses identified with low baseline tT4 concentrations using the equine assay achieved a 50 % or greater increase from baseline using the canine assay. Equine and canine assay-derived values (for baseline and post-TRH tT4) were strongly correlated, with weak concordance correlation coefficients. Results from this study support that a single low tT4 concentration cannot be used to accurately diagnose hypothyroidism in horses and dynamic testing is required. While further evaluation is required, use of a canine T4 assay calibrated to achieve detection of lower tT4 concentrations in horses is promising.

Mass spectrometry in measurement of thyroid biomarkers

In 2022, the number of patients with thyroid disease in China exceeded 200 million (10 million with hyperthyroidism, 90 million with hypothyroidism, and 100 million with other thyroid disease such as goiter, thyroid nodules, and thyroid cancer). Well-established markers include FT3, FT4, TT3, TT4, and TSH tested by a number of immunoassay methods. This approach is based on the primary binding of antigen with antibody and a subsequent secondary chemical reaction that provides an indirect measure. The use of traceable standards for quantitation remains an important factor to ensure inter-assay reliability and precision. Recently, mass spectrometry (MS) has received considerable attention as an analytic tool due to high resolution and quantitative accuracy. In addition, MS allows for sensitive determination of low-abundance markers making it ideal for development of traceable standards. Furthermore, this technology will allow for the development of highly accurate thyroid biomarker assays to facilitate diagnosis, enable early treatment and improve outcomes. Herein, we provide a systematic review and summary of MS in enhancing the analysis of thyroid biomarkers.

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.

Metabolic and Endocrine Disorders in Donkeys

The donkey evolved under harsh and arid environmental conditions, developing unique energy-efficiency traits, with an efficiency to rapidly mobilize fat in situations of increased energy demands or when food is scarce. This evolution has led to an inherent predisposition of donkeys to obesity, dyslipidemias, insulin dysregulation/metabolic syndrome, pituitary pars intermedia dysfunction, and endocrinopathic laminitis. Marked differences have been described in hormone dynamics and testing protocols for the diagnosis of these endocrine and metabolic diseases in donkeys compared with horses, underlining the necessity of a species-specific approach in order to avoid misdiagnosis, unnecessary or inadequate treatments, and additional costs.

Donkey Internal Medicine—Part I: Metabolic, Endocrine, and Alimentary Tract Disturbances

Metabolic and endocrine disturbances are common in donkeys. This species has an inherent ability to thrive with limited and poor-quality roughage. Donkeys are extremely efficient in energy storage and mobilization, which predisposes to hyperlipemia, obesity, and metabolic syndrome. The prevalence of dyslipidemias is higher in donkeys than other equids, which is more evident under stressful conditions. Diagnosis of endocrine and metabolic disorders in donkeys should be based on species-specific information considering that differences in a multitude of variables compared with horses have been demonstrated. Protocols to assess endocrine disorders (e.g., pituitary pars intermedia dysfunction, metabolic syndrome, and thyroid illness) are unavailable, and extrapolation from horse data can be misleading. Treatment guidelines for these conditions in donkeys are currently not reported. On the other hand, the typical stoic and hardy behavior of donkeys can hinder prompt diagnosis of gastrointestinal problems, specifically colic, which is commonly caused by dental issues in this species. Moreover, subclinical gastric ulcer syndrome appears to be a common pathology in this species, especially in working donkeys.

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Donkeys are different to horses.

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Numerous physiological and clinic-pathologic idiosyncrasies are reported in horses.

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Data published for horses should not be extrapolated for donkeys.

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Specific reference ranges, doses, and protocols have to be used for donkeys.

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 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.

Pharmacokinetics of orally administered phenylbutazone in African and Asian elephants (Loxodonta africana and Elephas maximus)

The pharmacokinetic parameters of phenylbutazone were determined in 18 elephants (Loxodonta africana and Elephas maximus) after single-dose oral administration of 2, 3, and 4 mg/kg phenylbutazone, as well as multiple-dose administrations with a 4-wk washout period between trials. After administration of 2 mg/kg phenylbutazone, mean serum concentrations peaked in approximately 7.5 hr at 4.3 +/- 2.02 microg/ml and 9.7 hr at 7.1 +/- 2.36 microg/ml for African and Asian elephants, respectively, while 3 mg/kg dosages resulted in peak serum concentrations of 7.2 +/- 4.06 microg/ml in 8.4 hr and 12.1 +/- 3.13 microg/ml in 14 hr. The harmonic mean half-life was long, ranging between 13 and 15 hr and 39 and 45 hr for African and Asian elephants, respectively. There was evidence of enterohepatic cycling of phenylbutazone in Asian elephants. Significant differences (P < 0.0001) in pharmacokinetic values occurred between African and Asian elephants for clearance (27.9 and 7.6 ml/hr/kg, respectively), terminal half-life (15.0 and 38.7 hr, respectively), and mean residence time (22.5 and 55.5 hr, respectively) using 2-mg/kg dosages as an example. This suggests that different treatment regimens for Asian and African elephants should be used. There were no apparent gender differences in these parameters for either elephant species.

Evidence-based literature pertaining to thyroid dysfunction and Cushing's syndrome in the horse

The evidence-based literature pertaining to thyroid dysfunction and Cushing's syndrome is discussed in this article. Summaries of and recommendations for the treatment of these conditions are made. There is a need for reliable diagnostic tests for these conditions in horses.

Effects of deracoxib and aspirin on serum concentrations of thyroxine, 3,5,3′-triiodothyronine, free thyroxine, and thyroid-stimulating hormone in healthy dogs

OBJECTIVE

To evaluate the effects of deracoxib and aspirin on serum concentrations of thyroxine (T4), 3,5,3'-triiodothyronine (T3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) in healthy dogs.

ANIMALS

24 dogs.

PROCEDURE

Dogs were allocated to 1 of 3 groups of 8 dogs each. Dogs received the vehicle used for deracoxib tablets (PO, q 8 h; placebo), aspirin (23 to 25 mg/kg, PO, q 8 h), or deracoxib (1.25 to 1.8 mg/kg, PO, q 24 h) and placebo (PO, q 8 h) for 28 days. Measurement of serum concentrations of T4, T3, fT4, and TSH were performed 7 days before treatment (day -7), on days 14 and 28 of treatment, and 14 days after treatment was discontinued. Plasma total protein, albumin, and globulin concentrations were measured on days -7 and 28.

RESULTS

Mean serum T4, fT4, and T3 concentrations decreased significantly from baseline on days 14 and 28 of treatment in dogs receiving aspirin, compared with those receiving placebo. Mean plasma total protein, albumin, and globulin concentrations on day 28 decreased significantly in dogs receiving aspirin, compared with those receiving placebo. Fourteen days after administration of aspirin was stopped, differences in hormone concentrations were no longer significant. Differences in serum TSH or the free fraction of T4 were not detected at any time. No significant difference in any of the analytes was detected at any time in dogs treated with deracoxib.

CONCLUSIONS AND CLINICAL RELEVANCE

Aspirin had substantial suppressive effects on thyroid hormone concentrations in dogs. Treatment with high dosages of aspirin, but not deracoxib, should be discontinued prior to evaluation of thyroid function.

Effects of oral administration of levothyroxine sodium on serum concentrations of thyroid gland hormones and responses to injections of thyrotropin-releasing hormone in healthy adult mares

OBJECTIVE

To determine the effects of levothyroxine sodium (L-T4) on serum concentrations of thyroid gland hormones and responses to injections of thyrotropin-releasing hormone (TRH) in euthyroid horses.

ANIMALS

12 healthy adult mares.

PROCEDURE

8 horses received an incrementally increasing dosage of L-T4 (24, 48, 72, or 96 mg of L-T4/d) for weeks 1 to 8. Each dose was provided for 2 weeks. Four additional horses remained untreated. Serum concentrations of total triiodothyronine (tT3), total thyroxine (tT4), free T3 (fT3), free T4 (fT4), and thyroid-stimulating hormone (TSH) were measured in samples obtained at weeks 0, 2, 4, 6, and 8; 1.2 mg of TRH was then administered i.v., and serum concentrations of thyroid gland hormones were measured 2 and 4 hours after injection. Serum reverseT3 (rT3) concentration was also measured in the samples collected at weeks 0 and 8.

RESULTS

Treated horses lost a significant amount of weight (median, 19 kg). Significant treatment-by-time effects were detected for serum tT3, tT4, fT3, fT4, and TSH concentrations, and serum tT4 concentrations were positively correlated (r, 0.95) with time (and therefore dosage) in treated horses. Mean +/- SD serum rT3 concentration significantly increased in treated horses (3.06 +/- 0.51 nmol/L for week 8 vs 0.74 +/- 0.22 nmol/L for week 0). Serum tT3, tT4, fT3, and TSH concentrations in response to TRH injections differed significantly between treated and untreated horses.

CONCLUSIONS AND CLINICAL RELEVANCE

Administration of levothyroxine sodium increased serum tT4 concentrations and blunted responses toTRH injection in healthy euthyroid horses.

Influence of acetylsalicylic acid and ketoprofen on canine thyroid function tests

Many factors including drugs can influence thyroid function in humans, rats and dogs. Studies in humans report significant effects of non-steroidal anti-inflammatory agents (NSAIDs) on thyroid function tests, which can lead to misinterpretation of the results and inappropriate therapeutic decisions. As NSAIDs are used more and more frequently in dogs, it is important to know to what extent they can influence results. Eighteen spayed female beagle dogs were randomly assigned to three treatment sequences in a 3 x 3 crossover study design with treatments consisting of acetylsalicylic acid (ASA) (25 mg/kg BW q 12 h), ketoprofen (Keto) (1 mg/kg BW q 24 h) or placebo administered for a 1-week period with a 3-week washout period between treatment periods. Blood samples for determination of total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), thyrotropin (TSH), reverse triiodothyronine (rT3), Keto and ASA concentrations were taken during each treatment period on days 0, 1, 3 and 7. During the washout period samples were taken weekly. A significant decrease in TT4 was observed as soon as 24 h after ASA administration, whereas the decrease in TT3 was less pronounced and differed significantly from the placebo only after 1 week of administration. No significant effects were found for free T4 and TSH with ASA administration. No significant effects on thyroid results were found following Keto administration. The results indicate that TT4 can be markedly decreased by ASA therapy and until the results of further studies are available, thyroid function test results should be interpreted cautiously in dogs on NSAIDs therapy.

Results of thyroid function tests and concentrations of plasma proteins in dogs administered etodolac

OBJECTIVE

To determine the effects of etodolac administration on results of thyroid function tests and concentrations of plasma proteins in clinically normal dogs.

ANIMALS

19 healthy random-source mixed-breed dogs.

PROCEDURE

Blood samples for measurement of serum thyroxine (T4), 3,5,3'-triiodothyronine (T3), free T4 (fT4), and endogenous canine thyroid stimulating hormone (cTSH) were measured twice before as well as on days 14 and 28 of etodolac administration (mean dosage, 13.7 mg/kg, PO, q 24 h). Plasma total protein, albumin, and globulin concentrations and serum osmolality were measured once before as well as on days 14 and 28 of etodolac administration.

RESULTS

Etodolac administration did not significantly affect serum T4, T3, fT4, or cTSH concentrations or serum osmolality. Significant decreases in plasma total protein, albumin, and globulin concentrations were detected on days 14 and 28 of administration.

CONCLUSIONS AND CLINICAL RELEVANCE

Results of thyroid function tests are not altered when etodolac is administered for up to 4 weeks. Therefore, interpretation of results of these tests should accurately reflect thyroid function during etodolac treatment. Plasma total protein, albumin, or globulin concentrations that are less than the respective reference range in a dog administered etodolac for > or = 2 weeks may be an effect of treatment rather than an unrelated disease process. A decrease in plasma protein concentrations may reflect subclinical injury of the gastrointestinal tract.

Equine thyroid dysfunction

Hypothyroidism is the most common type of thyroid gland dysfunction reported in horses. Primary, secondary, and tertiary causes of hypothyroidism are discussed. Equine hypothyroidism remains a controversial endocrine disorder because extrathyroidal factors, including the administration of drugs and systemic diseases, affect serum triiodothyronine (T3) and thyroxine (T3) concentrations in horses. Accurate diagnosis of hypothyroidism therefore requires assessment of the hypothalamic-pituitary-thyroid axis. Diagnostic procedures for evaluating thyroid gland function are outlined and results of studies utilizing experimental models are discussed.

Adverse drug reactions and interactions in the horse

Drugs undergo extensive evaluation before they are marketed. The occurrence of adverse reactions, however, may be so rare that thousands of patients must receive the drug before reliable data are available. It is necessary that veterinarians be informed about the drugs they use, be able to recognize drug-associated complications, know how to evaluate the patient for evidence of drug-associated toxicity, report adverse effects of drugs to the respective manufacturers, and be prepared to provide medical support and antidotal treatment (if it exists) for a patient if toxicosis occurs.

Pharmacologic considerations for opiate analgesic and nonsteroidal anti-inflammatory drugs

When administering opioid analgesic drugs or nonsteroidal anti-inflammatory drugs, veterinarians are often not familiar enough with the underlying pharmacology of the drugs, particularly with the potential for drug interactions and adverse effects. This article considers some of the pharmacologic features of these drugs and provides a basis for important interactions, contraindications, and adverse effects.

Correlation of two nonradioactive immunoassays to a radioimmunoassay technique for thyroxine measurement in equine serum

The purpose of this study was to compare 2 different nonradioactive assay methods with a conventional radioimmunoassay (RIA) measuring the concentration of serum thyroxine (T4) in horses. Serum was obtained from 85 adult standardbred horses. The T4 concentration of each sample was analyzed by RIA, chemiluminescent enzyme immunoassay (CEI), and homogeneous enzyme immunoassay (HEI). The correlation between the HEI method and RIA method was significantly greater (r = 0.89) than the correlation between the CEI and the reference method (r = 0.53). In addition, the precision of the HEI method was significantly greater than the CEI method; within-run percentage coefficients of variation were 4.5% and 15.9%, respectively, at mean T4 concentrations of 19-20 nmol/liter. On the basis of these findings, the HEI method was evaluated further. Both between-run precision and linearity were deemed adequate upon dilution by the HEI method. In addition, recovery of L-thyroxine added to equine serum was linear over 6 concentrations tested and averaged 79.6% with a manufacturer recommended data correction factor. An in-house correction factor was calculated by linear regression analysis of the RIA and HEI results from the original equine serum samples. Use of this correction factor improved the average recovery to 94.2% while maintaining excellent linearity (r2 = 0.9978). Although both nonradioactive methods of T4 analysis could likely substitute for the RIA reference method, the HEI method had the highest correlation and precision. The HEI technique also yielded adequately accurate results after correction of the data with an appropriate correction factor. Individually derived in-house correction factors may improve the accuracy of the HEI method to a greater extent than manufacturer suggested correction factors.