Dermatological and haemato-biochemical characteristics of canine hypothyroidism

J.P. Kachhawa1, A.P. Singh Mukesh Srivastava2, S. Kachhawaha2, N.K.Singh3, *, Anil Ahuja*
Department of Clinical Veterinary Medicine, Ethics and Jurisprudence
College of Veterinary and Animal Science, RAJUVAS, Bikaner- 334 001(Rajasthan)
Abstract
A golden retriever spayed female and a mongrel, male dog suspected for hypothyroidism based
on various types of classical skin disorders such as, rat tail, puppy like coat, obesity, myxoedema
etc. The results of blood biochemistry confirmed for decreased hemoglobin concentration, RBC
counts and neutrophil counts, low levels of T3, TT4 and FT4 indicating hypothyroidism.
Whereas, elevated values of serum ALT, ALP and Cholesterol were noticed. The dog treated with
oral administration of levothyroxine without any side effects and completely recovered after 42
days.
Key words: Hypothyroidism, dermatological, thyroxine sodium
Introduction
Hypothyroidism is an endocrinopathy caused by decreased production of thyroid
hormone. Because most cells in the body are affected by thyroid hormone, hypothyroidism can
affect most organs. Common signs are related to the dermatologic system and decreased
metabolic rate. Hypothyroidism is considered to be one of the most common endocrine disorders
of dogs (Feldman and Nelson1996). However, it is a disease with complex clinical signs because
of the effect of thyroid hormone deficiency on multiple body systems.
Canine Hypothyroidism is found in dogs 4-10 years old. It is developed more in the
middle ages. Affects more mid or large sized dogs. Rare in toy and miniature breeds of dogs.
Spayed females are at higher risk.
Hypothyroidism is due to decreased thyroidal production of the thyroid hormones
thyroxine (T4) and triiodothyronine (T3). Greater than 90% of cases are primary and are due to
acquired immune mediated destruction of the thyroid gland which is preceded by thyroiditis,
idiopathic atrophy or less commonly neoplasia. Secondary forms of the disease include thyroid
stimulating hormone (TSH) deficiency, pituitary neoplasia, and cystic Rathke’s pouch, are
uncommon clinical entities. Tertiary hypothyroidism with thyrotropin releasing hormone (TRH)
deficiency has not been documented in dogs. Congenital cases have been reported in both dogs
and cats. The diagnosis of hypothyroidism in dogs is further complicated by the lack of a single
test that provides an accurate confirmation of the clinical diagnosis. In addition, the presence of
factors such as systemic illness, breed, and drug administration can alter thyroid function tests,
making it difficult to interpret these tests.
Case history and clinical findings
A 5-years old golden retriever spayed female and a mongrel 6 years old male dog was
presented in the Medicine Clinic of Teaching Veterinary Clinical Complex with almost similar
complaint of dullness, hair fall and weight gain. The dogs underwent thorough physical and
haemato-biochemical examination. The clinical findings included hair thinning particularly
affecting the flanks, tail and thighs, dry hair coat, alopecia over areas of friction, such as the tail
(“rat tail” appearance), ventral neck, and legs particularly over elbow. Bilaterally symmetrical
lateral alopecia on trunk was seen in Golden Retriever, dorsal nasal alopecia was seen in mongrel
dog (Figures 1 and 2). Lichenification, hyperpigmentation, comedones, with seborrhoea were
seen and the lesions were non-pruritic. Both dogs were mentally dull, lethargy, exercise
intolerant, and obese without increase appetite.
Diagnosis and treatment
The test results from laboratory findings presented in Table 1. Haematology revealed
increased white cell numbers and decreased hemoglobin concentration, RBC counts and
neutrophil counts. He biochemical analysis revealed increased concentrations of serum
triglyceride, cholesterol, glucose, mild increases in alanine transaminase (ALT), aspartate
aminotransferase (AST) and alkaline phosphatase (ALP).
The total thyroxine (TT4) was low and canine thyroid stimulating hormone (TSH)
concentration was elevated. Based on the clinical signs, physical examination findings, lower
TT4 and elevated TSH level, the disease was diagnosed as canine hypothyroidism in both the
dogs.
Free TT4 (fT4; by equilibrium dialysis) was also low (6.8 pmol/L; reference range, 9 to
40 pmol/L), and his (0.61 ng/mL; reference range, 0.1 to 0.4 ng/mL), consistent with a diagnosis
of hypothyroidism.
The dogs were subsequently treated with thyroid replacement therapy utilizing
levothyroxine (20 μg/kg body weight, orally on an empty stomach for six weeks continuously.
Treatment of hypothyroidism involves replacement therapy.
Results and Discussion
 The marked reversals of clinical signs were started from three weeks of commencement
of therapy and the dogs recovered clinically after six weeks of treatment.
Hypothyroidism is a systemic disorder resulting from inadequate circulating
concentrations of the thyroid hormones. The most commonly recognized form of hypothyroidism
is adult-onset primary thyroid gland failure resulting from either lymphocytic thyroiditis or
idiopathic atrophy (Feldman and Nelson 1996).
Hypothyroidism is conventionally considered to be a disease of medium to large dogs
viz., Dachshunds, Dobermans, Golden retrievers, Cocker spaniels and Pomeranians (Milne and
Hayes 1981, Panciera 1994 and Ettinger et al., 2010). However, Panciera (1994) found that
neutering was a significant risk factor in both males and females.
Usual signs of hypothyroidism in dogs include a variety of dermatological and metabolic
abnormalities. Thyroid hormones are important in the maintenance of dermal health. Persistence
of the telogen growth phase results in easily epilated hair and eventually alopecia, and
hyperkeratosis causes scaling and scurfing of the skin (Panciera 1990). The accumulation of
dermal mucopolysaccharides and hyaluronic acid results in myxoedematous skin thickening
(Bernhard and others 1996). Thyroid hormones assist the humoral and cellular immune
responses, and secondary pyodermas can therefore also occur in hypothyroidism (Peterson and
Ferguson 1989; Panciera 1990 and Lathan, 2016). Dermatological abnormalities affected 80 per
cent of the hypothyroid dogs; the most common were hair thinning or actual alopecia, poor
quality hair coat and skin hyperpigmentation. Metabolic abnormalities were the most common
clinical signs. These abnormalities are due to decreased cellular metabolism depressing the dog's
mental status and activity; if untreated they may progress to a state of myxoedematous dementia
or coma (Feldman and Nelson 1996; Lathan, 2016).
Thyroid hormones stimulate virtually all aspects of lipid metabolism, induding synthesis,
mobilisation and degradation, but in hypothyroidism, degradation is most severely affected
resulting in lipid accumulation commonly reported hypercholesterolaemia,
hypertriglyceridaemia, elevated circulating CK concentration, and a mild non-regenerative
anaemia (Panciera 1994; Feldman and Nelson 1996 and Tappin, 2014). Decreased erythropoietin
production and a lack of a direct stimulatory effect of thyroid hormones onerythroid precursors
are thought to be responsible for decreased haemolobin concentration (Green and Ng 1986).
However, a CBC and biochemical profile are usually not very helpful for diagnosing
hypothyroidism, they are valuable as part of a thorough evaluation for other potential conditions
and to assess premedication health status.
Accuracy of serum TT4 in evaluating thyroid function is 85% to 90%;2 however, it is
important to remember that several factors can artificially affect serum TT4 values such as age,
breed, Phenobarbital, Estrogen, furosemide, progesterone, glucocorticoids, insulin, sulfonamides,
narcotic analgesics etc. Endogenous canine TSH is increasing specificity to 98% and can provide
valuable evidence supporting hypothyroidism (Davidson, 2001). The TSH is within the reference
range in 20% to 40% of hypothyroid dogs, so it cannot be used alone for a diagnosis. Combining
TT4 with TSH measurements will reveal approximately 80 per cent of cases; however TSH can
be normal in 20-40 per cent of cases (Dixonand Mooney, 1999). Serum TT4 and endogenous
canine TSH are the primary tests to confirm the diagnosis (Peterson et al., 1997 and Kintzer,
1998). According to Tappin (2014) total T3 (TT3) has a lower diagnostic accuracy than TT4,
thus the measurement of both TT3 and free T3 (fT3) is not particularly helpful in the diagnosis of
hypothyroidism.
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