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ATTITUDE

ATTITUDE. “The people who get on in this world are the people who get up and look for the circumstances they want, and if they can’t find them, make them. ” - George Bernard Shaw. ENDOCRINE SYSTEM DISEASES. ‘CRINE’ – to secrete. Endocrine System Diseases. Main trigger: Hypothalamus.

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ATTITUDE

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  1. ATTITUDE “The people who get on in this world are the people who get up and look for the circumstances they want, and if they can’t find them, make them.” -George Bernard Shaw

  2. ENDOCRINE SYSTEM DISEASES ‘CRINE’ – to secrete

  3. Endocrine System Diseases

  4. Main trigger: Hypothalamus

  5. Review of the basics • Endocrine ____________- basic units of the endocrine system. • Secrete hormones ___________ into the bloodstream. • Circulate throughout body and produce effects when attach to receptors in or outside of cells. • __________ glands. • Exocrine glands- units that secrete their products onto epithelial surfaces through tiny tubes called _____________.

  6. Hormones • ___________ messengers produced by endocrine glands and secreted directly into blood vessels. • Produce effects when find their receptors in or on cells. • Each body cell has specific receptors to certain hormones (___________). • If body does not have receptor, hormone will pass by. • Only certain hormones can _______ to receptors and when it occurs, then it changes the activity of the cell.

  7. Hormones

  8. Control of Hormone Secretion • “Negative Feedback System” • Endocrine glands will be stimulated to produce more hormone when it drops below a certain amount in the body. • If hormone is of adequate levels, gland will either slow or stop production of the hormone which is called negative feedback. • Direct Stimulation of Nervous System • Secretion of some hormones is stimulated by sympathetic nerve impulses when an animal feels threatened. • Fight or flight response from sympathetic nervous system

  9. DISEASES OF THE THYROID GLAND HYPERTHYROIDISM HYPOTHYROIDISM

  10. Hypothyroidism

  11. Thyroid Gland • Gland not usually palpable • Located at ventral cervical region along lateral margins of trachea • Hormones produced • T3 (___________________) and T4 (_____________________), iodine containing hormones. • Produced by follicular cells • ______________ – Causes Calcium deposition in bone which decreases blood Calcium concentrations • Produced by parafollicular cells

  12. Hypothyroidism • Definition: clinical state associated with ____________________ which causes low cell metabolism in most tissues of the body • Primary acquired – 90% of dogs • Caused by ________________or _________________________ • Also by iodine deficiency, neoplasia, infection • Secondary acquired- RARE • Anterior Pituitary dysfunction or destruction from neoplasia – leads to ↓TSH • Congenital Hypothyroidism-RARE • Cretinism (newborns)

  13. Hypothyroidism • MOST COMMON ENDOCRINE DISEASE IN____________; rare in cats • Breeds: Golden Retriever, Doberman, Irish Setter, Schnauzer, Cocker Spaniel, Dachshund, others • 4-10 yrs of age • Females • Greyhounds and Scottish deerhounds physiologically have lower T4 (thyroxine)

  14. Hypothyroidism • Clinical Signs - COMMON • __________________________________ • Skin changes • Bilaterally symmetric truncal alopecia (which other disease has this clinical sign? ) • ______________________ neck, axillae, and other areas of friction • Seborrhea • Superficial pyoderma • Dry, lusterless haircoat • Hyperpigmentation • Cold intolerance (why?) • Lethargy/sleeping • Exercise intolerance

  15. Hypothyroidism

  16. Hypothyroidism

  17. Hypothyroidism

  18. Hypothyroidism

  19. Hypothyroidism • Clinical signs/Bloodwork – Less common • ___________________– generalized weakness, ataxia, facial paralysis/paresis, seizures (secondary to cerebral atherosclerosis) • _______________– Constipation, Regurgitation caused by megaesophagus • Bloodwork abnormalities –_____________lipidemia is most common, gross lipemia ( milky appearance to the serum), ____________________cholesterolemia (80%), anemia (mild non-regenrative) • Eye – hyperlipidemia => corneal lipidosis and anterior uveitis *Virtually all body systems are affected, clinical signs are generally non-specific

  20. Hypothyroidism: DIAGNOSIS • Blood Tests • Hypothyroid dogs have lowered level of T4 • Test total T4(TT4), +/- T3 levels • Free T4: Free T4 is thyroxine that is not protein bound (ED is most accurate test for fT4 measurement) • Basal TSH concentration • Measures TSH in blood, should be used in conjunction with other tests and clinical signs *ED = equilibrium dialysis

  21. Hypothyroidism: Considerations • Remember sick animals and animals on certain medications (anti-epileptics, glucocorticoids) may have depressed T4 levels. (_________________) • Wait and re-test after treatment of underlying cause if clinical signs persist. • Greyhounds have low T4 levels naturally diagnose based on clinical signs as well as test results; treat if clinically evident.

  22. Hypothyroidism • Treatment • Thyroid supplement – _________________ • Oral, synthetic levothyroxine (0.02 mg/kg BID) • Daily administration (after cs resolves consider SID) • Steady state levels – 4/8 wks (1st 6-8 months) • Test levels and adjust dose until T4 normal • Want to test 4-6 hours after dose is given (when serum levels are highest)

  23. Thyroid replacement hormone (levothyroxine sodium)

  24. Hypothyroidism • Client Education • Supplement for ________________ • Daily dosing required • Overdose => hyperthyroidism • Regular rechecks are recommended including bloodwork. • PU/PD; nervousness, weight loss, panting, weakness, inc. appetite • Vet may recommend a reduced fat diet until body weight is satisfactory and T4 levels are normal.

  25. Hyperthyroidism Definition: Pathologic, sustained, high overall metabolism caused by high circulating concentrations of thyroid hormones • Most common Endocrine disease in ____________ (one of the big 3 diseases of older cats) • Very rare in dogs • Pathophysiology • Autonomously ___________________________, no physiologic controls (functional thyroid adenoma) • Secrete _______ and ____________

  26. Hyperthyroidism in cats

  27. Hyperthyroidism • Clinical Signs • Multi-systemic: reflects increase in metabolism • _________________ • __________________ • Vomiting/diarrhea • _____________________ • Tachypnea/dyspnea • Hyperactivity • Aggression

  28. Hyperthyroidism • Clinical signs cont’d • ____________________(thickening of LV and heart muscle) • Hypertension • Poor body condition • Thickened nails • Unkempt appearance • ______________________ gland 70% - bilateral

  29. Hyperthyroid cat Middle age to older cats Blindness with retinal detachment Wt loss Palpable enlarged Thyroid gland Polyphagia Aggressive Tachycardia unkempt haircoat

  30. Hyperthyroid cat: Goiter

  31. Hyperthyroidism • Diagnosis • Palpate enlarged thyroid gland • Elevated T4, FT4 • X-rays for associated heart disease

  32. Hyperthyroidism: Scintigraphy Normal cat Normal uptake in salivary glands and thyroid glands Hyperthyroid cat Unilateral thyroid adenoma

  33. Hyperthyroidism: Scintigraphy Hyperthyroid cat Bilateral thyroid adenoma Hyperthyroid cat Ectopic (intrathoracic) thyroid adenoma Hyperthyroid cat Functional thyroid carcinoma (represents regional metastasis)

  34. Hyperthyroidism • Treatment • ______________________ (Tapazole) – anti-thyroid drug – block incorporation of iodine into thyroglobulin. • Monitor: q 2-3 weeks • COMMON AND PRACTICAL FOR CLIENTS • Radioiodine treatment – I131 • Effective • Emitted radiation destroys functioning follicular cells • ______________________________________________ • Surgical removal of gland • May cause hypothyroidism • May result in hypocalcemia due to hypoparathyroidism

  35. Hyperthyroidism: Medical Rx METHIMAZOLE ORAL DRUG, BUT CAN BE FORMULATED INTO A TRANSDERMAL OINTMENT

  36. Hyperthyroidism • Complications • Renal disease/failure unveiled when thyroid levels controlled • 2-3 months after medication started • Occasionally tapazole will no longer be effective usually after 2-3 years of treatment • Prognosis • Excellent if uncomplicated • If labs show ___________________ prior to treatment, prognosis more guarded

  37. Hyperthyroidism: Client Info • Cause of disease is unknown • Surgery or Radiation are only cures • Cat may become hypothyroid following Rx – usually not clinically significant and supplementation can be initiated if necessary • Following Tapazole, Blood pressure and kidney values should be checked routinely

  38. EDUCATION Education is learning what you didn’t even know you didn’t know. -Daniel J. Boorstin

  39. DISEASES OF THE PARATHYROID GLANDS HYPERPARATHYROIDISM HYPOPARATHYROIDISM

  40. Thyroid/Parathyroid glands 1=normal thyroid gland 2 and 3=parathyroid gland 4=enlarged thyroid gland

  41. Parathyroid gland • Secretion: Parathyroid hormone (PTH, Parathormone) • Function: ↑ plasma Ca2+ concentration • 1. ↑ osteoclast activity • 2. ↑ Ca++ absorption from GI tract • 3. ↑ Ca++ reabsorption from kidney tubules • Hyperparathyroidism →hypercalcemia • Hypoparathyroidism →hypocalcemia

  42. Hyperparathyroidism • Causes: • 1º hyperparathyroidism—adenoma or carcinoma • 2º hyperparathyroidism—poor diet; low Ca intake • Clinical signs: • Many animals show no clinical signs • signs occur as organ dysfunction occurs • urinary/renal calculi (high plasma Ca++) • cardiac arrhythmias, tremors (Ca++ necessary for normal muscle contraction • Anorexia, vomiting, constipation • weakness

  43. Hyperparathyroidism Dx: • Routine chemistry panel • ↑ blood Calcium (normal: ~8-10 mg/dl)) • +/- ↓ blood Phosphorus (normal: ~2-6 mg/dl) • PTH assay • normal PTH: dogs ~20 pg/ml, cats ~17 pg/ml • In a normal animal: if blood Ca++ is high, PTH is low (neg feedback) • 1º Hyperparathyroidism: Ca++ high, PTH elevated • Ultrasound of neck – enlarged glands, abdomen - uroliths

  44. Hyperparathyroidism Tx: 1. Surgical removal of diseased parathyroid (generally 4 lobes are imbedded in thyroid gland) Other options: 2. Ultrasound-guided chemical (ethanol) 3. Ultrasound-guided heat (laser) ablation Post-Op Care: 1. Hospitalize for 1 wk; ↓PTH may predispose animal to hypocalcemia 2. Calcium therapy (oral tabs, liquid) 3. Vit D supplements (promotes Ca intestinal absorption)

  45. Hyperparathyroidism Client Info • Most hyperparathyroid animals show no signs when first diagnosed • Run yearly chem panels on all normal, older animals

  46. Hypercalcemia: Other causes • Causes • Neoplasia (lymphoma, perianal gland tumors) • Renal failure • Hypoadenocorticism • Vitamin D rodenticide • Drugs or artifacts (ex lipemia) • Clinical signs vary with cause • PU/PD, anorexia, lethargy, vomiting, weakness, stupor/coma (severe), uroliths

  47. Hypercalcemia • Tests • Elevated serum calcium levels • Low to low-normal phosphorus concentrations

  48. Hypercalcemia • Treatment • Fluids: 0.9% NaCl • No Ca2+ containing fluids • Diuretics (furosemide) • Steroids • Complications • Irreversible renal failure • Soft tissue calcifications

  49. Hypocalcemia Causes: • Parathyroid disease • Inadvertent removal of parathyroid during thyroidectomy (most common cause • 1º Hypoparathyroidism (uncommon in animals) • Chronic renal failure— • may cause ↑ serum P, which can result in ↓ serum Ca (Ca:P inverse relation) • Vit D normally activated in kidney • Protein-losing nephropathy results in loss of albumin-bound Ca • Puerperal Tetany (Eclampsia)—late gestation thru post-partum period • Improper prenatal nutrition • Heavy lactation • Inappropriate Ca++ supplementation http://www.thepetcenter.com/gen/eclampsia.html#The_video

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