Epidermal renewal after treatment of primary canine hypothyroidism using levothyroxine

Background: Primary canine hypothyroidism, an endocrine disorder that causes imbalances in the hypothalamus-pituitarythyroid axis, is a common cause of endocrine dermatoses, which frequently presents with opaque dry brittle hair. Tissue changes are also visible, such as myxedema, hyperkeratosis, epidermal atrophy, alopecia, and others. This paper describes the skin changes caused by primary hypothyroidism in a female dog before and after treatment with levothyroxine. Case: This case study involved a 7-year-old Dalmatian bitch with a history of weight gain and changes such as rough dry brittle hair. For about a year, the dog also had also presented symmetrical erythematous and alopecia skin lesions in the regions of the hind limbs, lower back and tail, progressive lethargy and fatigue after exercise. A hemogram showed mild normocytic and normochromic regenerative anemia, as well as mild leukopenia and neutropenia. Biochemical tests revealed increased levels of creatinine, total cholesterol, and triglycerides. Skin biopsy revealed the presence of comedones in the epidermis and acanthosis and trichilemmal keratinization. Hormonal tests revealed high TSH and low free T4 and total T4 levels. A cervical ultrasound scan showed changes in the thyroid glands, with hypoechoic parenchyma, in addition to increased size of the right lobe, suggesting thyroiditis. Based on these exams, the patient was diagnosed with primary hypothyroidism, and treatment with levothyroxine was instituted. Discussion: Around 90% of dogs with hypothyroidism show a decrease in total T4 and about 65-75% of them show an increase in TSH levels. In endocrinopathy, there is a decrease in the expression of T3 receptors in the keratinocytes and genes responsible for epidermal renewal. Also, molecules that affect epidermal differentiation bind to intracellular receptors belonging to the steroid/thyroid hormone superfamily. In this study, however, the application of the minimum levothyroxine dose restored the normal epidermal pattern for the species and the remaining parameters returned to normal. The hormone T3 acts in the differentiation of keratinocytes, a fact that, although not yet proven, is believed to be indirect and mediated by the epidermal growth factor or by the expression of the genes responsible for the renewal of the epidermis. Besides, some effects on the epidermis caused by deficiency of thyroid hormones may be due to secondary vitamin A deficiency, which is necessary for epithelial differentiation and binding epidermal growth factor (EGF) to the cell. Still, there is a theory that sex hormones also affect the differentiation of the epidermis, as studies show that deficiency causes effects similar to those caused by hypothyroidism. Some studies indicate the investigation of the relationship between secondary vitamin D deficiency and the increased cellularity of the epidermis of the spayed hypothyroid female rats. Additionally, the mechanism of the formation of hyperkeratosis in hypothyroidism is not yet elucidated. T3 is known to regulate keratin gene expression and perhaps also epidermal maturation, epithelial cycle, and normal keratin synthesis. The single treatment with levothyroxine in the female dog was effective in promoting the restoration of gene expression to T3 in keratinocytes.

Pulmonary adenocarcinoma in dogs: surgical treatment with real-time video-thermometry

Background: Pulmonary neoplasia is an abnormal proliferation of cells at the lung tissue, and may be classified as primary, secondary or metastatic, and multisystemic. However, primary neoplasia is rare in canids. Additionally, neoplasms may be classified according to their biological behavior as either malignant or benign. Malignant tumors are more prevalent. The diagnosis can be difficult due to nonspecific symptoms, taking into account that some affected patients do not have symptoms at all; thus, the real incidence of the disease might remain undiagnosed on certain occasions. Therefore, we aimed to report an unprecedented successful case of lung lobectomy surgery in dogs with the aid of infrared video thermometry, which showed real-time images during the surgical procedure. Case: A 10-year-old male dog, crossbreed with Cocker Spaniel, was attended with a history of lethargy, dullness, progressive weight loss, cough, and difficulty breathing. Due to the chronic severity of the clinical signs and the normal physiological clinical examination, complementary exams were requested, such as radiography of the cervical and thoracic regions, cranial and thoracoabdominal computed tomography (TCT). The results of the exams showed the presence of a nodule mass in the right caudal pulmonary lobe which caused a lateral deviation to the left hemithorax of the cardiac silhouette. The patient underwent a surgical procedure with an approach through the thoracic region, at the height of the seventh intercostal space, and a total lobectomy was performed. Throughout the surgical procedure, video thermometry in real-time through the MART station (Metabolic Activity in Real-Time FLIR SC325®) was used to determine the viability of adjacent tissues through temperature differences measured in degrees Celsius. The surgical fragment containing the direct caudal pulmonary lobe and the mass were sent to the pathology sector for anatomopathological evaluation. An abundant papillary epithelial proliferation was visualized through microscopy, presenting areas of necrosis and inflammatory polymorphonuclear infiltrate. The nodule was diagnosed as lung papillary adenocarcinoma. Discussion: Adenocarcinomas consist of papillary, acinar, solid, or mixed glandular structures. They may originate from the airways, bronchial glands, or bronchoalveolar region, and often show invasive growth presenting a rudimentary and irregular shape. The clinical signs are non-specific, including exercise intolerance, non-productive cough, chronic respiratory signs such as tachypnoea or dyspnea, reduced appetite, weight loss, lethargy, chest palpation pain, hemothorax, pneumothorax, and pleural effusion. The diagnosis is concluded through imaging diagnostic tests, of which chest radiography is the most important, followed by magnetic resonance and computed tomography. Also, histopathological examination is essential to determine a definitive diagnosis. The treatment of choice for adenocarcinoma nodules is a surgical excision of the tumor mass. However, the type of surgical approach is determined by different factors such as size, location, and involvement of adjacent structures. The ablation of pulmonary masses may be performed either via partial or total lobectomies. Nevertheless, partial lobectomy is more often performed on non-neoplastic masses or to obtain material for biopsy, whilst total lobectomy is recommended for a malignant neoplasm removal. The prognosis is always guarded, having a more favorable outcome in masses of the smaller diameter without the involvement of adjacent structures.(AU)

Minimum dose of levothyroxine restored the autonomic balance on a Dalmatian female dog with primary hypothyroidism

Background: Hypothyroidism is an endocrine disease that leads to a reduction in the hormones thyroxine (T3) and triiodothyronine (T4), which therapy with levothyroxine restores the clinical signs related to the metabolic rate. Due to the influence of thyroid hormones on the heart, which is under the constant influence of the autonomic nervous system (ANS), dogs with hypothyroidism can develop bradycardia, arrhythmia, and dysautonomia. Heart rate variability (HRV) assesses autonomic modulation by the Holter method, which is scarce in dogs. We aimed to report the cardiac and autonomic effects of the primary hypothyroidism untreated and treated with levothyroxine in a canine case by Holter monitoring. Case: A 7-year-old female Dalmatian, weighing 36 kg, was referred for clinical evaluation due to apathy, weight gain, low hair quality, and lethargy. On physical examination, alopecic lesions on the hind limbs and tail, as well as bradycardia with a heart rate (HR) of 40-50 beats per minute (bpm) were observed, in addition to a 3/6 mitral murmur and 2/6 tricuspid murmur. Given the suspicion of thyroid gland disorder, the blood hormonal measurement revealed an increase in thyroidstimulating hormone (TSH; 0.65 ng/mL) and a decrease in free T4 (0.11 ng/mL) and total T4 (0.44 ng/mL), confirming primary hypothyroidism. Therapy was started with a minimum dose of levothyroxine (0.913 mg, every 12 h), which clinical signs were restored in 5 months of treatment, with weight loss, hair growth, and active behavior. To assess the impact of untreated and treated hypothyroidism on the patient’s ANS, a Holter monitoring exam was performed for 24 h before and after therapy. Before treatment, the average HR was 75 bpm, and the HR2.0s), 1st-degree atrioventricular blocks (AVB), six...

Minimum dose of levothyroxine restored the autonomic balance on a Dalmatian female dog with primary hypothyroidism

Background: Hypothyroidism is an endocrine disease that leads to a reduction in the hormones thyroxine (T3) and triiodothyronine (T4), which therapy with levothyroxine restores the clinical signs related to the metabolic rate. Due to the influence of thyroid hormones on the heart, which is under the constant influence of the autonomic nervous system (ANS), dogs with hypothyroidism can develop bradycardia, arrhythmia, and dysautonomia. Heart rate variability (HRV) assesses autonomic modulation by the Holter method, which is scarce in dogs. We aimed to report the cardiac and autonomic effects of the primary hypothyroidism untreated and treated with levothyroxine in a canine case by Holter monitoring. Case: A 7-year-old female Dalmatian, weighing 36 kg, was referred for clinical evaluation due to apathy, weight gain, low hair quality, and lethargy. On physical examination, alopecic lesions on the hind limbs and tail, as well as bradycardia with a heart rate (HR) of 40-50 beats per minute (bpm) were observed, in addition to a 3/6 mitral murmur and 2/6 tricuspid murmur. Given the suspicion of thyroid gland disorder, the blood hormonal measurement revealed an increase in thyroidstimulating hormone (TSH; 0.65 ng/mL) and a decrease in free T4 (0.11 ng/mL) and total T4 (0.44 ng/mL), confirming primary hypothyroidism. Therapy was started with a minimum dose of levothyroxine (0.913 mg, every 12 h), which clinical signs were restored in 5 months of treatment, with weight loss, hair growth, and active behavior. To assess the impact of untreated and treated hypothyroidism on the patients ANS, a Holter monitoring exam was performed for 24 h before and after therapy. Before treatment, the average HR was 75 bpm, and the HR<50 bpm occurred during 05 h 20 min 36 s. Still, 320 pause events (>2.0s), 1st-degree atrioventricular blocks (AVB), six...(AU)