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.

Refeeding syndrome in a miniature donkey.

OBJECTIVE: To describe refeeding syndrome in an equid without a history of recognized risk factors. CASE SUMMARY: Refeeding syndrome with marked hypophosphatemia developed in an aged miniature donkey gelding during treatment of suspected enterocolitis. Hypophosphatemia (manifested clinically as ileus and neuromuscular weakness) developed despite a short (3 day) history of hyporexia, increased body condition (7/9), and adherence to nutritional recommendations for critically ill equids. Nutritional support included nasogastric enteral feeding with a commercial equine nutrition product claiming to provide 100% of the National Research Council's daily recommended protein, vitamin, and mineral requirements for equids. Hypophosphatemia developed despite this enteral supplementation and was ultimately corrected by intravenous administration of sodium phosphate solution. NEW OR UNIQUE INFORMATION PROVIDED: This case report suggests that risk factors for refeeding syndrome in equids may be broader than previously recognized. Specifically, critically ill equids at risk for insulin dysregulation may have unique nutritional co-morbidities and requirements. This report highlights the need for both broader recognition of risk factors for refeeding syndrome, and revised best-practice nutritional guidelines and supplementation products to improve equine critical care.