When normal is abnormal: keys to laboratory diagnosis of hidden endocrine disease

Although veterinary clinicians commonly rely on panels of laboratory tests with individual results flagged when abnormal, care should be taken in interpreting normal test results as well. There are several examples of this in evaluating patients with endocrine disease. The finding of a normal leukogram (absence of a stress leukogram) can be indicative of adrenal insufficiency in dogs, and this disorder can be especially elusive when there are no overt indicators of mineralocorticoid deficiency. Cats with hyperthyroidism can have normal serum thyroid hormone concentrations, normal hematocrits, and normal serum concentrations of creatinine despite the presence of disease that affects these parameters. A normal serum phosphorus concentration, in the face of azotemia, isosthenuria, and hypertension can point a clinician toward a diagnosis of primary hyperaldosteronism rather than primary renal disease. A normal serum parathyroid hormone concentration in the face of hypercalcemia is inappropriate and can indicate the presence of primary hyperparathyroidism. Similarly, hypoglycemia accompanied by a normal serum insulin concentration can be found in cases of hyperinsulinism. These normal findings in abnormal patients, and their mechanisms, are reviewed.     

Serum thyroid hormone concentrations in New Zealand horses

Total thyroxine and total tri-iodothyronine concentrations were measured in the sera from 125 horses of mixed age, breed and sex, and varied clinical histories. While low serum thyroxine concentrations were detected in 35 horses, the majority of those horses had serum thyroxine values within the reference range when retested. Only one horse had a mildly decreased serum tri-iodothyronine concentration. Those horses in which the serum thyroxine concentration was low when retested had a normal thyrotropin releasing hormone stimulation test. Hypothyroidism was not diagnosed in any horses in this study. The low serum thyroxine concentrations measured in the present study were attributed to either normal fluctuations in serum concentrations in healthy horses, the effect of drugs, or to the effects of non-thyroidal illness. Because thyroid hormone concentrations are altered by many factors, hypothyroidism should not be diagnosed on the basis of a single low value and further testing, preferably including active stimulation of the thyroid gland, should be carried out.     

Is it possible to diagnose canine hypothyroidism?

A definitive diagnosis of hypothyroidism can be difficult because of the many clinical abnormalities associated with thyroid hormone deficiency, and the lack of readily available diagnostic tests with high sensitivity and specificity. Thyroid function tests should be performed only in dogs with clinical findings consistent with hypothyroidism. Measurement of serum total thyroxine (T4) concentration is a useful initial screening test since most hypothyroid dogs have values below the reference range. Serum free T4 concentration measured by equilibrium dialysis is a more sensitive and specific test of thyroid function than total T4 and is particularly useful in dogs with non-thyroidal illness or atypical clinical signs. Measurement of serum endogenous thyroid-stimulating hormone concentration is also helpful, but many hypothyroid dogs have normal results. The gold standard for diagnosis of hypothyroidism remains the thyroid-stimulating hormone response test. It should be used to confirm hypothyroidism when other tests do not agree with the clinical impression or if atypical signs or non-thyroidal illness exist or there has been administration of drugs known to alter thyroid function tests. Ultimately, a positive response to treatment is expected in hypothyroid dogs treated appropriately with levothyroxine.     

Serum thyroxine concentrations and pregnancy rates 15 to 16 days after ovulation in broodmares

OBJECTIVE: To determine whether serum thyroxine (T4) concentration was associated with pregnancy rates 15 to 16 days after ovulation in mares and to determine whether thyroid hormone supplementation would enhance fertility in mares. DESIGN: Cohort study. ANIMALS: 329 clinically normal broodmares. PROCEDURE: Mares were examined 15 to 16 days after ovulation to determine whether they were pregnant; blood samples for determination of serum T4 concentration were collected at the same time. Sixty mares were receiving thyroid hormone supplementation prior to the study because of low serum T4 concentration (< 16 microg/dl) prior to breeding. RESULTS: Serum T4 concentration ranged from 4.5 to 53.9 mg/dl. Forty (12%) mares had low (< 16 microg/dl) concentrations, 283 (86%) had normal concentrations, and 6 (2%) had high (> 45 microg/dl) concentrations. Two hundred thirty-one mares were pregnant 15 to 16 days after ovulation. A significant association between serum T4 concentration (low, normal, or high) and pregnancy (yes or no) was not detected, and logistic regression analysis indicated that serum T4 concentration was not significantly related to pregnancy. Of the 269 mares not receiving thyroid hormone supplementation, 187 were pregnant, and of the 60 mares receiving thyroid supplementation, 44 were pregnant. There was no significant relationship between thyroid hormone supplementation and pregnancy status. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that serum T4 concentration in mares is not significantly associated with pregnancy 15 to 16 days after ovulation. Results also suggest that supplementation of mares that only have low T4 concentrations is not indicated or likely to be beneficial.     

Acute overdose of levothyroxine in a dog.

An overdose of up to 850 levothyroxine sodium tablets (0.2 mg) in a healthy 6-year-old 16.8-kg dog induced an episode of vomiting and hippus within 9 hours of ingestion. The dog was treated with activated charcoal and saline (magnesium sulfate) cathartic. Initially the serum concentration of thyroxine (T4) 4,900.9 nmol/L. On the second day, serum concentration of triiodothyronine (T3) was 5.3 nmol/L. Serum T4 concentration decreased slowly and was not determined to be normal until day 36. Serum T3 concentration was found to be normal on day 6. Serum alanine transaminase activity peaked on day 6 at 345 U/L. Significant abnormalities were not found during the following 36 days. Clinical signs of thyroid hormone toxicosis in dogs and cats include hyperactivity, lethargy, tachycardia, tachypnea, dyspnea, abnormal pupillary light reflexes, vomiting, and diarrhea. High overdoses of levothyroxine sodium in dogs should be managed by initial decontamination and administration of activated charcoal with a cathartic followed by supportive care.     

Effect of recombinant human thyroid stimulating hormone on serum thyroxin and thyroid scintigraphy in euthyroid cats

This study investigated the thyroidal response to administration of recombinant human thyroid stimulating hormone (rhTSH) by means of serum total thyroxine (TT(4)) concentration and pertechnetate uptake by the thyroid gland in six healthy euthyroid spayed female cats. A pertechnetate scan was performed on day 1 to calculate thyroid/salivary gland (T/S) uptake ratio. On day 3, 25 microg rhTSH was injected intravenously. Six hours later the thyroid scan was repeated as on day 1. Blood was drawn for serum TT(4) measurement prior to injection of rhTSH and performance of the pertechnetate scan. Statistically significant differences in mean serum TT(4) concentration, T/S uptake ratio before and 6h after rhTSH administration and T/S uptake ratio between left and right lobes were noted. We can conclude that 25 microg rhTSH increases pertechnetate uptake in the thyroid glands of cats, this should be taken into account when thyroid scintigraphy after rhTSH administration is interpreted.     

Optimal Testing for Thyroid Hormone Concentration after Treatment with Methimazole in Healthy and Hyperthyroid Cats

Background: Methimazole suppresses thyroid hormone synthesis and is commonly used to treat feline hyperthyroidism. The degree of variation in thyroid hormone concentrations 24 hours after administration of methimazole and optimal time for blood sampling to monitor therapeutic efficacy have not been determined.
Objective: To assess thyroid hormone concentration variation in serum of normal and hyperthyroid cats after administration of methimazole.
Animals: Four healthy cats and 889 retrospectively acquired feline thyroid hormone profiles.
Methods: Crossover and retrospective studies . In the crossover study, healthy cats were treated with increasing doses of oral methimazole until steady state of thyroid suppression was achieved. Thyroid hormones and thyroid stimulating hormone (TSH) were serially and randomly monitored after methimazole. Paired t -tests and a 3-factor analysis of variance were used to determine differences between thyroid hormone concentrations in treated and untreated cats in the crossover study. Thyroid profiles from methimazole-treated hyperthyroid cats were retrieved from the Diagnostic Center for Population and Animal Health database and reviewed. Linear regression analysis evaluated relationships of dosage (mg/kg), dosing interval (q24h versus q12h), and time after methimazole to all thyroid hormone concentrations.
Results: All serum concentrations of thyroid hormones were significantly suppressed and TSH was significantly increased for 24 hours after administration of oral methimazole in healthy cats ( P < .005). In hyperthyroid cats, there were no significant relationships between thyroid hormone concentrations and time postpill or dosing interval.
Conclusions: Timing of blood sampling after oral methimazole administration does not appear to be a significant factor when assessing response to methimazole treatment.     

Effect of dietary soy on serum thyroid hormone concentrations in healthy adult cats

OBJECTIVE: To compare effects of short-term administration of a soy diet with those of a soy-free diet on serum thyroid hormone concentrations in healthy adult cats. ANIMALS: 18 healthy adult cats. PROCEDURE: Cats were randomly assigned to receive either a soy or soy-free diet for 3 months each in a crossover design. Assays included CBC, serum biochemical profile, thyroid hormone analysis, and measurement of urinary isoflavone concentrations. RESULTS: Genistein, a major soy isoflavone, was identified in the urine of 10 of 18 cats prior to dietary intervention. Compared with the soy-free diet, cats that received the soy diet had significantly higher total thyroxine (T4) and free T4 (fT4) concentrations, but unchanged total triiodothyronine (T3) concentrations. The T3/fT4 ratio was also significantly lower in cats that received the soy diet. Although the magnitudes of the increases were small (8% for T4 and 14% for fT4), these changes resulted in an increased proportion of cats (from 1/18 to 4/18) that had fT4 values greater than the upper limit of the laboratory reference range. There was no significant effect of diet on any other measured parameter. CONCLUSIONS AND CLINICAL RELEVANCE: Short-term administration of dietary soy has a measurable although modest effect on thyroid hormone homeostasis in cats. Increase in T4 concentration relative to T3 concentration may result from inhibition of 5'-iodothyronine deiodinase or enhanced T3 clearance. Soy is a common dietary component that increases serum T4 concentration in cats.     

Thyroid function in dogs with spontaneous and induced congestive heart failure.

The effects of spontaneous and experimentally induced congestive heart failure on serum thyroxine (T4), 3,5,3'-triiodothyronine (T3), 3,3'5'-triiodothyronine (reverse T3), free T4, free T3 concentrations, and the serum T4 and T3 concentrations in response to administration of thyrotropin were studied. Serum thyroid hormone concentrations were not different between eight dogs with spontaneous congestive heart failure and normal age matched control dogs. Seven dogs with experimental heart failure were tested before and after induction of congestive heart failure by rapid ventricular pacing. Mean serum T4 and free T3 concentrations were decreased and mean serum reverse T3 concentration was increased following induction of heart failure. The serum T4 and T3 responses to thyrotropin were not altered. Thyroid gland morphology appeared normal in dogs with experimental heart failure. Experimental congestive heart failure, similar to some other nonthyroidal illnesses, alters thyroid hormone secretion and metabolism in dogs.     

Serum total thyroxine, total triiodothyronine, free thyroxine, and thyrotropin concentrations in epileptic dogs treated with anticonvulsants.

OBJECTIVE: To determine whether administration of phenobarbital, potassium bromide, or both drugs concurrently was associated with abnormalities in baseline serum total thyroxine (T4), triiodothyronine (T3), free T4, or thyrotropin (thyroid-stimulating hormone; TSH) concentrations in epileptic dogs. DESIGN: Prospective case series. ANIMALS: 78 dogs with seizure disorders that did not have any evidence of a thyroid disorder (55 treated with phenobarbital alone, 15 treated with phenobarbital and bromide, and 8 treated with bromide alone) and 150 clinically normal dogs that were not receiving any medication. PROCEDURE: Serum total T4, total T3, free T4, and TSH concentrations, as well as serum concentrations of anticonvulsant drugs, were measured in the 78 dogs with seizure disorders. Reference ranges for hormone concentrations were established on the basis of results from the 150 clinically normal dogs. RESULTS: Total and free T4 concentrations were significantly lower in dogs receiving phenobarbital (alone or with bromide), compared with concentrations in clinically normal dogs. Administration of bromide alone was not associated with low total or free T4 concentration. Total T3 and TSH concentrations did not differ among groups of dogs. CLINICAL IMPLICATIONS: Results indicate that serum total and free T4 concentrations may be low (i.e., in the range typical for dogs with hypothyroidism) in dogs treated with phenobarbital. Serum total T3 and TSH concentrations were not changed significantly in association with phenobarbital administration. Bromide treatment was not associated with any significant change in these serum thyroid hormone concentrations.     

Selective parathyroidectomy of the dog.

Selective parathyroidectomy (PTX) is preferred to thyroparathyroidectomy (TPTX) when specific effects of parathyroid hormone depletion are being studied. However, because of the anatomic proximity of thyroid and parathyroid glands, TPTX often is performed, leaving animals depleted of thyroxine (T4) and calcitonin as well as parathyroid hormone (PTH). In the present study, six normal dogs had parathyroid tissue and about seven-eighths of thyroid tissue removed. This quantity of thyroid tissue was inadequate to maintain normal serum T4 concentrations, despite allowance of 168 days for thyroid recovery. Five of six dogs with reduced renal mass had successful selective PTX and normal serum T4 concentrations at 28 days, when one-half or more of thyroid tissue was spared. We conclude that with attention to the surgical technique, selective PTX can be achieved in a high percentage of dogs and sufficient thyroid tissue spared to maintain euthyroidism.     

Euthyroid sick syndrome in dogs with idiopathic epilepsy before treatment with anticonvulsant drugs

Euthyroid sick syndrome is a common finding in dogs and is attributable to nonthyroidal illness or treatment with any of a variety of drugs such as phenobarbital. In dogs with epilepsy, treatment with anticonvulsant drugs can lead to subnormal plasma thyroid hormone concentrations despite normal thyroid function. One-hundred thirteen dogs with seizure activity were retrospectively evaluated to determine the influence of idiopathic epilepsy (IE) on thyroid hormone concentrations. Blood samples were taken from 60 dogs with IE before initiation of anticonvulsant therapy. Control groups consisted of 34 dogs with IE and receiving anticonvulsants and 19 dogs with secondary epilepsy. Thyroid concentrations consistent with euthyroid sick syndrome were diagnosed in 38% of dogs with untreated IE without clinical signs of hypothyroidism or concomitant diseases. There was a significant correlation (r = 0.363, P = .01) between seizure frequency and plasma thyroid hormone concentrations: the longer the interval between 2 seizure events, the higher the serum total thyroxine concentration. There was no correlation between the degree of alteration of thyroid hormone concentrations and the time span between the most recent seizure event and blood collection, the type of the most recent seizure event, the duration of the complete seizure history, or the predominant seizure type. These results suggest that IE can be a reason for euthyroid sick syndrome in dogs. The effect of phenobarbital on plasma thyroid hormone concentrations must be investigated in future studies, as it might be less pronounced than expected.     

Delayed growth in two German shepherd dog littermates with normal serum concentrations of growth hormone, thyroxine, and cortisol

Four German Shepherd Dogs from a litter of 10 were evaluated because of postnatal onset of proportionate growth stunting that clinically resembled well-documented hypopituitary dwarfism in that breed. Although 2 pups had histologic evidence of hypopituitarism, the remaining 2 pups had normal serum growth hormone concentration and adrenocorticotropin secretory capability, and normal adrenal function test and thyroid function study results. Furthermore, the initially stunted German Shepherd Dogs grew at a steady rate until at 1 year, body weight and shoulder height approximated normal measurements. Seemingly, delayed growth in these pups may represent one end of a clinical spectrum associated with hypopituitarism in German Shepherd Dogs.     

Thyroid function testing in Greyhounds.

OBJECTIVE: To evaluate thyroid function in healthy Greyhounds, compared with healthy non-Greyhound pet dogs, and to establish appropriate reference range values for Greyhounds. ANIMALS: 98 clinically normal Greyhounds and 19 clinically normal non-Greyhounds. PROCEDURES: Greyhounds were in 2 groups as follows: those receiving testosterone for estrus suppression (T-group Greyhounds) and those not receiving estrus suppressive medication (NT-group Greyhounds). Serum thyroxine (T4) and free thyroxine (fT4) concentrations were determined before and after administration of thyroid-stimulating hormone (TSH) and thyroid-releasing hormone (TRH). Basal serum canine thyroid stimulating hormone (cTSH) concentrations were determined on available stored sera. RESULTS: Basal serum T4 and fT4 concentrations were significantly lower in Greyhounds than in non-Greyhounds. Serum T4 concentrations after TSH and TRH administration were significantly lower in Greyhounds than in non-Greyhounds. Serum fT4 concentrations after TSH and TRH administration were significantly lower in NT-group than T-group Greyhounds and non-Greyhounds. Mean cTSH concentrations were not different between Greyhounds and non-Greyhounds. CONCLUSIONS AND CLINICAL RELEVANCE: Previously established canine reference range values for basal serum T4 and fT4 may not be appropriate for use in Greyhounds. Greyhound-specific reference range values for basal serum T4 and fT4 concentrations should be applied when evaluating thyroid function in Greyhounds. Basal cTSH concentrations in Greyhounds are similar to non-Greyhound pet dogs.     

Increased Serum Growth Hormone Concentration in Feline Hypertrophic Cardiomyopathy

Serum growth hormone concentration was measured by radioimmunoassay in 31 cats with hypertrophic cardiomyopathy, 38 normal cats, and 35 cats with other cardiac disease. Cats with hypertrophic cardiomyopathy had a significantly increased serum growth hormone concentration when compared with normal cats and cats with other cardiac disease. The serum growth hormone concentration in cats with hypertrophic cardiomyopathy was less than that previously reported in cats with growth hormone secreting pituitary tumors. Pituitary tumors were not identified in eight of the cats with hypertrophic cardiomyopathy examined at necropsy. An increased serum growth hormone concentration may be measured in cats with hypertrophic cardiomyopathy but it is unclear if the increased serum growth hormone concentration is a cause or effect of hypertrophic cardiomyopathy.     

Serum thyroid hormone concentrations and thyrotropin responsiveness in dogs with generalized dermatologic disease.

Fifty-eight dogs with generalized dermatologic disease that had not been given glucocorticoids systemically or topically within 6 weeks of entering the study were evaluated for thyroid function by use of the thyrotropin-response test. Dogs were classified as euthyroid or hypothyroid on the basis of test results and response to thyroid hormone replacement therapy. Baseline serum thyroxine (T4), free T4 (fT4), and triiodothyronine (T3) concentrations were evaluated in the 58 dogs. Serum T4, fT4, and T3 concentrations were evaluated in 200 healthy dogs to establish normal values. Hormone concentrations were considered low if they were less than the mean -2 SD of the values for control dogs. Specificity of T4 and fT4 concentrations was 100% in predicting hypothyroidism; none of the euthyroid dogs with generalized skin disease had baseline serum T4 or fT4 concentration in the low range. Sensitivity was better for fT4 (89%) than for T4 (44%) concentration. Significant difference was not observed in serum T4 and fT4 concentrations between euthyroid dogs with generalized skin disease and healthy control dogs without skin disease. Serum T3 concentration was not accurate in predicting thyroid function; most of the euthyroid and hypothyroid dogs with skin disease had serum T3 concentration within the normal range.     

Effects of thyroid hormones on serum and cutaneous fatty acid concentrations in dogs

The effects of thyroid hormones on the serum and cutaneous fatty acid concentration profiles of dogs were evaluated. Thyroidectomized dogs had significant (P less than 0.05) increases in serum oleic acid and linoleic acid concentrations, and decreases in concentration of dihomo-gamma-linolenic acid, arachidonic acid, and other elongation products of fatty acid metabolism. These changes were reversed in response to thyroid hormone replacement. Similar changes were found in cutaneous fatty acid concentration profiles. Thus, in dogs, thyroid hormones may be involved in the regulation of fatty acid delta-6-desaturase activity.     

Thyroid testing in Sloughis

Background: Thyroid hormone concentrations were found to be different in Greyhounds and Whippets compared with nonsight hound dogs.
Hypothesis: In Sloughis, thyroid hormone concentration is lower than in nonsight hounds and comparable to Greyhounds.
Animals: Fifty-one Sloughis with no evidence of disease and a mean age of 4 years (range, 1–12 years).
Methods: Thyroid profiles consisting of total thyroxine (tT4), free thyroxine (fT4), free thyroxine after equilibrium dialysis (fT4 after ED), canine thyroid stimulation hormone (cTSH), and thyroglobulin antibodies as well as CBC and serum biochemistry results of Sloughis were compared with those of normal dogs. In 8 Sloughis, TSH stimulation tests were performed.
Results: In Sloughis, tT4 concentrations and fT4 concentrations measured by chemiluminescence were lower than those of controls (1.13 ± 0.65 μg/dL compared with 2.9 ± 0.8 μg/dL, P < .0001 and 11 ± 4.3 pmol/L compared with 16.7 ± 5.2 pmol/L, P < .0001, respectively). Concentrations of fT4 after ED and TSH were increased in Sloughis, when compared with controls (41.3 ± 26.9 pmol/L compared with 20.98 ± 10.29 pmol/L, P < .0001 and 0.22 ± 0.15 pmol/L compared with 0.15 ± 0.13 pmol/L, P = .0138, respectively). T4 concentration after TSH stimulation increased from 1.5 μg/dL (range, 0.2–2.7 μg/dL) to 2.7 μg/dL (range, 1.2–4.7 μg/dL); the recommended post-TSH T4 concentration was achieved by only 3 of 8 Sloughis. Hemoconcentration was found in 84.3% and hypoglobulinemia in 80.3%.
Conclusions and Clinical Importance: When evaluating Sloughis for hypothyroidism, veterinarians should be aware that these dogs have different thyroid hormone concentrations than nonsight hound dogs.     

Serum total thyroxine, total triiodothyronine, free thyroxine, and thyrotropin concentrations in dogs with nonthyroidal disease

OBJECTIVE: To determine whether nonthyroidal disease of various causes and severity is associated with abnormalities in baseline serum concentrations of total thyroxine (T4), triiodothyronine (T3), free T4, or thyrotropin (thyroid-stimulating hormone [TSH]) in dogs believed to be euthyroid. DESIGN: Case-control study. ANIMALS: 223 dogs with confirmed nonthyroidal diseases and presumptive normal thyroid function, and 150 clinically normal dogs. PROCEDURE: Serum total T4, total T3, free T4, and TSH concentrations were measured in dogs with confirmed nonthyroidal disease. Reference ranges for hormone concentrations were established on the basis of results from 150 clinically normal dogs. RESULTS: In dogs with nonthyroidal disease, median serum concentrations of total T4, total T3, and free T4 were significantly lower than those in clinically normal dogs. Median serum TSH concentration in sick dogs was significantly greater than that of clinically normal dogs. When stratified by severity of disease (ie, mild, moderate, and severe), dogs with severe disease had low serum concentrations of total T4, total T3, or free T4 more commonly than did dogs with mild disease. In contrast, serum TSH concentrations were more likely to remain within the reference range regardless of severity of disease. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that serum total T4, free T4, and total T3 concentrations may be low (ie, in the hypothyroid range) in dogs with moderate to severe nonthyroidal disease. Serum TSH concentrations are more likely to remain within the reference range in sick dogs.     

Iodine deficiency, iodine requirement and iodine excess of farm animals--experiments on growing pigs

Since insufficient iodine intake is widespread among the German population, farm animals should if possible receive iodine above requirement, thus concentrating the trace element in milk, eggs and possibly meat. Experiments with a total of 29 fattening pigs with grain soy-bean meal diets without iodine supplementation or with increasing supplements up to 1000 micrograms iodine/kg diet did not show any effect on growth intensity (gain) and feed efficiency. At and above 125 micrograms supplementary iodine/kg diet the thyroid was not or only little hypertrophied and iodine incorporation into thyroglobulin sufficed to sustain serum T4 concentration. The glucosinolates of rape feeds increase iodine requirement. In an experiment with a total of 36 fattening pigs the thyroid iodine depot was decreased due to rapeseed meal feeding, this in agreement with antithyroid drugs which had been also tested. A thyroid with emptied iodine depot is hardly able to synthesize and release hormone, the serum thyroxine concentration showed a drastic decrease. More iodine may compensate for effects of glucosinolates, however, only with not too much of these compounds in the feed. Excessive iodine dosages (10 mg/kg diet) were compared with supplements in the range of recommendations (100 and 1000 micrograms/kg diet) with a total of 120 pigs in three groups of 40 animals each. The dosage of 10 mg iodine/kg diet decreased serum T3 concentration. The enlarged thyroid with double weight had a very high iodine concentration. In comparison with physiological application (100 or 1000 micrograms iodine/kg diet) the thyroid deposited only little iodine in the group with the excessive iodine intake related to consumed iodine quantity. In case of sufficient and excessive iodine supply--industry of compounds feed applies up to 2.5 mg supplementary iodine/kg diet--T4 and iodine of serum but also thyroid weight cannot serve as markers. This range of usual iodine supply is better characterized by the iodine depot of the thyroid. As a rule, thyroid weight increase indicates glucosinolate effects, generally those of dietary antithyroid compounds, more seldom it shows extreme and longterm iodine undersupply or iodine excess.