New member who needs IR or Thyroid advice


Cate2016
 

Backgrounder: Oldenburg mare, 5 years old, owned since weanling, healthy, easy keeper but NOT fat. Shiny coat, happy, alert. Exercise was regular (WT, just started C on flat) until issue, but looks very sound now (August, Sept).

Feed (for 5 yrs): Ration balancer (NSC 2%), Beet pulp, no molasses, 3x rinsed

Owner: knowledgeable on horse care, diet, and VERY careful intro to spring grass, avoids t/o at fall frosts, etc., who has WBs that have NEVER had laminitis issue ever … in all the years I have had my horses in my care (18 years).

Said 5 yr old Oldenburg had laminitic issue in June (off pasture since, or time-rationed) and blood tests in mid-July found very low thyroid and high insulin. X-rays done, seems OK but shoes on anyway. Looks to be feeling perfect. Vet put mare on hypothyroid meds based on blood test at beginning of August, but after 30+ days another blood test shows no change in levels! 3 blood tests, mid-July, early August, early September  with the last one 30 days after starting med for thyroid. What is the difference between thyroid count and insulin count or do they go hand-in-hand and are IR.

Although I can’t ignore the blood results, I wonder if something else is going on???

What’s your experience?
Mare doesn’t display all symptoms, as has shiny coat, chipper, happy under saddle, etc.
Much research seems to debunk hypothyroid in horses, but why the LOW count (5.3)

Glucose 5.9 normal range, Insulin 34.7

Please help me!

--
Cate's mom
Ontario, Canada
2021


Lavinia Fiscaletti
 

Hello Cate's mom,

Welcome to the group! 

Warmbloods aren't generally prone to IR, but a particular individual doesn't necessarily read the manuals. An individual that is prone to EMS/IR may start to exhibit symptoms once they stop growing, as the high energy demands of growth drop off, so that could be what's happening with your 5yo. If the glucose result is in mmol and the insulin in uIU, then those results show insulin and glucose numbers that are elevated, even tho they may be within the lab's reference ranges. Laminitis is definitely a sign of EMS/IR. She really is too young to be worried about PPID. Being an easy keeper can also be a symptom of EMS/IR. Good that she hasn't been allowed to become overweight. Excess weight doesn't cause IR but it can be symptom of it as EMS horses tend to not have an "off-switch" when it comes to eating and they are also very efficient in processing the calories they do consume to the max (see DIAGNOSIS section below).

We're going to need more specifics on your girl, which is where the case history comes in. What are the units of measure and reference ranges for those blood work results? What were the actual thyroid test results and which tests were run? As you have read, primary hypothyroidism is extremely rare in horse but Euthyroid Sick Syndrome is not. This is when the thyroid production is depressed secondary to other factors - fix the primary cause and the thyroid rebounds. Dietary deficiencies of iodine are one very common reason for low thyroid numbers. Tightly mineral balancing her rations is the way to make sure her diet is covering all the bases appropriately (see DIET section below). Diseases or hormonal issues (like EMS/IR) can also impact thyroid numbers. Supplementation with thyroid meds can temporarily jump up the production but if the body is suppressing the levels of hormone, then it will compensate by dropping natural production even more.

Low thyroid does not cause/treat/cure IR, so supplementing thyroid meds may temporarily assist in jump-starting weight loss in an individual whose needed weight loss seems to be stalled by creating hyperthyroidism but it has no effect on lowering insulin.

It would be helpful to see a the radiographs that have been done and a full set of hoof photos. Info on what's needed is found below in the TRIM section. Shoes do not solve laminitis, nor do they solve trim issues, athough they can camouflage problems to some extent. If there were no problems noted on the rads, why was she put in shoes?

The remainder of this note contains our Official Welcome, with a boat load of info and links to specifics. Grab a cup of your favorite beverage and have a read. It's helpful to store a copy somewhere easy to access for future reference.


The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you.


--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Cate2016
 


--
Grace
Ontario, Canada
2021


Cate2016
 

Here are the first results in mid-July


--
Grace
Ontario, Canada
2021


Lorna Cane
 

Hi Grace,

Did you see Lavinia's welcome post to you?
https://ecir.groups.io/g/main/message/268828

There is information there about setting up a Case History,so that you can post Cate's details all in one place,for the volunteers to see.
I'm not sure if you tried to send an attachment,but we can't see attachments here.

If you need help with your Case History after looking at the guidelines, just ask.


--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Cate2016
 

Sorry, I guess the pasted version didn't come through.  

Hemo index = normal
Lipemia index = normal
T-4 = <5.2 (13-43 mmol/L)
Gluc = 5.9 (4.2 - 6.4 mmol/L)
Insulin = 34.7 (4.5 - 20 uIU/mL)

Using your calculator it says;
G/I ratio 3.06
RISQI ratio 0.17
MIRG ratio 9.6 (is 5.6 or less ideal?)


Turnout was all day on grass horse pasture, but now only early morning. Stalled dusk until dawn. Then free-choice grass hay.
Morning feed: Brook's Enhancer (RB) 250 g (approx 1.5 cups)
Evening feed: 100 g beet pulp shreds soaked, no molasses, rinsed and drained several times. 2 flakes grass hay.
Madbarn Omneity premix 2 scoops (half daily amount, as another RB at morning feed). 1 tbs plain salt, 1 scoop Equishure (since spring re hind gut), and 150g (approx 1 cup) Masterfeed Light pellet (yes it's 12%, but it's just a bit to top dress beet pulp)

--
Grace
Ontario, Canada
2021


Sherry Morse
 

Hi Grace,

Please get this information into a case history with actual weight of hay being fed, current weight of horse, ideal weight of horse, etc.  Information on how to do this was sent to you last Friday.

Your bloodwork results show that Cate is IR and as such should not be out on grass at all.  She should also not be allowed free choice hay but a measured amount that reflects either 2% of her ideal weight or 1.5% of her current weight (whichever is greater) if she needs to lose weight.

If you are feeding her concentrates you need to take that into account as part of her diet as well.  The Brooks product is not suitable for an IR horse if the numbers here are correct (https://madbarn.com/feeds/enhancer-brooks-feeds/).  You would be better off having a mineral balance done for the hay you are currently feeding.  You can find people who can help you with that here: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf.

Beet pulp needs to be rinsed/soaked/rinsed to clean it of impurities including iron.  The Masterfeed Light pellet may not be safe either but without an ingredient list or an idea on the ESC and starch content it's hard to comment on that.