Hypothyroidism hyperlipidemia

RAV-7-induced hyperlipidemia could be a result of hypothyroidism. Hyperlipidemia appears to be common in hypothyroid animals, where there is a decrease in lipid utilization or catabolism (Hoch, 1974). 

The past medical history was remarkable for hypothyroidism, hyperlipidemia, an appendectomy, tonsillectomy, and 30 pack-years of tobacco use. The echocardiogram of November 2000 showed an ejection fraction of 20%. 

The cornerstone of treatment in primary hyperlipidemia is diet restriction and weight reduction. Limit or eliminate alcohol intake. Use drug therapy in conjunction with diet, and after maximal efforts to control serum lipids by diet alone prove unsatisfactory, when tolerance to or compliance with diet is poor or when hyperlipidemia is severe and risk of complications is high. Treat contributory diseases such as hypothyroidism or diabetes mellitus. 

Hyperlipidemia, secondary causes Prior to initiating therapy, exclude secondary causes of hyperlipidemia (eg, poorly controlled diabetes mellitus, hypothyroidism, nephrotic syndrome, dysproteinemias, obstructive liver disease, other drug therapy, alcoholism) and measure total-C, HDL-C, and triglycerides. 

In adults, the signs and symptoms of hypothyroidism include somnolence, slow mentation, dryness and loss of hair, increased fluid in body cavities (e.g., the pericardial sac), low metabolic rate, tendency to gain weight, hyperlipidemia, subnormal temperature, cold intolerance, bradycardia, reduced systolic and increased diastolic pulse pressure, hoarseness, muscle weakness, slow return of muscle to the neutral position after a tendon jerk, constipation, menstrual abnormalities, infertility, and sometimes myxedema (hard edema of subcutaneous tissue with increased content of proteoglycans in the fluid). A goiter (i.e., enlargement of the thyroid gland) may be present. 

After binding, the LDL-receptor complex is internalized by endocytosis. [Note A deficiency of functional LDL receptors causes a significant elevation in plasma LDL and, therefore, of plasma cholesterol. Patients with such deficiencies have type II hyperlipidemia (familial hypercholesterolemia) and premature atherosclerosis. The thyroid hormone, T3, has a positive effect on the binding of LDL to its receptor. Consequently, hypothyroidism is a common cause of hypercholesterolemia.]... 

Hydrocortisone should be used with extreme caution in patients with GI ulceration, renal disease, hypertension, osteoporosis, diabetes mellitus, thromboembolic disorders, seizures, myasthenia gravis, congestive heart failure (CHF), tuberculosis, hypoalbuminemia, hypothyroidism, cirrhosis of the liver, emotional instability, psychotic tendencies, hyperlipidemias, glaucoma or cataracts, because the drug may exacerbate these conditions (see Tables 11 and 14). 

Of the secondary hyperlipidemias those of hypothyroidism and biliary cirrhosis deserve particular attention, since they may show considerable elevation of cholesterol without hyperglyceridemia. In addition, xanthomas may occur in both with long duration. While biliary cirrhosis is characterized by the presence of jaundice, a very low ester cholesterol to free cholesterol ratio, and significant elevation of the phospholipid level, the exclusion of hypothjrroidism is not always as simple and may require appropriate thyroid function tests. 

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