Other Conditions
13
6. Thyroid Disease
➤ 6.1 In patients with hyperlipidemia, we recommend ruling out
hypothyroidism as the cause of the hyperlipidemia before treatment with
lipid lowering medications. (1|⊕⊕⊕⊕)
Technical Remark:
▶ Hypothyroidism can elevate both cholesterol and TG levels, which improve with
treatment.
➤ 6.2 In patients with hyperthyroidism, we recommend re-evaluating the
lipid panel after the patient becomes euthyroid. (1|⊕⊕⊕⊕)
Technical Remark:
▶ Changes in LDL-C have been observed as early as 3 months after the patient is
euthyroid.
➤ 6.3 In patients with overt hypothyroidism, we suggest against treating
hyperlipidemia until the patient becomes euthyroid in order to more
accurately assess the lipid profile. (2|⊕
)
➤ 6.4 In patients with subclinical hypothyroidism (thyroid-stimulating
hormone <10 mIU/L) with associated hyperlipidemia, we suggest
considering thyroxine treatment as a means of reducing LDL levels.
(2|⊕
)
Technical Remark:
▶ Take into consideration the patient's age and general health, the possibility of
suppression of thyroid-stimulating hormone, and whether the patient has CVD.
7. Excess Glucocorticoids
➤ 7.1 In adult patients with Cushing syndrome, we recommend monitoring
the lipid profile in order to identify cases of dyslipidemia. (1|⊕⊕
)
Technical Remark:
▶ Monitor lipid profile at the time of diagnosis and periodically afterwards at the
discretion of the treating physician.
Lipid-Lowering Therapy in Cushing Syndrome
➤ 7.2 In adults with persistent endogenous Cushing syndrome, we suggest
statin therapy, as adjunct to lifestyle modification, to reduce CV risk
irrespective of the CV risk score. (2|⊕
)
Technical Remarks:
▶ LDL-C should be the primary target, and therapy should be considered if LDL-C
is over 70 mg/dL (1.8 mmol/L).
▶ Patients receiving mitotane therapy for Cushing syndrome commonly develop
secondary dyslipidemia from therapy.
▶ Lipid lowering therapy may not be appropriate for patients with limited life
expectancy, such as those with an underlying malignancy.
