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Lipid Management in Endocrine Disorders

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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.

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