Optimal Management of Dyslipidemia in 50-Year-Old Man With Hypothyroidism

Clinical Case

Connie B. Newman, MD, MACP, FAHA, FAMWA

October 31, 2023

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Case Presentation

A 50-year-old man with primary hypothyroidism is referred by his primary care physician to a cardiologist for evaluation of high low-density lipoprotein cholesterol (LDL-C). Although the patient's symptoms of hypothyroidism have been improving since starting levothyroxine 50 mg 4 weeks ago, he is still experiencing fatigue and constipation. His family history is negative for clinical heart disease, but his mother has hypertension. Regarding social history, the patient is a nonsmoker with no recent history of recreational drug use. He reports occasional alcohol consumption of approximately two to three glasses of wine on the weekends. He has no history of chest pain or shortness of breath.

The patient's vital signs and body mass index (BMI) at presentation are:

Blood pressure: 120/85 mm Hg
Heart rate: 60 beats/min
Temperature: 97.6 °F
Oxygen saturation: 97%
Weight: 170 lb
Height: 5 ft 10 in
BMI: 24

The physical examination reveals mild periorbital edema and pedal edema. The thyroid gland is firm, nontender, and mobile and about twice the normal size. The remainder of the exam is unremarkable. Laboratory studies reveal:

Thyroid-stimulating hormone: 70 mIU/mL (normal range, 0.5-5.0 mIU/L)
Free thyroxine (T4): 0.4 ng/dL (normal range, 0.7-1.9 ng/dL)
Total cholesterol: 315 mg/dL (8.1 mmol/L)
Low-density lipoprotein cholesterol (LDL-C): 200 mg/dL (5.8 mmol/L)
High-density lipoprotein cholesterol (HDL-C): 65 mg/dL (1.7 mmol/L)
Triglycerides (TG): 250 mg/dL (2.8 mmol/L)
A1c: 5.0%

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Cite this: Optimal Management of Dyslipidemia in 50-Year-Old Man With Hypothyroidism - Medscape - Oct 31, 2023.

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