Lipid abnormalities in thyroid disease
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
A relationship between hypothyroidism, lipid disorders, and coronary artery disease was first suggested in the 1960s . This was at a time when the diagnosis of hypothyroidism was based upon symptoms and signs, and sometimes serum cholesterol measurements, rather than measurements of serum thyroxine (T4) and thyroid-stimulating hormone (TSH). In some cases, a high serum cholesterol concentration was regarded as evidence for “premyxoedema” in the absence of symptoms of hypothyroidism . How many of these patients in fact had hypothyroidism is not known. While there is no doubt that many hypothyroid patients have abnormal serum lipid concentrations, the increased risk of coronary artery disease seen in hypothyroid patients is likely multifactorial in etiology. (See "Cardiovascular effects of hypothyroidism".)
Many hypothyroid patients have high serum concentrations of total cholesterol and low-density lipoprotein (LDL) cholesterol , and some have high serum concentrations of triglycerides , intermediate-density lipoproteins , apoprotein A-1  and apoprotein B [6-8]. (See "Lipoprotein classification, metabolism, and role in atherosclerosis".)
In one study of 295 hypothyroid patients, the following patterns of serum lipids were noted, using the Frederickson classification :
●Type IIa (hypercholesterolemia) – 56 percent
●Type IIb (hypercholesterolemia and hypertriglyceridemia) – 34 percent
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