Vol.2 No.2 {us Taiwan Geriatr Gerontol

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1 j Vol.2 No.2 {us Taiwan Geriatr Gerontol f {us 1 n 2 h éè r f Èu (LDL) Èu v q Ë f} vf Èu Ì{ s 46 mg dl 131 mg dl f (HDL) Èu x ˆ šá j f ( ) 1.3% % Ç f jë {f s š ï j Ç ï f {f r Ëf k } lr r u j (2) {xj Èuf u uf x ˆ 1 u{u { k 2 é é l ri n ri é é l 806 yž so chungyu.anchen@msa.hinet.net 63

2 u j f 2 2 i f k x ˆ z { Ë 1960 sg [1] i tf Èu u Ö } f (T4) (TSH) u Ë f Èu gh (premyxedema) k sr è è iè f šá x ˆ k ~ ru } i éè f Èu (LDL) è r u u(tg) (intermediate density lipoprotein, IDL) apoprotein A-1 apoprotein B Ë ~u 295 Frederickson vð f k [2]:Type IIa ( Èu f ) 56 % Type IIb ( Èuf u uf ) 34 % Type IV ( u uf ) 1.5% 8.5 % è{ f (HDL) Ë Ú g Ëv HDL-2 }HDL-3 Ë T4 Ç [3] f Ç ï (a) Ë Ë z {[4] Ë z l [5] (meta-analysis) 19 ~ Ú f Èu [6] zó f Èu 310 mg dl Ë z Ì { 46 mg dl nr 310 mg dl {ès 131 mg dl èëidl }( x Ç ) IDL Ë {[7] ( ) q Èuf q LDLË f} (receptors) r LDL Œ k (catabolism) r LDL Èu Ëf è Ç ËLDL } [8] è r LDL (upregulation) ÇLDL ÖÇ èð j Ë ~ 64

3 Vol.2 No.2 {us Taiwan Geriatr Gerontol ÖÇÐ[genotype(-/-)] Ë z genotype (+/+){ f Èu èsç [9] v ~ f È u q 1. LDL Œ(oxidation) Ë á v f LDL Èu {[10] 2.Ë ˆ k Èu ru u u èr u uf Ç i (lipoprotein lipase) { u u (chylomicron remnants)ë Ë z g r {[11] ( ) t x ˆ { x ˆ á š j š f á r ä r u å r x Ç } f Èu fä Ë x Ç [31] Ë ~ ~ f Èu þí f (antithyroglobulin) (antithyroid microsomal antibodies) f q (a) Ç j Ë x Ç [12] ÉWhickhamË r 2,800 Ë 20 rp z x ˆ { { t ~ x { [13] ( ) f f f } 1,210 f Èu é 200 mg dl v 1.3% 11.2% [14] Ë ~248 f v 2.8% 4.4% [15] Ç Èuf u uf jë s {f s š ï j Ç f {f è r t f 65

4 u j f 2 2 f l ïë "broad beta" disease (type III) f r f IDL Ë Èu f (ÇLDL {) r Èu Ë u uf r u u éè f f Èu LDL (a) [7,16] Ë Ç [17,18]: Ì { Èu 9 15 mg dl LDL 11 mg dl Ë Èuf ï Ë ~ LDLËr { 36 mg dl p 0.01 [19] èëidl } { (a) f HPL Ë [16] Ë Ìá [21] Ç r r Ëf k } lr î f Èu LDL HDL apoprotein-b [22] u { á i (lipolysis)á è r f u Ë ~ (a) Ë z á [22] j f ( ) 1.3% % Ç f j Ë {f s š ï j Ç ï f {f 1. Bastenie PA, Vanhaelst L, Neve P: Coronary-artery disease in hypothyroidism. Lancet 1967; 2: O'Brien T, Dinneen SF, O'Brien PC, et al: Hyperlipidemia in patients with primary and secondary hypothyroidism. Mayo Clin Proc 1993; 68: Verdugo C, Perrot G, Ponsin G, et al: Time-course of alterations of high density lipoproteins HDL. during thyroxine administration to 66

5 Vol.2 No.2 {us Taiwan Geriatr Gerontol hypothyroid women. Eur J Clin Invest 1987; 17: Tzotzas T, Krassas GE, Konstantinidis T, Bougoulia M: Changes in lipoprotein(a) levels in overt and subclinical hypothyroidism before and during treatment. Thyroid 2000; 10: Klausen IC, Nielsen FE, Hegedus L, et al. Treatment of hypothyroidism reduces low density lipoproteins but not lipoprotein a. Metabolism 1992; 41: Tanis BC, Westendorp RGJ, Smelt HM: Effect of thyroid substitution on hypercholesterolaemia in patients with subclinical hyperthyroidism: A reanalysis of intervention studies. Clin Endocrinol 1996; 44: Ito M, Takamatsu J, Matsuo T, et al: Serum concentrations of remnant-like particles in hypothyroid patients before and after thyroxine replacement. Clin Endocrinol 2003; 58: Hoogerbrugge N, Jansen H, Staels B, et al: Growth hormone normalizes low-density lipoprotein receptor gene expression in hypothyroid rats. Metabolism 1996; 45: Wiseman SA, Powell JT, Humphries SE, et al: The magnitude of the hypercholesterolemia of hypothyroidism is associated with variation in the low density lipoprotein receptor gene. J Clin Endocrinol Metab 1993; 77: Costantini F, Pierdomenico SD, De Cesare D, et al: Effect of thyroid function on LDL oxidation. Arterioscler Thromb Vasc Biol 1998; 18: Weintraub M, Grosskopf I, Trostanesky Y, et al: Thyroxine replacement therapy enhances clearance of chylomicron remnants in patients with hypothyroidism. J Clin Endocrinol Metab 1999; 84: Lotz H, Salabe GB: Lipoprotein (a) increase associated with thyroid autoimmunity. Eur J Endocrinol 1997; 136: Vanderpump MPJ, Tunbridge WMG, French JM, et al: The development of ischemic heart disease in relation to autoimmune thyroid disease in a 20-year follow-up study in an English community. Thyroid 1996; 6: Bruckert E, De Gennes JL, Dairou F, Turpin G: Frequency of hypothyroidism in a population of hyperlipidemic subjects. Presse Med 1993; 22: Tsimihodimos V, Bairaktari E, Tzallas C, et al: The incidence of thyroid function abnormalities in patients attending an outpatient lipid clinic. Thyroid 1999; 9: Danese MD, Ladenson PW, Meinert 67

6 u j f 2 2 CL, Powe NR: Effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J Clin Endocrinol Metab 2000; 85: Caraccio N, Ferrannini E, Monzani F: Lipoprotein profile in subclinical hypothyroidism: response to levothyroxine replacement, a randomized placebo-controlled study. J Clin Endocrinol Metab 2002; 87: Meier C, Staub JJ, Roth CB, et al: TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double blind, placebo-controlled trial (Basel Thyroid Study). J Clin Endocrinol Metabolism 2001; 86: Michalopoulou G, Alevizaki M, Piperingos G, et al: High serum cholesterol levels in persons with 'high-normal' TSH levels: Should one extend the definition of subclinical hypothyroidism? Eur J Endocrinol 1998; 138: Ganotakis ES, Mandalaki K, Tampakaki M, et al: Subclinical hypothyroidism and lipid abnormalities in older women attending a vascular disease prevention clinic: effect of thyroid replacement therapy. Angiology 2003; 54: Ito M, Takamatsu J, Sasaki I, et al: Disturbed metabolism of remnant lipoproteins in patients with subclinical hypothyroidism. Am J Med 2004; 117: Hoppichler F, Sandholzer C, Moncayo R, et al: Thyroid hormone reduces lipoprotein a plasma levels. Atherosclerosis 1995; 115:

7 [Review Article] Lipid Profile Deviation in Thyroid Disorders Chung-Yuan Chen 1, Chin-I Lin 2 Abstract Many hypothyroid patients have higher serum levels of lipid profile, i.e. total cholesterol and low-density-lipoprotein (LDL) cholesterol. The primary mechanism of accumulation of LDL cholesterol in hypercholesterolemia in hypothyroidism is caused by reduced number of cell surface receptors for LDL or decreased catabolism of LDL. With Thyroxine (T4) supplement, the serum total cholesterol levels in patients with overt hypothyroidism shows a decrease distribution from 46 mg/dl to 131 mg/dl. With respect to serum high-density-lipoprotein (HDL) cholesterol concentrations, higher, normative or lower levels have been reported among different studies. And it still remains uncertain whether patients with hypothyroidism are at a greater risk of developing coronary heart disease. The prevalence of hypothyroidism (including overt and subclinical hypothyroidism) in patients with hyperlipidemia ranges from 1.3% to 11.2%. It is therefore suggested that patients with hyperlipidemia should be screened on their hypothyroidism before they are administered with a specific lipid-lowering medication. If hypothyroidism is present, the patient should be treated with T4 for three to four months. If the serum lipid concentrations are not then normal, specific lipid-lowering therapy may be considered. Patients with hyperthyroidism tend to be reported changes in lipid metabolism generally opposite to those for hypothyroidism. (Taiwan Geriatr Gerontol 2006;2(2):63-69) Key words: hypothyroidism, hypercholesterolemia, hypertriglyceridemia, coronary heart disease, anti-thyroid antibody 1 Department of Endocrine and Metabolism, Kaohsiung Municipal Min-Shen Hospital; 2 Department of Nursing, Tajen University Correspondence: Chin-I Lin Address: chungyu.anchen@msa.hinet.net 69

Original article : Correlation of Lipid level in Thyroid Disorder Patients: A Case Control Study

Original article : Correlation of Lipid level in Thyroid Disorder Patients: A Case Control Study Dr. Arohi Kumar Associate Professor, Department of General Medicine, Narayan Medical College & Hospital,