Lipoprotein and Apolipoprotein Levels in Subclinical Hypothyroidism: Effect of Levothyroxine Therapy

doi:10.1001/archinte.1990.00390210077017

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Vol. 150 No. 10, October 1990

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Lipoprotein and Apolipoprotein Levels in Subclinical Hypothyroidism

Effect of Levothyroxine Therapy

Ridha Arem, MD; Wolfgang Patsch, MD

Arch Intern Med. 1990;150(10):2097-2100.

Abstract

• To assess whether subclinical hypothyroidism is associatedwith changes in lipoprotein fractions, 13 patients maintainedin a stable state of subclinical hypothyroidism for at least3 months were studied prior to and 2 and 4 months followingrestoration of a euthyroid state with incremental levothyroxinesodium therapy. Thyrotropin levels (±SEM) had decreasedfrom 16.6±3.2 mU/L to 3.1 ±0.7 mU/L and 3.2±0.7mU/L at 2 months and 4 months. At 2 months, levothyroxine treatmentled to a decrease in levels of total cholesterol from 5.5±0.3mmol/L (213±12 mg/dL) to 4.8±0.3 mmol/L(186±12mg/dL), in low-density lipoprotein cholesterol (LDL-C) from3.7±0.3 mmol/L (143±12 mg/dL) to 2.9 ±0.3mmol/L (112± 12 mg/dL), and in apolipoprotein B from91 ±8 mg/dL to 74±7 mg/dL. At 4 months, levelsof LDL-C and apolipoprotein B remained significantly lower thanpretreatment values (2.9±0.2 mmol/L [112±8 mg/dL]and 75±6 mg/dL, respectively). While high-density lipoproteincholesterol (HDL-C), HDL₃-C, and apolipoprotein A-I were notsignificantly affected by levothyroxine therapy, there was aslight trend of increase in HDL₂-C during levothyroxine substitution.There was also a tendency for a decrease in triglyceride levelsfrom 1.3 ± 0.2 mmol/L (115±18 mg/dL) to 0.9±0.1mmol/L (80±9 mg/dL) at 4 months of levothyroxine therapy.Levels of HDL-C tended to decrease from 4.8±0.4 mmol/L(186±15 mg/dL) to 4.5±0.5 mmol/L (174±19mg/dL) at 2 months and to 3.9±0.4 mmol/L (151 ±15mg/dL) at 4 months. The LDL-C/HDL-C ratio also decreased from3.3±0.3 mmol/L (128±12 mg/dL) to 2.9±0.5mmol/L (112±19 mg/dL) and 2.5 ± 0.3 mmol/L (97± 12 mg/dL) at 2 months and 4 months, respectively. Theseresults suggest that long-term levothyroxine therapy in patientswith subclinical hypothyroidism is associated with a decreasein LDL-C and apolipoprotein B levels that are reflected in atrend of decreases in cholesterol/HDL-C and LDL-C/HDL-C ratiosknown to have a relationship with coronary artery disease.

(Arch Intern Med. 1990;150:2097-2100)

Author Affiliations

From the Divisions of Endocrinology and Metabolism (Dr Arem) and Atherosclerosis (Dr Patsch), Department of Medicine, Baylor College of Medicine, Houston, Tex.

Footnotes

Accepted for publication April 17,1990.

Reprint requests to Division of Endocrinology and Metabolism,Baylor College of Metabolism, One Baylor Plaza, Houston, TX77030 (Dr Arem).

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