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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 associated with changes in lipoprotein fractions, 13 patients maintained in a stable state of subclinical hypothyroidism for at least 3 months were studied prior to and 2 and 4 months following restoration of a euthyroid state with incremental levothyroxine sodium therapy. Thyrotropin levels (±SEM) had decreased from 16.6±3.2 mU/L to 3.1 ±0.7 mU/L and 3.2±0.7 mU/L at 2 months and 4 months. At 2 months, levothyroxine treatment led to a decrease in levels of total cholesterol from 5.5±0.3 mmol/L (213±12 mg/dL) to 4.8±0.3 mmol/L(186±12 mg/dL), in low-density lipoprotein cholesterol (LDL-C) from 3.7±0.3 mmol/L (143±12 mg/dL) to 2.9 ±0.3 mmol/L (112± 12 mg/dL), and in apolipoprotein B from 91 ±8 mg/dL to 74±7 mg/dL. At 4 months, levels of LDL-C and apolipoprotein B remained significantly lower than pretreatment values (2.9±0.2 mmol/L [112±8 mg/dL] and 75±6 mg/dL, respectively). While high-density lipoprotein cholesterol (HDL-C), HDL₃-C, and apolipoprotein A-I were not significantly affected by levothyroxine therapy, there was a slight trend of increase in HDL₂-C during levothyroxine substitution. There was also a tendency for a decrease in triglyceride levels from 1.3 ± 0.2 mmol/L (115±18 mg/dL) to 0.9±0.1 mmol/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±19 mg/dL) at 2 months and to 3.9±0.4 mmol/L (151 ±15 mg/dL) at 4 months. The LDL-C/HDL-C ratio also decreased from 3.3±0.3 mmol/L (128±12 mg/dL) to 2.9±0.5 mmol/L (112±19 mg/dL) and 2.5 ± 0.3 mmol/L (97 ± 12 mg/dL) at 2 months and 4 months, respectively. These results suggest that long-term levothyroxine therapy in patients with subclinical hypothyroidism is associated with a decrease in LDL-C and apolipoprotein B levels that are reflected in a trend of decreases in cholesterol/HDL-C and LDL-C/HDL-C ratios known 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, TX 77030 (Dr Arem).

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