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Seth Bilazarian, MD's insight:
Just half of primary-care patients with hypercholesterolemia received recommended thyroid-function screening, a new retrospective study has found.
Hypothyroidism is an important secondary cause of elevated total cholesterol and LDL cholesterol. In overt hypothyroidism cases, thyroid hormone replacement treatment often normalizes the cholesterol levels. For that reason, guidelines from the AACE, American Thyroid Association, and National Cholesterol Education Program (NCEP) recommend testing for hypothyroidism.
Dr. Willard's study was designed to determine the rate of adherence to the guidelines by primary-care physicians. "The 50% rate of screening is a bit surprising. Although guidelines from the NCEP and [American College of Physicians] ACP state that thyroid dysfunction is [included in the] differential [diagnosis] for new-onset dyslipidemia, the practice of screening in standard clinical practice seems to often be overlooked."
Of the total 4349 patients who had TSH levels screened, 151 had TSH levels greater than 5 mIU/L and 74 had TSH levels over 10 mIU/L. Of these 225 patients (with TSH levels >5), 50.7% received levothyroxine treatment, Of those 114 patients treated with levothyroxine, 75.4% did not receive a lipid-lowering agent within 1 year, possibly because correction of their hypothyroidism resulted in improvement of their lipid panel and correction of the dyslipidemia.