甲狀腺疾患與血脂異常

大多數甲狀腺功能低下症病患常有過高的血清中總膽固醇和低密度脂蛋白(LDL)膽固醇濃度，其機轉為低密度脂蛋白在細胞表面受體的數目或活性減少所致。病案以甲狀腺素治療後，依據其血清中總數膽固醇濃度，平均降幅可達46mg/dL至131mg/dL。血清高密度脂蛋白(HDL)膽固醇濃度有可能是偏高、常態或偏低，而甲狀腺功能低下症的病患罹患冠狀動脈心臟病的比率是否增加至今仍未有定論。高血脂症的病患之中患有甲狀腺功能低下症（包括明顯的甲狀腺功能低下及亞臨床性甲狀腺功能低下症）的比率是1.3%-11.2%，因此所有高血脂症的病患應該在給特定降血脂的藥物治療之前先檢查是否合併有甲狀腺功能低下，如果有者，病患應該用甲狀腺素治療三到四個月，如果血脂濃度仍高，才使用降血脂藥物治療。至於甲狀腺功能亢進的病患在血脂代謝異常方面的改變通常和甲狀腺功能過低者相反。

關鍵字

甲狀腺功能低下症；高總膽固醇血症；高三酸甘油酯血症；冠狀動脈心臟病；抗甲狀腺抗體

並列摘要

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.

並列關鍵字

hypothyroidism ； hypercholesterolemia ； hypertriglyceridemia ； coronary heart disease ； anti-thyroid antibody

國際替代計量

甲狀腺疾患與血脂異常

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