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Effect of Thyroxine Therapy on Serum Lipoproteins in Patients with Mild Thyroid Failure: A Quantitative Review of the Literature¹

Departments of Epidemiology (M.D.D., C.L.M., N.R.P.) and Health Policy and Management (N.R.P.) and Center for Clinical Trials (M.D.D., C.L.M.), The Johns Hopkins University School of Hygiene and Public Health; Endocrine Cost-Effectiveness Study Unit (M.D.D., P.W.L., N.R.P.) and Divisions of Endocrinology and Metabolism (P.W.L.) and General Internal Medicine (N.R.P.), The Johns Hopkins University School of Medicine; and Welch Center for Prevention, Epidemiology and Clinical Research (N.R.P.), The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205-2223

Address correspondence and requests for reprints to: Neil R. Powe, M.D., The Johns Hopkins University, 2024 East Monument Street, Suite 2-600, Baltimore, Maryland 21205-2223. E-mail: npowe{at}jhmi.edu

The objective of our study was to estimate the expected change in serum lipoprotein concentrations after treatment with T₄ in patients with mild thyroid failure (i.e. subclinical hypothyroidism).

Our data sources included MEDLINE, between January 1966 and May 1999, and review of references from relevant articles.

There were 1,786 published studies identified, 461 abstracts reviewed, 74 articles retrieved, 24 articles evaluated against predetermined entry criteria, and 13 studies systematically reviewed and abstracted.

All studies reported serum total cholesterol concentration changes during T₄ treatment, 12 reported triglyceride changes, 10 reported high-density lipoprotein (HDL) cholesterol changes, and 9 reported low-density lipoprotein (LDL) cholesterol changes.

There were 247 patients in 13 studies. The mean decrease in the serum total cholesterol concentration was -0.20 mmol/L (-7.9 mg/dL), with a 95% confidence interval of -0.09 to -0.34. The decline in serum total cholesterol was directly proportional to its baseline concentration. Studies enrolling hypothyroid participants receiving suboptimal T₄ doses reported significantly larger decreases in serum total cholesterol after thyroid-stimulating hormone normalization than studies enrolling previously untreated individuals with mild thyroid failure [-0.44 mmol/L (-17 mg/dL) vs. -0.14 mmol/L (-5.6 mg/dL), P = 0.05]. The change in serum LDL cholesterol concentration was -0.26 mmol/L (-10 mg/dL), with a 95% confidence interval of -0.12 to -0.41. Serum HDL and triglyceride concentrations showed no change.

These results, although based on fewer than 250 patients, suggest that T₄ therapy in individuals with mild thyroid failure lowers mean serum total and LDL cholesterol concentrations. The reduction in serum total cholesterol may be larger in individuals with higher pretreatment cholesterol levels and in hypothyroid individuals taking suboptimal T₄ doses. There do not seem to be significant effects of T₄ on serum HDL or triglyceride concentrations.

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