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Therapeutic Dilemma With Thyroxine Replacement in Hypothyroidism

Hiroyuki Koshiyama, MD; Toshikiyo Koh, MD; Teuki Sone, MD
Arch Intern Med. 1994;154(17):1997. doi:10.1001/archinte.1994.00420170145022.
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It has been well documented that overt hypothyroidism is associated with hyperlipidemia, and that overt hyperthyroidism causes a decrease in bone mineral density. However, it has recently been debated whether subclinical hypothyroidism is associated with an increase in total cholesterol1,2 and whether subclinical hyperthyroidism causes a decrease in bone mineral density.3-5 These controversies raise the therapeutic dilemma about levothyroxine (l-T4) replacement therapy in patients with hypothyroidism. We investigated the total cholesterol and bone mineral density levels in patients with hypothyroidism who were treated with l-T4 replacement. These levels and the thyroid stimulating hormone level were examined in a total of 200 patients with hypothyroidism. The thyroid stimulating hormone levels were measured using an immunoradiometric assay (TSH-RIABEAD II, Dinabot Co, Tokyo, Japan). The subjects included those who were diagnosed as having Hashimoto's thyroiditis (n=191), postoperative hypothyroidism (n=5) (benign tumor [n=1] and malignant tumor [n=4]), and Graves' disease after therapy


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