Hypothyroidism presenting as hypercholesterolaemia and simvastatin-induced myositis.
We report on a 50-year-old woman who presented with hypertension. She was given simvastatin for hypercholesterolaemia. The creatine kinase level was 3180 U/L at the 3-month follow-up visit, which was thought to be due to simvastatin treatment. Although treatment was discontinued, the creatine kinase level 4 months later remained higher than 3000 U/L. Echocardiography revealed mild pericardial effusion and normal left ventricular function; the electromyogram was also normal. The patient subsequently showed signs and symptoms suggestive of hypothyroidism, which was confirmed by measurements of the concentration of thyroid-stimulating hormone (>100 mU/L) and free thyroxine (<2 pmol/L). Thyroxine replacement therapy normalised the creatine kinase and cholesterol levels. This case illustrates the importance of excluding underlying causes of hypercholesterolaemia before contemplating lipid-lowering therapy.
Hung
Y T
YT
Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, 118 Shatin Pass Road, Wongtaisin, Hong Kong.
Yeung
V T
VT
D000924:Anticholesteremic Agents / Q000009:adverse effects*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000209:etiology*; D007037:Hypothyroidism / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D009220:Myositis / Q000139:chemically induced*; D019821:Simvastatin / Q000009:adverse effects*; D013974:Thyroxine / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D019821:Simvastatin; D013974:Thyroxine