virgola82
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A 52 yo man has had type 2 diabetes for 10 years. He has no known complications and has been treated with glyburide and metformin. He has a known history of hyperlipidemia and is taking aspirin 325 mg/day and simvastin 20 mg/day in addition to his anti diabetic therapy. lipid lowering therapy was instituted 1 year ago. At hsi annual examination he has the follwing lab findings: fasting glucose 170, HbA1c 7.5%, TSH 5.5 mIU/L, creatinine 1.2, cholesterol 240, TG 250, HDL 25, calculated LDL 165.
What treatment would most likely achieve a beneficial decrease in cholesterol?
A add a resin such as cholestyramine
B add gemfibrozil
C change to 10mg atorvastatin
D begin thyroid hormone replacement
E Add niacin
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| vradojc1
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E - will bring down TGs, LDL and lift HDL. It could though raise blood sugar.
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| ram3
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I disagree gemfibrozil will decrease triglcycerides and increaes hdl
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| dr in trouble
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I will go with D as TSH level is increased, hypothyroidsm is a cause for hypercholestrolemia so giving thyroxine can decrese cholestrol levels
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| sprint123
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Niacin increases HDL ---It is the best next step ..
But beneficial decrease in cholesterol can be obtained by gicing thyroxine....since TSH is elebated.I will go with D
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| ram3
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Tsh is not elevated guys
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| sprint123
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According to recent guideleines, TSH is normal value is between .3 to 3 mIU/L
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| hanialkhadher
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Gemfibrozil , it will improve the high Glucose too.
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| virgola82
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The right answer is A.
This is how it's explained: Niacin is poorly tolerated and likely to worsen glycemic control in this setting. The thyroid status is marginal so T4 replacement would have only minimal effects on lipid profile if any. Use of a fibrate is unlikely to achieve it's lipid target. Doubling the statin dose might result in about 15% reduction of his cholesterol but is unlikely to be as effective as adding a resin. Adding the resin therefore is the most appropriate therapy in this setting
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| dr19
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attention!
cholestyramine decreases LDL,but increases TG leves.
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| ashfaque
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good question virgoloa
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