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  #1  
Old 10-20-2011
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A 67-year-old man comes to your office complaining of weight gain, lethargy, and cold intolerance. His blood pressure is155/95 mm Hg.
After these findings you began therapy with levothyroxine. Now, 6 months later, the patient returns for further follow-up and reports feeling much more energetic. Provided that he has responded appropriately to the medication and that his TSH normalizes, what effect would you expect to see on his blood pressure and lipid profile?



A.

Decreased blood pressure, decreased LDL, and decreased triglycerides


B.

Decreased blood pressure, increased LDL, and increased triglycerides


C.

Increased blood pressure, decreased LDL, and decreased triglycerides


D.

Increased blood pressure, increased LDL, and increased triglycerides


E.

No change in blood pressure or lipid profile
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  #2  
Old 10-20-2011
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in hypo state there is a bradycardia and a increase in cholesterol lvls so treating it would cause a increase in BP and would lower the cholesterol lvls

i would choose C
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  #3  
Old 10-20-2011
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yah its cccc...
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Old 10-20-2011
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C. Increased blood pressure, decreased LDL, and decreased triglycerides
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Old 10-20-2011
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The correct answer is A. Hypothyroidism has important effects on the cardiovascular system. Both blood pressure and lipid profile are adversely affected. Paradoxically, low levels of circulating thyroxine will actually elevate blood pressure. The process is mediated through an increase in peripheral vascular resistance. The effect is most pronounced in those with established hypertension. Hypothyroidism also decreases heart rate and myocardial contractility, lowering overall cardiac output. However, the increase in peripheral vascular resistance is more prominent, resulting in an overall increase in mean arterial pressure. A screening TSH to rule out hypothyroidism is a routine part of the workup for secondary causes of hypertension. Hypothyroidism also decreases lipid clearance from the blood by the liver, resulting in elevated serum total, LDL, and triglyceride fractions. In a prospective study, 4.2% of those with hyperlipidemia were found to have hypothyroidism. Only those patients with a serum TSH concentration above 10 mU/L had a significant reduction in the serum cholesterol concentration during thyroid hormone replacement. The effect of thyroid hormone replacement in the setting of subclinical hypothyroidism is usually small and varies considerably. Because of these two effects, both blood pressure and lipid profiles should improve during thyroid hormone replacement. Choices B, C, D, and E all describe cardiovascular changes that would be unexpected.
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