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Therapy for Hypercholesterolemia; Standardization of Cholesterol Measurements

Joel I. Hamburger, MD
JAMA. 1990;263(3):375. doi:10.1001/jama.1990.03440030058020.
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To the Editor.—  As Drs Blum and Levy1 indicate, cholestyramine and colestipol are insoluble powders that lower cholesterol levels by interrupting the enterohepatic circulation of bile acids. They are safe and effective agents, but there is one important contraindication to their use, ie, dependency on exogenous thyroid hormone to correct hypothyroidism. This is not news to thyroidologists. Indeed, a 1969 report in JAMA clearly described this problem.2 However, our recent experience indicates that the information has not received adequate attention in the medical literature. In fact, this potential complication was not mentioned by Drs Blum and Levy.In the past 18 months, we have seen 11 patients (Table) who required thyroid hormone to correct or prevent hypothyroidism (7 with Hashimoto's thyroiditis, 3 who had previously been treated with radioactive iodine for hyperthyroidism, and 1 who had been treated surgically and with radioactive iodine for thyroid cancer), who


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