The effects of hypocholesterolemic agents on cholesterol esterification in vitro.
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Secondary hyperlipoproteinaemia necessitates direct management of the main disease (hypothyroidism, nephrosis, etc.), whereas primary forms are essentially handled by dietary regimens adapted to subject types, as classified by Fredrickson-Levy-Lees and adopted by the WHO. These regimens are described and discussed schematically. Drugs may be employed if diet proves ineffectual. Anionic exchange resins, d-thyroxine, clofibrate and nicotinic acid have been shown effective for this purpose. Their mechanisms, doses and side-effects are described. The criteria governing their selection are explained in the light of the recent literature and with reference to the six phenotypes proposed by Fredrickson-Levy-Lees.
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Thyroid Hormone Resistance (RTH) is characterized by the diminished response of thyroid hormone-responsive tissues in varying degrees in association with elevated serum levels of total and free T4 and T3 and inappropriately normal or elevated TSH levels. In almost all cases it is due to different mutations in only one allele of the thyroid hormone receptor beta gene which blocks the action of normal allele thus producing dominantly inherited RTH. In RTH, varying degrees of target tissue responsiveness result in a heterogenous clinical presentation. Resistance in the thyrotrophs and the peripheral tissues is assessed by the evaluation of TSH secretion and changes in peripheral markers of thyroid hormone action after administration of L-T3, respectively. The treatment decision depends on the individual characteristics of each patient. Patients with hypothyroid and hyperthyroid symptoms may require treatment with thyroid hormone and with agents such as beta blockers, antithyroid drugs and thyroid hormone analogues.
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21 patients with hyperlipoproteinaemias of type IIa and IIb were treated with D-thyroxin (4 mg/die) after a placebo phase. The observed changes of the cholesterol and triglyceride level in the serum are described. Hypermetabolic and cardiac side effects did not appear in the patients. The possible sites of action of D-thyroxin in the intermediary lipid metabolism are discussed.