Cholesterol Disorders

Cholesterol Disorders

Alternative names: Hyperlipidemia, Hyperlipoproteinemia, Hypolipidemia, Hypolipoproteinemia

What are cholesterol disorders?
What are the signs of cholesterol disorders?
What causes cholesterol disorders?
How does my doctor tell if I have a cholesterol disorder?
How are cholesterol disorders treated?

What are cholesterol disorders?

Cholesterol is essential for life, and is found in the body cells of all animals, including humans. Your body needs cholesterol to work properly. Two cholesterol disorders are hyperlipidemia, and hypolipidemia.

Hyperlipidemia means you have an unusually high level of fat (lipids) in your blood. This puts you at risk for many health problems, including heart attack and stroke. It is sometimes called high blood cholesterol.

Hypolipidemia means you have an unusually low level of fat in your blood. It is sometimes called low blood cholesterol.

What are the signs of cholesterol disorders?

There are two basic kinds of cholesterol: LDL (low-density lipoprotein, or “bad cholesterol,”) and HDL (high-density lipoprotein, or “good cholesterol”).

In a patient with high blood cholesterol, LDL cholesterol builds up in the inner walls of the arteries that carry blood to the heart and brain. Although many people with high cholesterol levels have no symptoms, this narrowing of the arteries (arteriosclerosis) can cause angina (chest pain), heart attack, and stroke.

Low blood cholesterol rarely causes symptoms, but it may indicate the presence of another disorder.

What causes cholesterol disorders?

High blood cholesterol

When you eat meat, eggs, and dairy products – any food that comes from an animal – you are adding cholesterol to your blood. A diet high in saturated fat and cholesterol is just one thing that may cause high blood cholesterol. Other factors include:

• Being overweight
• Not exercising regularly
• Overuse of alcohol
• Family history. High blood cholesterol can be an inherited condition.
• Age and sex. As you age, your LDL (“bad cholesterol”) level rises. After age 55, women have higher LDL levels than men.
• Diseases like diabetes, hypothyroidism, Cushing’s syndrome, and kidney failure
• Medications like birth control pills, beta-blockers, estrogen, corticosteroids, and certain diuretics

Low blood cholesterol

Hypolipidemia can be caused by several things:

• Hypothyroidism
• Anemia (a low amount of red blood cells)
• Malnutrition, or a lack of food
• Liver disease
• The body being unable to absorb food (malabsorption)
• Rare genetic conditions, such as hypobetalipoproteinemia and abetalipoproteinemia
• Tangier disease

How does my doctor tell if I have a cholesterol disorder?

Blood cholesterol tests tell how much fat is in your blood. A total cholesterol level test measures both your LDL (low-density lipoprotein, or “bad cholesterol,”) and HDL (high-density lipoprotein, or “good cholesterol”) levels in milligrams per deciliter (mg/dL).

Normal total cholesterol levels are below 200 mg/dL. HDL levels should be above 40 mg/dL. Triglyceride levels also should be below 200 mg/dL.

How are cholesterol disorders treated?

High blood cholesterol

Lifestyle

• Follow a healthful diet, eating foods low in total fat and saturated fat
• Maintain a healthful weight
• Exercise at least three times a week, for 30 minutes at a stretch
• Have your total cholesterol rechecked in one to two years if:
  • Your cholesterol reading was above 240 mg/dL
  • You have other risk factors for heart disease, such as high blood pressure, diabetes, or being overweight

Medications

• Statins lower LDL (“bad cholesterol”) levels
• Bile Acid Sequestrants (seh-KWES-trants) are sometimes prescribed with statins, and help lower LDL cholesterol levels
• Nicotinic (Nick-o-tin-ick) Acid lowers LDL cholesterol and triglycerides, and raises HDL (“good” cholesterol) levels
• Fibrates lower triglyceride levels, and may increase HDL levels
• Ezetimibe blocks cholesterol absorption, and lowers LDL cholesterol

Low blood cholesterol

Treatment focuses on the root causes of hypolipidemia

Side note:  Gastric bypass surgery can help lower cholesterol and improve the ratio of total cholesterol to HDL (good) cholesterol (Surgery to Treat High Cholesterol?)

Source Credit: https://www.dartmouth-hitchcock.org/endo/cholesterol_disorders.html

Thyroidectomy

Thyroidectomy is the removal of all or part of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck. It produces hormones that regulate every aspect of your metabolism, from your heart rate to how quickly you burn calories.

Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).

How much of your thyroid gland is removed during thyroidectomy depends on the reason for surgery. If only a portion is removed (partial thyroidectomy), your thyroid may be able to function normally after surgery. If your entire thyroid is removed (total thyroidectomy), you need daily treatment with thyroid hormone to replace your thyroid’s natural function.

Why it’s done

A thyroidectomy may be recommended for conditions such as:

• Thyroid cancer. Cancer is the most common reason for thyroidectomy. If you have thyroid cancer, removing most, if not all, of your thyroid will likely be a treatment option.
• Noncancerous enlargement of the thyroid (goiter). Removing all or part of your thyroid gland is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing or, in some cases, if the goiter is causing hyperthyroidism.
• Overactive thyroid (hyperthyroidism). Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine. If you have problems with anti-thyroid drugs and don’t want radioactive iodine therapy, thyroidectomy may be an option.
• Indeterminate or suspicious thyroid nodules. Some thyroid nodules can’t be identified as cancerous or noncancerous after testing a sample from a needle biopsy. Doctors may recommend that people with these nodules have thyroidectomy if the nodules have an increased risk of being cancerous.

Risks

Thyroidectomy is generally a safe procedure. But as with any surgery, thyroidectomy carries a risk of complications.

Potential complications include:

• Bleeding.
• Infection.
• Low parathyroid hormone levels (hypoparathyroidism) caused by surgical damage or removal of the parathyroid glands. These glands are located behind your thyroid and regulate blood calcium. Hypoparathyroidism can cause numbness, tingling or cramping due to low blood-calcium levels.
• Airway obstruction caused by bleeding.
• Permanent hoarse or weak voice due to nerve damage.

How you prepare

Food and medications

If you have hyperthyroidism, your doctor may prescribe medication — such as an iodine and potassium solution — to regulate your thyroid function and decrease the risk of bleeding.

You may need to avoid eating and drinking for a certain period of time before surgery, as well, to avoid anesthesia complications. Your doctor will provide specific instructions.

Other precautions

Before your scheduled surgery, ask a friend or loved one to help you home after the procedure. Be sure to leave jewelry and valuables at home.

What you can expect

Before the procedure

Surgeons typically perform thyroidectomy during general anesthesia, so you won’t be conscious during the procedure. The anesthesiologist or anesthetist gives you an anesthetic medication as a gas — to breathe through a mask — or injects a liquid medication into a vein. A breathing tube will then be placed in your trachea to assist breathing throughout the procedure.

The surgical team places several monitors on your body to help make sure that your heart rate, blood pressure and blood oxygen remain at safe levels throughout the procedure. These monitors include a blood pressure cuff on your arm and heart-monitor leads attached to your chest.

During the procedure

Once you’re unconscious, the surgeon makes an incision low in the center of your neck. It can often be placed in a skin crease where it will be difficult to see after the incision heals. All or part of the thyroid gland is then removed, depending on the reason for the surgery.

If you’re having thyroidectomy as a result of thyroid cancer, the surgeon may also examine and remove lymph nodes around your thyroid. Thyroidectomy usually takes one to two hours. It may take more or less time, depending on the extent of the surgery needed.

There are several approaches to thyroidectomy, including:

• Conventional thyroidectomy.This approach involves making an incision in the center of your neck to directly access your thyroid gland. The majority of people will likely be candidates for this procedure.
• Transoral thyroidectomy. This approach avoids a neck incision by using an incision inside the mouth.
• Endoscopic thyroidectomy. This approach uses smaller incisions in the neck. Surgical instruments and a small video camera are inserted through the incisions. The camera guides your surgeon through the procedure.

After the procedure

After surgery, you’re moved to a recovery room where the health care team monitors your recovery from the surgery and anesthesia. Once you’re fully conscious, you’ll be moved to a hospital room.

Some people may need to have a drain placed under the incision in the neck. This drain is usually removed the morning after surgery.

After thyroidectomy, a few people may experience neck pain and a hoarse or weak voice. This doesn’t necessarily mean there’s permanent damage to the nerve that controls the vocal cords. These symptoms are often temporary and may be due to irritation from the breathing tube (endotracheal tube) that’s inserted into the windpipe (trachea) during surgery, or as a result of nerve irritation caused by the surgery.

You’ll be able to eat and drink as usual after surgery. Depending on the type of surgery you had, you may be able to go home the day of your procedure or your doctor may recommend you stay overnight in the hospital.

When you go home, you can usually return to your regular activities. Wait at least 10 days to two weeks before doing anything vigorous, such as heavy lifting or strenuous sports.

It takes up to a year for the scar from surgery to fade. Your doctor may recommend using sunscreen to help minimize the scar from being noticeable.

Results

The long-term effects of thyroidectomy depend on how much of the thyroid is removed.

Partial thyroidectomy

If only part of your thyroid is removed, the remaining portion typically takes over the function of the entire thyroid gland, and you might not need thyroid hormone therapy.

Complete thyroidectomy

If your entire thyroid is removed, your body can’t make thyroid hormone and without replacement you’ll develop signs and symptoms of underactive thyroid (hypothyroidism). As a result, you’ll need to take a pill every day that contains the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, Unithroid).

This hormone replacement is identical to the hormone normally made by your thyroid gland and performs all of the same functions. Your doctor will determine the amount of thyroid hormone replacement you need based on blood tests.

Source Credit: https://www.mayoclinic.org/tests-procedures/thyroidectomy/about/pac-20385195