J Korean Med Sci.  2005 Jun;20(3):502-505. 10.3346/jkms.2005.20.3.502.

A Case of Hypothyroidism and Type 2 Diabetes Associated with Type V Hyperlipoproteinemia and Eruptive Xanthomas

• Park JR
• Jung TS
• Jung JH
• Lee GW
• Kim MA
• Park KJ
• Kim DR
• Chang SH
• Chung SI
• Hahm JR

• KMID: 1778515
• DOI: http://doi.org/10.3346/jkms.2005.20.3.502

Abstract

Primary hypothyroidism and type 2 diabetes are both typically associated with the increased level of triglycerides. To date, there have been only a few case reports of type 2 diabetes patients with both type V hyperlipoproteinemia and eruptive xanthomas, but there have been no reports of hypothyroidism patients associated with eruptive xanthomas. We report here on a case of a 48-yr old female patient who was diagnosed with type 2 diabetes and primary hypothyroidism associated with both type V hyperlipoproteinemia and eruptive xanthomas. We found rouleaux formation of RBCs in peripheral blood smear, elevated TSH, and low free T4 level, and dyslipidemia (total cholesterol 18.1 mM/L, triglyceride 61.64 mM/L, HDL 3.0 mM/L, and LDL 2.54 mM/L). She has taken fenofibrate, levothyroxine, and oral hypoglycemic agent for 4 months. After treatment, both TSH level and lipid concentration returned to normal range, and her yellowish skin nodules have also disappeared.

Keyword

Hyperlipoproteinemia Type V; Xanthomatosis; Hypothyroidism; Diabetes Mellitus; Erythrocyte Aggregation

MeSH Terms

Antilipemic Agents/therapeutic use
Diabetes Mellitus, Type 2/blood/*complications/drug therapy
Erythrocyte Aggregation
Female
Humans
Hyperlipidemia/blood
Hyperlipoproteinemia Type V/blood/*complications/drug therapy
Hypoglycemic Agents/therapeutic use
Hypothyroidism/blood/*complications/drug therapy
Middle Aged
Procetofen/therapeutic use
Research Support, Non-U.S. Gov't
Skin Diseases/blood/complications/drug therapy
Thyrotropin/blood/therapeutic use
Thyroxine/blood
Treatment Outcome
Xanthomatosis/blood/*complications/drug therapy

Figure

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  Fig. 1 Rouleaux formation of red blood cells. Peripheral blood smear shows the rouleaux formation of RBCs, a stack of coins (×1,000).

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  Fig. 2 Eruptive xanthoma. (A) Eruptive xanthoma appeared over the elbow of the patient before medication. (B) The lesion of eruptive xanthomas was completely regressed after medications.

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  Fig. 3 A profile of lipoproteins. A result of lipoprotein electrophoresis indicates that the patient has type V hyperlipoproteinemia. There are well defined bands of chylomicrons and grossly elevated pre-β lipoproteins. HDL (α-lipoprotein) and VLDL (pre-β lipoprotein) move with α1-globulins (the most left area) and α2-globulins (first peaks). LDL (β-lipoprotein) migrates with beta-globulins and chylomicron (second peak) remains at the origin.

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