A 57-year-old man is evaluated in the clinic for a routine physical exam. He is followed for hypertension and hyperlipidemia. He has no complaints except for some fatigue and constipation. He exercises regularly, eats healthy and takes all of his medications. His medications include atorvastatin and lisinopril. His blood pressure is 126/80 and the body mass index is 23. His physical exam is unremarkable. Laboratory studies reveal elevated total cholesterol and LDL levels. Fasting blood glucose is normal. Which of the following is the most appropriate next step in management?
a. Add an additional cholesterol-lowering agent
b. Increase statin dosage
c. Measure hemoglobin A1c level
d. Measure thyroid-stimulating hormone level

d. Measure thyroid-stimulating hormone level

Explanation:

The most suitable next step in management of this patient is to measure a thyroid stimulating hormone, or thyrotropin level.

This patient's apparent treatment refractory dyslipidemia is most likely contributed by undiagnosed thyroid disease. Despite sticking to the treatment with atorvastatin, his  LDL AND total cholesterol are raised.

Additionally, there are some clinical signals that give an idea about the diagnosis of hypothyroidism especially  fatigue and constipation.

Hypothyroidism is concerned with and is a very common secondary cause of dyslipidemia and thyrotropin level measures are indicated.

Hyperlipidemia may show better results to thyroid stimulating hormone.

Hence option D is the right answer.

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