Is every case of muscle damage during hypolipemic therapy the side effect of this therapy? A case report

Hypolipemic agents, both statins and fibrates, may cause a spectrum of side-effects, including the transient increase in creatine phosphokinase (CPK) activity. Muscle injury may present as common myalgia, non-specific myositis with normal CPK levels, myopathy and in the most serious cases, as rhabdomyolysis. Muscle damage is much more probably in patients with concomittant kidney and liver diseases, hypothyroidism, and serious infections or after some injuries or a heavy physical effort. On the other hand, one of the most common causes of secondary hypercholesterolemia and myopathy is hypothyroidism. This condition, which may enhance the risk of muscle damage in the course of hypolipemic treatment, may sometimes present with an atypical clinical presentation, making its diagnosis challenging. In this article, we present the case of a 50-year-old male physical worker presented with marked dyslipidemia, in whom myopathy was diagnosed during therapy with hypolipemic agents. Cessation of the treatment resulted in the only moderate reduction of CPK activity. Only just the introduction of thyroid hormone supplementation led to regression of symptoms and normalization of abnormalities found in laboratory examinations including remarkable improvement in lipid profile. After several months of observation we consider that hypolipemic treatment probably revealed previously occult autoimmune thyroid disease in this patient.