Serum cholesterol level will be elevated in case of:

UPUMS Nsg.Officer-2024

Medical & Surgical Nursing

Easy

Appeared in: UPUMS Nsg.Officer-2024

Explanation

Hypothyroidism is a primary secondary cause of hypercholesterolemia.
A deficiency in thyroid hormone leads to a decreased number and activity of LDL receptors on the liver.
This impaired LDL receptor function reduces the clearance of LDL cholesterol from the blood, causing serum levels to rise.
Both total cholesterol and LDL cholesterol are typically elevated in hypothyroidism.

Option A: Diabetes mellitus, particularly type 2, is more characteristically associated with high triglycerides and low HDL cholesterol (atherogenic dyslipidemia), rather than isolated elevated cholesterol.
Option B: Hyperthyroidism (excess thyroid hormone) has the opposite effect. It increases the number of LDL receptors, which enhances cholesterol clearance and leads to lower serum cholesterol levels.
Option C: Cretinism is a form of severe, untreated congenital hypothyroidism. While it would lead to elevated cholesterol, 'Hypothyroidism' is the broader, more encompassing, and therefore better clinical answer that includes adult-onset forms as well.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Secondary causes of hypercholesterolemia as background academic context rather than a clinical decision trigger.
It is a standard nursing and medical practice to screen for hypothyroidism (usually by measuring TSH) in any patient presenting with newly diagnosed or unexplained hypercholesterolemia.
Treating the underlying hypothyroidism with thyroid hormone replacement therapy can often normalize or significantly improve the patient's cholesterol levels, sometimes eliminating the need for statin therapy.
What if? If a patient on statins for high cholesterol continues to have elevated levels, an undiagnosed or undertreated secondary cause like hypothyroidism should be investigated by the nurse and healthcare team.

How to Approach the Question

Identify the core of the question: which of the listed conditions causes an increase in serum cholesterol.
Recall the basic metabolic effects of the conditions listed. Focus on the role of thyroid hormone in overall metabolism.
Remember that thyroid hormone generally 'speeds up' metabolic processes. Therefore, a lack of it (hypothyroidism) would 'slow down' processes, including the breakdown and clearance of cholesterol.
Conversely, an excess of thyroid hormone (hyperthyroidism) would accelerate cholesterol clearance, leading to lower levels.
Evaluate the other options. Diabetes is known for lipid issues, but primarily high triglycerides. Cretinism is a specific type of hypothyroidism, making the general term more appropriate.
Conclude that hypothyroidism is the most direct and significant cause of elevated serum cholesterol among the choices.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 393-395

E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 1 (pp 26-370 of 370) p. 267-269