SAT-245 Breaking the Triglyceride Barrier: A Case of Severe Hypertriglyceridemia Management

Abstract Disclosure: H. Ilyas: None. A. Akram: None. H. Ilyas: None. A. Shafi: None. P. Singh: None. M. Haider: None. M. Haider: None. S. Sule: None. Introduction: Severe hypertriglyceridemia (HTG) is characterized by triglyceride (TG) levels exceeding 1000 mg/dL and poses a significant risk for acute pancreatitis and cardiovascular disease. Standard management involves lifestyle modifications, lipid-lowering agents, and targeted triglyceride-lowering therapies. However, consensus guidelines for asymptomatic severe HTG remain limited. Here, we present a case of severe HTG managed successfully with pharmacologic therapy and lifestyle changes, highlighting the importance of individualized treatment approaches. Case Presentation: A 58-year-old female with a history of hypothyroidism, hypertension, prior acute pancreatitis, and severe HTG presented to the clinic to establish care. She had no acute complaints at the time of visit. Laboratory results revealed total cholesterol level of 794 mg/dL and TG level of 2089 mg/dL. Her HbA1c was 5.7 and creatinine was 0.49. She denied excessive alcohol consumption. Modifiable risk factors identified included a diet high in concentrated sweets, low physical activity, overweight status, and hypothyroidism.The patient was advised aerobic exercise for at least 150 minutes per week and dietary adjustments such as reducing concentrated sweets and incorporating unsaturated fats. Pharmacologic therapy included continuation of rosuvastatin 40 mg, fenofibrate 160 mg, and ezetimibe 10 mg. Patient was also started on Icosapent ethyl 2 g twice daily and Levothyroxine (LTX) was increased from 125 mcg to 150 mcg due to an elevated TSH level of 10.4 µIU/mL with a free T4 of 1.0 ng/dL. At follow-up in 4 weeks, the patient was asymptomatic, compliant with lifestyle modifications and medications, and subsequent labs showing marked improvement with TG reduced to 293 mg/dL and total cholesterol 176 mg/dL. The patient was also prescribed evolocumab, but insurance restrictions required specialist approval. She was referred to endocrinologist as well. Discussion: Severe HTG necessitates an aggressive yet individualized treatment approach to mitigate the risk of acute pancreatitis and cardiovascular disease. Lifestyle modifications with diet and structured exercise in combination with pharmacotherapy including fibrates, statins, omega-3 fatty acids, and ezetimibe play key roles in reducing TG levels. Optimizing thyroid hormone replacement is essential, as hypothyroidism worsens lipid abnormalities. The patient’s TG levels significantly improved within one month, demonstrating the success of a comprehensive treatment strategy. For symptomatic severe HTG cases, particularly with acute pancreatitis, IV insulin and therapeutic plasma exchange are key treatment options. Further research is needed to assess long-term outcomes and the role of emerging therapies in severe HTG management. Presentation: Saturday, July 12, 2025