PCSK9 and hypothyroidism: A generalizable approach to managing SAMS in high-risk patients includes ruling out secondary causes (e.g., hypothyroidism, vitamin D deficiency, drug interactions); statin discontinuation followed by symptom monitoring; CK, renal function, and symptom surveillance during rechallenge; stepwise reinitiation using low-intensity or intermittent statin dosing; and transition to non-statin agents (e.g., ezetimibe, PCSK9 inhibitors) if intolerance persists (Figure 4) [12-15].