Statins

[Bridkid67]

Just some advice please iam currently on 75mcg of levothyroxine but currently prescribed 20mg of atorvastatin by Dr a couple of years ago before diagnosised with hypothyroidism I've read that people with hypothyroidism should not take statins I've stopped taking them and will speak to my Dr as iam due another blood test if that's the case why had my Dr not picked up on it ? Thanks for any advice.

[TopBiscuit]

I have auto immune hypothyroidism, treated with Levothyroxine and T3 and my GP is constantly after me to take statins. The NHS guidelines are:

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

This is clearly being interpreted as statins are fine if you're being treated for your hypothyroidism. Personally, I say 'no thanks' but it's an individual choice.

Recently my cholesterol was a little over range but my thyroid results (the T3) were low so I increased my thyroid meds (with the agreement of my endocrinologist) and my cholesterol was within range the next time it was tested, but my GP still wanted me to take statins. This is because of something called the Qrisk test score. It used to be that you were prescribed statins with a score of above 20 but they've lowered it to 10.

qrisk.org/

[arTistapple in reply to TopBiscuit]

Yes the whole issue is a travesty. When I started on thyroid meds my cholesterol was 9.9. I am definitely not optimal and it’s now 6.4 a recent drop from 6.8.

I have replied to someone else today re: Dr. Peter Taylor (endocrinologist and researcher Cardiff) has done some excellent work on this. However as usual, finding a doctor who will read it, understand it, apply it etc is like finding a needle in a haystack.

My cardiologist basically shuts me out when I discuss it. This time she googled it in front of me and still argued the point, such is their entrenchment.

[SlowDragon Administrator]

Looking at previous posts you only got increased to 75mcg a couple of months ago

being on too low a dose levothyroxine will mean you are still hypo and high cholesterol is direct result

have you had thyroid and vitamin levels retested since increasing dose?

what were last vitamin test results

What vitamin supplements are you taking

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Have you had both thyroid antibodies tested?

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Post all about what time of day to test

healthunlocked.com/thyroidu...

[Bridkid67 in reply to SlowDragon]

Thanks for that I currently take B complex and 4000iu vitamin D apparently last blood test vitamin d was within range need to book in for another blood test .

[SlowDragon Administrator in reply to Bridkid67]

How much do you weigh in kilo

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

Some people need a bit less than guidelines, some a bit more

NICE guidelines on full replacement dose

Even though many of us start on 50mcg …..we still need to eventually get up to full replacement dose

Levothyroxine doesn’t “top up” failing thyroid, it replaces it

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

[Bridkid67 in reply to SlowDragon]

Roughly about 104 kg

[SlowDragon Administrator in reply to Bridkid67]

so you are likely to need several further increases in dose levothyroxine over next year

104kg x 1.6mcg = 166mcg as perhaps the eventual daily dose levothyroxine you might need

[Bridkid67 in reply to SlowDragon]

It beats me why they don't weigh you beforehand all very slack to me .

[SlowDragon Administrator in reply to Bridkid67]

Many GP’s don’t know about guidelines on how to dose or how to read test results

They will start people on low dose, get TSH somewhere just within range and leave them on that

We get many people each week turn up on forum very unwell, been left on just 50mcg or 75mcg far too long

Good post by tattybogle on TSH

healthunlocked.com/thyroidu...

[PRJ20]

Good afternoonBridkid67 , You are correct "that people with hypothyroidism should not take statins" and, moreover, this is according to NICE guidelines so, no idea why your Dr has not 'picked up' on it...for the last couple of years (or more?! 🙄)...other than s/he is behind the times (polite!) and/or________ (fill in the blanks!) 🤔 For recent information given on this subject (as it's a recurring one on the forum), see the replies on the thread following:👇

healthunlocked.com/thyroidu...

As to any other issues you may have with your dosing of replacement thyroid hormone, any symptoms, etc., it would really help if you could not only:

-- fill in your Bio so that admin and other members on the forum can understand your thyroid journey (just ask if you're having problems doing that); but,

-- give your latest blood tests with ranges (in brackets), as these vary from lab-to-lab; and also to point out

-- you are entitled to not only on-line access to all your results but, to printed copies of the same.

Oh, and just an afterthought with another useful link (from pinned posts, which are all very useful 👍) to thyroid test results calculators👇 so that you can start being your own best advocate: ☺️

healthunlocked.com/thyroidu...

[Bridkid67 in reply to PRJ20]

Thanks I did mention it a while back to my pharmacist and he basically said Your Dr wouldn't prescribe it otherwise so maybe both are clueless to the fact .

[PRJ20 in reply to Bridkid67]

Precisely!...and dare I say it...led by Big Pharma?!! (I've said it!) 🙃😂

ETA: BTW, my own GP practice (which I hope to leave as soon as they answer an on-going complaint I have with them) is now run by the adjoining Pharmacy or, more precisely, the son of the now retired Principal GP who he took on as an 'Associate' at the practice in the run-up to his retirement and who just happens to be...A Pharmacist!! 🙄

[TopBiscuit in reply to PRJ20]

I'm not trying to nitpick but I don't think that you are correct in saying that people with hypothyroidism should not take statins according to NICE guidelines (see below). As stated in one of the threads you reference, NICE guidelines are that:

Prescribe atorvastatin with caution to people:

With pre-disposing factors for rhabdomyolysis, including:

Renal impairment, hypothyroidism, personal or familial history of hereditary muscular disorders, previous history of unexplained muscle pain (whether associated or not with previous lipid-regulating drugs), a history of liver disease or where substantial quantities of alcohol are consumed, in elderly (aged over 70 years), taking other medicines that interact and may cause plasma levels to increase.

As I said in my response, this has clearly been taken, by GPs at least, to mean that as long as the patient is being treated for hypothyroidism and are within range then statins are okay. I'm not saying I agree (I personally have turned down statins multiple times) but I'm just clarifying.

[Bridkid67 in reply to TopBiscuit]

I take your point but I was put on Statins before I was diagnosed with hypothyroidism and looking back at it I cannot recall having any blood test etc to see if I needed them I just got a msg saying they were going to start me on them my fault I know I should have asked more .

[TopBiscuit in reply to Bridkid67]

No, fair enough. You should have been checked. You have the option now of pointing out to your GP that your thyroid was low and that now you are being treated you might like to stop taking the statins for a while and then have your cholesterol checked.

Unfortunately they're under pressure right now to prescribe statins to anyone who is over 10 on the Qrisk rating.

[helvella Administrator Thyroid UK in reply to TopBiscuit]

I completely agree with you that GPs seem to interpret that as statins being OK once treated.

My view is that if that was what the authors of the guidance had meant, they could, indeed should, have referred to "adequately treated" or "compensated" hypothyroidism or something similar. They chose not to. My inference being that anyone with hypothyroidism - however well treated - still has a pre-disposing risk factor for rhabdomyolysis.

[Zephyrbear]

Personally, I would not touch statins with a 10ft bargepole! My cholesterol is only just around the top of the range and the GPs keep trying to push them on to me but I will never take them. I saw what they did to my husband and that was quite enough! He has a familiar high cholesterol condition and he was put onto Simvastatin for many years. But in those years his muscles became increasingly weak and he developed Type 2 diabetes. I referred him to read Malcolm Kendrick’s Great Cholesterol Con and he stopped the statins there and then! His muscles are fully recovered now and his diabetes is completely under control by diet alone! His cholesterol is still higher than normal but he feels that’s acceptable. He will never touch statins again either!