Levothyroxine and Atorvastatin: Can anyone tell... - Thyroid UK

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Levothyroxine and Atorvastatin

Can anyone tell me if there is any interaction between Levothyroxine & atorvastatin.

My 76 year old mum had been on Levothyroxine for over 25 years at 75mg and has been fine.

Her cholesterol was high a few years ago and they put her on Atorvastatin. She showed symptoms of her thyroid medication not being right so had tests. Her GP reduced her thyroxine to 25mg which proved too low. It was then moved to 50mg for 3 mths.

The last recent test has shown T4 and TSH as high again so she now has another appointment for the GP to examine her gland.

We don't understand what is going on because if T4 is high surely TSH should be low?

I'm wondering if there is an interaction between the drugs as she was fine before. I have googled it but can't find anything to say there Atorvastatin affects thyroxine dosage.

She also takes warfarin & sotalol for a atrial fibrillation but was on this with thyroxine long before the problems arose.

How important are the statins?

I'd be grateful if anyone can explain it to me.

Thank you.

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Statins are not in the least little bit important. They are useless for women and not recommended for hypos. If her cholesterol is high, it's more than likely that her FT3 is low. Does she ever have her FT3 tested?

The body need cholesterol, and it's not advisable to lower it, because if you do, it will affect sex hormones - and she may be 75, but she still needs her progesterone, estrogen and testosterone to be well. Statins will lower them. But, doctors know as little about cholesterol as they do about hormones - the two are intimately connected.

If her FT4 is high and her TSH is also high, it more than likely means she has a conversion problem and her FT3 is low. But, she needs full thyroid testing to know that:

TSH

FT4

FT3

TPO antibodies

Tg antibodies

vit D

vit B12

folate

ferritin

Doctors rarely do all those tests, so most people have to do them privately. But, if you want to know what is happening to her, it's imperative to have them all done. :)

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I am not medically qualified but a higher cholesterol level is due to being hypothyroid (it is one of the clinical symptoms) and it reduces as our levothyroxine is raised. Many doctors are unaware of the clinical symptoms and are apt to prescribe other medication for any other symptoms rather than ensuring that the dose of levothyroxine is optimum. The aim is a TSH of 1 or lower with FT4 and FT3 in the upper part of the ranges.

Her dose of 50mcg seems low as it is a starting dose and she should have had a blood test every six weeks with an 25mcg increase until her TSH was 1 or lower.

Your mother needs a Full Thyroid Blood Test which is:-

TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.

All blood tests have to be at the earliest possible, fasting (she can drink water) and allow a gap of 24 hours between last dose of levo and blood test and take afterwards.

GP should also test B12, Vit D, iron, ferritin and folate.

To comment more fully members need the blood test results with the ranges. Labs differ as do the ranges and it enables members to comment.

Also levothyroxine should be taken on an empty stomach, usually when we awake with one full glass of water and wait an hour before eating. Food can interfere with the uptake of levo as does coffee.

thyroiduk.org.uk/tuk/about_...

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NHS guidelines on statins and hypothyroidism

nhs.uk/conditions/statins/c...

First thing is, does your Mum have any actual blood test results? if not will need to get hold of copies. She is legally entitled to printed copies of blood test results and ranges.

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

For full Thyroid evaluation your Mum needs TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised or if under medicated

Vitamins need to be optimal for good thyroid function

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how your Mum does tests?

Ask GP to test vitamins

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

Come back with new post once you get results and ranges on these

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Thank you for the advice.

It's so confusing!

The last result sheet that has prompted GP to call her back says the following:

Serum free T4 level 24.8 pmol/L

Serum free TSH level 8.76 mIU/L

They didn't test for T3.

Can you explain T3 please.

Thanks for your time.

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T3 is the Active thyroid hormone - needed in every cell of your body. So the T4/Levo your Mum is taking needs to convert into T3. This happens more efficiently when the body is well stocked with B12 - Folate - Ferritin - VitD - all need to be optimal. AF can happen with low iron too ...

The non testing of T3 is a scandal. Private Testing through Thyroid UK is used by thousands on this forum with home testing kits sent to your home - see link below and click onto About Testing.

thyroiduk.org

Never allow a dose to be reduced based on the TSH. Statins do not prevent heart disease ... they block VitD production - VitK2 & CoQ10 - all very important nutrients needed by the body.

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Likely she has very poor conversion due to low vitamins

Low B12 is especially common as we get older

Levothyroxine is FT4. This must be converted to FT3 in body before it can be used

Short film about how it works

drbradshook.com/understandi...

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Thank you so much for your time & advice. The film is brilliant.

I will go back to the doctor with her & ask for these tests. I understand it a bit better now. She has private health care so I may ask for a referral to an endocrinologist who will hopefully know more and be able to use the data.

If there is a problem with conversion of t4 to t3 (depending in why) how will this be corrected? For example if TPO or TG is the issue.

She takes antacids as well for another condition so this could be a reason in GI tract. However, it didn't cause a problem before. The problem seems to have occurred after starting the statin.

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Take a look at the graphs on this link :

drmalcolmkendrick.org/2012/...

It shows that overall mortality (the risk of death from any cause) is lowest for women when cholesterol is at its highest. So your mother is unlikely to benefit from being on statins.

And your mother really needs to read this link :

drmalcolmkendrick.org/2015/...

It shows how much extra life your mother can expect, on average, from taking statins. Let's just say that the results are underwhelming.

This is another good link :

spacedoc.com/articles/50-fa...

Number 17 on the list states :

17. Even taking the best possible figures, from selected trials, and painting them in the best possible light…if you took a statin for thirty years, you could expect five to six months of increased life and that is only for men with pre-existing heart disease. For women it is pointless and cannot extend your life by even one day.

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And for men, that extra five or six months isn't given to you when you are hale and hearty and can enjoy them. If you have taken statin drugs for 30 years you are probably in your 80s.

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I used to take atorvastatin with 150mg levo, no problems. I had a my thyroid removed during parathyroid surgery. I am 71 and now take rosuvastatin because it lowers cholesterol even more. My last LDL was in the 40`s which is what they want if you have had heart bypass. It`s been ten years since my operation.

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Short answer: Yes. Statins and Levo both use your thyroid binding globulin (TBG's) the transport molecules for getting "stuff" around the body via the blood. I am not sure of the exact mechanism but one of them will be losing out while the other is preoccupying the transporting medium (the TBGs). I don't know if one gets completely blocked out nor if one takes priority over the other or if they fluctuate randomly. But Yes, they interact.

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Thank you.

Please can you tell me where you found the information about statins using TBG's?

I'm just wondering that if my mum takes her statin & Levothyroxine at the same time this could be the cause of the problem. Would this give a high reading of T4 because it's not being converted?

What happens to the excess T4 that converted to T3?

I can't see it explained anywhere how the statin uses the TBG as well anywhere.

Sorry if i seem a bit dense. I'm just trying to understand it so i can ask her GP the right questions!

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Hi Lynny66. I have just picked up your message and it's 10:30pm here - my bed time. I will try to find the paper I read about the TBG transporters., but I agree with you it's hard to find, I just did a search to see if I could find it for you. I think I have a print out somewhere but I am falling asleep now. I'll be baaaack!

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Thsnk you. Hope you slept well!

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OK, SUCESS! I finally unlocked the mystery of where all the references to TBGs and drug interactions are. This is what you do:

1) Go to Google (easy, right?)

2) In the address bar type: scholar.google.com

3) A Google looking page shows up - but it looks just a little bit different.

4) Type in "Thyroid Binding Globulin and drug interactions".

And there you go, enough references to keep you busy for the rest of your life.

It looks like someone has researched just about every drug combo you can think of and lots you have never thought of. You are sure to get the combination you are interested in and more than you ever wanted to know about the chemistry of how they interact.

And it's 10:30pm again, so I'm off to bed. Good Night.

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Another thought comes to mind when taking statins and being treated for hypothyroidism.

When we are not optimally treated for hypo (including suboptimal Vit levels-esp Vit D) we can have severe generalized muscle and joint pains to the degree that often we are diagnosed and treated for other problems like fibromyalgia.

It's often easier for doctors to give us another diagnosis and more meds than to investigate and correct symptoms associated with thyroid problems.

And one of the more painful side effects many have had from statins can be severe muscle aches and pains.

I would suggest doing some online research re pros and cons of statins (avoid marketing info put out by Big Pharma) and make up your own mind about statins.

If you could get an honest answer it might also be informative to ask doctors who recommend you take statins if they take them or prescribe them for their families.

I'm 75, have A-fib,hypo, diabetes and several other medical situations. I'm also a retired nurse and I wouldn't touch statins with a ten foot pole. Just my opinion.

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Good points. The muscle aches and pains are such a flaming indicator of hypo, I fell into that trap you brought up. I was sent to an arthropod (not really, thats what I call arthritis docs) and put on another pill for arthritis. It didn't work because my hypo was drowning out the effect of the second pill. I upped my Levo (that's what I was on at the time), the pains went away and I started reading up on hypothyroidism. That was my first experience that made me a "believer". How come my Endo didn't know that? how come a simple experiment done by myself fixed a life altering problem? We are not supposed to experiment on ourselves - and that is good advice but we are driven to it if we want to be well with hypothyroidism.

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I fell into a fibromyalgia diagnosis that actually was a very low out of range Vit D level. Once the Endo treated me with large rx doses of D my aches and pains disappeared. Never had fibro.

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I think we have to read, draw our own conclusions and often have to make our own medical decisions just to prevent more harm, pain,and grief by the mainstream guidelines that drive the health establishment. Not just here (US) but probably worldwide.

The older I get the further away from mainstream medicine I tend to travel. They are often driven by what's best for the masses. I am driven by what my gut tells me is best for me. It's usually right.

I believe the Universe has given us a wonderful internal radar system so we can help ourselves when we read and learn and then trust our instincts.

Certainly doctors and others can help us remain healthy and recover health sometimes but I don't want to give them 100% control just because they are the recognized experts. I have often been helped by good medical care and it's not my intention to denigrate its importance.But it's important for each of us to decide for ourselves when and how we must draw the line in accepting others' decisions about how to live our lives.

We all have this ability-we don't have to be doctors or nurses-just normal people who want to do the best for ourselves.

The problem in life starts (in my opinion) when as children who come into this world with good self-preservation instincts we begin to lose this gift as adults teach us to always trust them over our instincts and cause us to doubt ourselves. By the time we are adults we have been indoctrinated to believe all the answers we need can be found outside ourselves.

I believe, for me at least, the older I get the more this lost instinct re- asserts itself and if I can begin to trust myself again (and outside sources less) my life will go smoother.

Governments, especially do not help us do this.

I read a quote not long ago that really resonates with me. It was by Senator John McCain-a decorated American war hero who was a POW in Vietnam and who I think was an honorable and decent politician-a small group by definition. (he died last year of a brain tumor.) He said "Everyone dies from one thing or another."

I take this to mean our cause of death is not important. What is important is that we are allowed to live our life until it's our time without too much interference by too many sophisticated attempts to keep us going longer than what is meant to be our natural time span here on earth. My definition of quality of life doesn't involve so many fights with the medical establishment over how much aggravation and suffering they want me to endure before I go.

Don't mean to be so philosophical but it's 4 AM herein Atlanta and I can't sleep-too many early morning thoughts I want to jot down.

Thanks for listening. irina 🐱

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You know I experiment on myself frequently. Not in a harmful ways-maybe a better term would be I do my own 'scientific research' so I can have answers before I talk to my doc about what might work for a problem I have.

(Sort of like the lawyer who never asks a question he doesn't already know the answer to!)

Case in point: Several weeks ago my primary PCP gave me a prescription for what he thinks is diabetic neuropathy. It was gabapentin-300mg in a capsule and said take 3 a day.

I am in 2 minds about this drug. It does help but it can be addictive, there are many pros and cons but that's a different issue.

I knew I wasn't going to pop 3 a day and that I would take one at bedtime to see if it helped me sleep. I know myself and except for something like an antibiotic where blood levels need to be adequate I often take less than the prescribed dose to start to see how it will affect me. A small dose often goes a long way with me.

The gabapentin is helping me not be awakened by the neuropathy but I noticed it was affecting my mood-irritable, anxious, brain fog. After skipping it one night (and sitting up watching every rerun on TV) I decided to cut my dose. I had to empty some powder out of the capsule to lower the dose-not very scientific- but the lower dose worked fine-no pain, good sleep, no side effects.

So Friday I sent an online message explaining and asking him to call in a Rx for100mg caplets that I could just cut in half and will probably get his repjy tomorrow. I'm pretty sure he will do it. He knows me. And I believe trusts that I won't do anything major on my own that will cause me harm.

I don't think we have to be doctors or nurses- just use common sense and share what we do with our doctor.

For me this is win-win. I haven't wasted a lot of back and forth timeon the phone trying to schedule a visit; I don't have to leave messages with a nurse, and wait several days for an answer or settle for her opinion when I really want to discuss it with the doctor. And my problem will be solved quickly. Just go to the pharmacy and get my med.

This might not always be a solution but even if I have to see a doctor to discuss the best solution at least I have some anecdotal info to help my case.

I believe there are times we can all try talking to a doctor armed with information about what we already know won't work and resolve our problems much faster and with less pain and aggravation.

Works for me.

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I'd just like to thank everyone for your support on here.

I took my mum to a private Endo consultant who was very interested in her and seemed very caring. He seems to have a holistic approach and did mention about not necessarily showing 'normal' results but getting her feeling well. I can't say I understood all of thus but he is looking into conversion problems, assay interference, or absorption issues and is considering the possibility of a link with the statin causing a problem as mum only seems to have had problems with her levels since starting this but needs it because of a previous stroke and AF. He is suggesting checking fasting lipids with a view to optimising management of her lipids, using the lowest dose of an alternative statin.

He is going to do the following blood tests as well as a comprehensive stool test:

U+E's,red cell magnesium, red cell selenium, TFT's, fT3, reverse T3, thyroid antibodies, 25-Vitamin D, CK, SHBG, fasting lipids and an additionial vial to be sent to cambridge to exclude assay interference.

I feel a sense of reassurance that things are now being looked into properly by this specialist.

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