Hello I’m hoping someone can give me answers. I had a stent fitted to my RCA in March and my left circumflex has 40% non significant plaque tested by wire study. All my other arteries are clear. I had a call from my dr last week saying that my thyroid has become borderline under active so therefore he wants to start me on 25mcg Levothyroxine. My TSH level was 7.2 and my T4 was 12.1. Now I have done some research which is suggesting that it could be dangerous to take Levothyroxine in over 50’s who have a history of CAD which I am and do have. So what then am I supposed to do? as it seems it’s dangerous to “not” treat it as well..? I feel really upset about all this as all I want to do is continue with my diet excercise medication etc to get better then get hit with this quandary. Can anyone shed any light on this please th
Is it dangerous : Hello I’m hoping someone can... - Thyroid UK
Is it dangerous
Let me be clear, you said:
I had a stent fitted to my RCA in March and my left circumflex has 40% non significant plaque tested by wire study.
And I do not understand that! I know what a stent is - and that is about all I get from that sentence!
A TSH of 7.2 strongly suggests that you are hypothyroid. T4 of 12.1 - depends on the reference interval! Do you have that?
As I understand, it isn't so much that taking levothyroxine is dangerous as that it is necessary to be careful and take things even slower than usual. Hypothyroidism is definitely bad for the heart.
Hi thank you for your reply... apologies that of course you didn’t understand the beginning of my post .. I had originally posted it in heart forum where it was suggested I post here as more would be known about thyroid in here... do to be clear what my sentence meant was that I had a stent fitted to my right coronary artery and my left circumflex artery has 40% blockage but all my other arteries are clear. I only included that part for this forum as my query is heart related. So is it not dangerous to take Levothyroxine with coronary artery disease then as I’ve read it can be but I’m not sure why hence my question? Can you shed more light on the subject for me?
Although I have some general idea about thyroid hormone and heart disorders, I am far from knowledgeable.
What I can readily say is that there is an awful lot of failure to understand the issues.
I hope that others with particular understanding will reply - and I shall try to keep an eye open.
Hi Buffy, as helvella said, with cad your doctor needs to be careful with increasing doses, doses need to be smaller and you possibly need more time to adjust. May I ask what the cause of plaque was? Also, my leaflet for levo says that you need to be started at a lower dose than 50 mcg of levo if you are over certain age, if you are frail, have history of cad. Who is the doctor who wants you on levo? Ahat is yout cardiologist saying?
I was prescribed 50mcg at first but I queried it with my own dr (as it was a different one who called me saying my thyroid was low so need a supplement) and my own dr then said to start on 25mcg for four weeks then go up to 50mcg and have blood test after 6 weeks total of taking it.... my cardiologist doesn’t know my thyroid has gone under active yet I don’t think and I’m not due to see him until July . I think my plaque was caused by smoking (which I’ve now stopped) snd familial hypercholestraemia (inherited high cholesterol) I’m really not happy about taking Levothyroxine but I feel it may be just as dangerous to wait till July gill I see my cardiologist? I just don’t know what to do
The problem with that approach is this:
It can take six weeks for levels (TSH, FT4 and, if you are lucky, FT3) to stabilise after a dose change.
If you started on 25 it might not have stabilised by four weeks. Then you adjust the dose and test after just two weeks! I think you can see you are unlikely to have stabilised.
The idea of four weeks on 25, then up to 50 might be fine. Especially if you are in the position of making the decisions yourself. That is, if you feel you need to raise it earlier, or defer the raise a bit, you can. But the dose change to test time is questionable.
It isn't that doing a test is awful. It this that decisions based on any tests would be questionable. And having had a test on one day, you might be refused one at the appropriate time!
Hey Buffy, it seems sensible to start at 25, rather than 50. You can also increase your dose by 12.5 mcg instead of 25 mcg afterwards, it might be more gentle, but it depends on how your body reacts. I don't think untreated hypothyroidism should wait any longer, but definitely have a chat with your cardiologist in July.
High cholesterol is linked to being hypothyroid
nhs.uk/conditions/statins/c...
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.
Quitting smoking can affect thyroid...though frequently the issues are there before quitting...but thyroid needs testing much more frequently for2 years after quitting
verywellhealth.com/cigarett...
ncbi.nlm.nih.gov/pmc/articl...
Standard starter dose of levothyroxine is 50mcg (unless over 65 years old).
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many patients need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range
NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
nhs.uk/medicines/levothyrox...
Also note what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
For full Thyroid evaluation you need 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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels and thyroid antibodies
You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood 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)
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
As you have heart issues....ask for referral to endocrinologist
I have atherosclerosis in lad 30-50% and 50% in right. I have that with hashimotos and fibromyalgia. I am on 80mg atorstatin to get cholesterol down to under 2! I take 75mcg one day and 100mcg another of levothyroxine.
Brandonsmum
That’s quite a low dose levothyroxine...suggest you get full thyroid and vitamin testing
Hi slowdragon, I've just had one in march and another next month. I've been quite ill the last few months and they increased the levo to 100mcg a day but my tsh dropped to 0.03 and they put me back down to 75mcg where I felt worse within about 2/3 weeks, they have now told me 75mcg one day and 100mcg another, its been about 2/3 weeks and still been rubbish. One doctor said its thyroid and another says it fibro (diagnosed a year ago) and another says its depression lol. More bloods next months as now sugar levels 47mmol and 1st stage liver, all go, just think 2 years ago I was normal lol 😆
Just testing TSH is completely inadequate.
Never ever agree to dose reduction based just on TSH
Fibromyalgia is a dustbin diagnosis...usually causes by low Ft3 due to inadequate dose of Levo and/or poor conversion of Ft4 to Ft3
Strongly recommend getting full thyroid and vitamin testing after 6-8 weeks on this reduced dose
For full Thyroid evaluation you need 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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels and thyroid antibodies if not been tested
You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood 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 you do your tests?
What vitamin supplements are you currently taking?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus ultra vitamin
medichecks.com/products/thy...
Medichecks often have special offers, if order on Thursdays
Thriva Thyroid plus vitamins
Blue Horizon Thyroid Premium Gold includes vitamins
bluehorizonbloodtests.co.uk...
Come back with new post once you get full results and ranges
Improving nutrients improves conversion
healthunlocked.com/thyroidu...
Also ....guidelines by weight might help push for dose increase
Even if frequently we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
NICE guidelines on full replacement dose
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.
gp-update.co.uk/Latest-Upda...
BMJ also clear on dose required
bestpractice.bmj.com/topics...
Few links about fibromyalgia
healthrising.org/blog/2019/...
thyroiduk.org/tuk/research/...
thyroiduk.org.uk/tuk/relate...
stopthethyroidmadness.com/f...
prohealth.com/library/new-t...
chriskresser.com/low-t3-syn...
clinicaltrials.gov/ct2/show...
Your on a statin, heres an exercise for you... read the insert side effects of statins, then research symptoms of coenzyme Q10 deficiency. Clue you'll think your reading the same leaflet, point is statins really tank coenzyme Q10 levels, hey supplement 200mg a day and maybe bye bye fibromyalgia...
atherosclerosis, maybe try higb dose vitamin C why plaque forms is in the absence of adequate vitamin C the collagen fibres start breaking down, if you don't add in vitamin C in time the body makes lipoprotein A, lipoprotein A is the hardener to cholesterol hence the plaque. Once the vitamin C is restored the body breaks down the plaque. This used to happen yearly before we had high vitamin C foods all year round, now things like smoking really depletes vitamin C...
Cholesterol isn't the problem its just in there with lipoprotein A you can get the book "the great cholesterol con, by Dr Malcolm Kendrick..."
Hope that helps and makes sense...
What vitamins would you suggest I take, as I'm not on any atm. Thanks
Get vitamin levels tested before starting on any vitamins
Vitamin D, folate, ferritin and B12
I put that on the post I started with blood results, as Im hijacking someone elses post, sorry 🙈
I am thyroidless due to cancer. So I am on thyroid hormone. I also have coronary artery disease, but no stents. Not only do I take T4, I take T3 as well. It is really important to understand that the heart requires optimal free T4 AND free T3 in order to function healthily and optimally. There are decades of research papers in the American cardiology literature on the value of free T3 in heart health. I would go so far as to say that not taking the recommended 25mcg of levothyroxine, while showing a TSH of 7.2 and a free T4 of 12.1, would do more harm to your heart than taking it. I do agree that any increase beyond that should be done with care. Your heart, like all of your organs and cells, needs a healthy amount of circulating thyroid hormone to function. I would want to talk to my cardiologist about checking and reporting your heart rate and blood pressure daily during the first six-week period on levothyroxine, just to be sure. The cardiologist may not feel it’s necessary, since thyroid function is so important to cardiac health. After 5-6 weeks, I would want to strongly request both free T3 and free T4 to be tested along with TSH (a pituitary hormone). I hope it goes very well for you.
Absolutely...we see hundreds of people on here with terribly low Ft3 ...the heart needs T3
Plus low vitamin levels are almost inevitable when hypothyroid...leading to low vitamin D and low magnesium
Magnesium is essential for good heart function
medicalnewstoday.com/articl...
So what is T3 and should I take it? Thanks
T3 is the active form of thyroid hormone. We take T4 when we take levothyroxine. It enters the blood as free T4, but it is inactive. It must be converted by the body (mainly in the liver) to FREE T3, which is the active - or bioavailable form of the hormone. But most who have hypothyroidism tend to have poor conversion and end up with insufficient Free T3, with cells and organs being starved for Free T3. Many of us need to take prescription T3 (Cytomel) to get free T3 and free T4 properly balanced and the body functioning well. However, doctors choose to ignore this, so we have to fight even to get FREE T3 tested in bloods. Knowing free T3 and free T4 is just as important as, if not more important than, knowing just TSH.
Important to be testing Ft4 and Ft3 to see if taking enough levothyroxine (Ft4) and wether converting Ft4 into Ft3
Frequently left on too low a dose of levothyroxine and then low vitamin levels
Low vitamins result in poor conversion of Ft4 to Ft3 and low TSH
So we should ALWAYS get Ft4, Ft3, vitamin D, folate, B12 and ferritin tested
All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many patients need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range
NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
nhs.uk/medicines/levothyrox...
Also note what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
Brilliant film
drbradshook.com/understandi...
Improving nutrients improves conversion
healthunlocked.com/thyroidu...
Also ....guidelines by weight might help push for dose increase
Even if we frequently don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
NICE guidelines on full replacement dose
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.
gp-update.co.uk/Latest-Upda...
BMJ also clear on dose required
bestpractice.bmj.com/topics...
Ok, thanks
The cardiologist didn't want to see me again unless in pain or breathless, as they wont stent the arteries til 70% blocked/narrowed. I see the cardiologist around same time I started on 50mcg levo dec 2018 and didn't mention it.
My heart rate and blood pressure very low last year, heart rate was in 40s most of the time, I think it went as high as late 50s after exercise, the doctor said I had bradycardia. When I looked online it was linked to hypothyroid, so I haven't been checking bp or hr since then.
Thanks
As cabro says - you can of course self.monitor with a home device such as Omron machine - quite cheap to buy - £60- and reasonably accurate - probably what your cardiologist has on his desk. Perhaps you monitor anyway but it will give more control / visibility of issues before they become problems. All the best
Wanting to add more (I also have no thyroid but do have cardiac issues) but really all I can say - reread the excellent replies from Slow Dragon and Cabro.
Patti in AZ
Just a suggestion but if you are that concern about taking it. I would phone your cardiologist secretary and ask her if she could either give him a message asking what you should do or ask if it would be possible for him to phone you. That's what l would do in your circumstances.
Hi, I have stopped taking the statins now, from 2 nights ago and will see what happens, I am due more blood test next month and I am due a doctors call in the next couple of weeks. I will mention things to him. Thanks
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