Following on from my post 4 months ago - my GP agreed to raise my thyroxine dose to 100mcg and see what happened to my cholesterol. I feel a little bit better for the raised levothyroxine but still get very tired in the afternoon and evening (basically only have any energy in the morning) and still have a lot of joint pain. Following more recent tests I now have the nurse ringing me presumably to try to get me to take statins which I don't want to do. I have Hashimoto's and am on strict gluten free diet, have also been trying dairy free but not sure if that helps, am trying to reintroduce a little dairy.
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.
Just testing TSH is completely inadequate
Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?
You need FULL Thyroid testing - TSH, Ft4 and Ft3
Plus vitamin D, folate, ferritin and B12
Have any of these vitamins been tested?
Add results and ranges if you have any
Presumably you have Hashimoto’s
guidelines by weight might help push for dose increase
Even if 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
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.
Weigh yourself in kilo x 1.6 = likely dose needed.
Some people need more, especially if lactose intolerant
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
Yes, I have hashimoto's and tests were early morning, fasting, no levo for 24hrs.
They tested Vitamin D and Serum iron which I have posted above. They will never test T3 and I had to fight to get them to test T4 this time, I suppose i will have to do medichecks test.
I weigh 58 kg (was 63kg before going gluten and dairy free at the beginning of May) so going by weight 100mcg Levothyroxine is about right by my calculations.
My cholesterol levels have come down a bit since my levothyroxine was increased to 100mcg on 29th March. Do you know if this is likely to continue to improve or if the improvement is fairly immediate and therefore they won't come down any more?
I last had the full Medichecks thyroid ultra vit in Dec 2019 -
Ferritin 52.2 ug/L (13- 150)
Folate - serum 19.58 ug/L (>3.89)
B12 active 84.900 pool/L (>37.5)
Vit D 40.1 mol/L (50 - 175) - below range
I usually take Vitamin D, B 12 ( and selenium except I have run out).
I don't know if I'm lactose intolerant. I went strictly gluten and dairy free at the beginning of May. I think my digestion is much better without gluten (less bloating and cravings for carbs) but I can't decide if the dairy makes any difference. I was strict about dairy for 2 months then started introducing a bit of butter and occasional goat's milk kefir and cheese. I've just looked at my levothyroxine and it does contain lactose so maybe that has negated all my dairy free efforts! My diet is pretty good, I cook from fresh ingredients and avoid sugar which really doesn't do me any good( I feel especially bad with even a glass or two of wine unfortunately!) My joint pain wasn't quite as bad for a while during June but it got bad again at the beginning of July and i can't work out any clear links to diet (I keep a food diary).
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thanks - lots of really useful information here. Need to re check my supplements. I take magnesium but not K2 mk7. I love the vitamin D calculator! Interesting about ferritin and hair loss too.
High cholesterol is linked to low T3. When T3 is low, the body cannot process and eliminate cholesterol correctly. Therefore you cannot know if low T3 is the cause of your high cholesterol without testing the FT3. Of couse, I know that doctors are completely lacking in logic, but I would have thought that even a GP could have worked that one out.
You are right to resist statins. The cholesterol won't hurt you, but the statins more than likely would!
The nurse just rang about my cholesterol and she agreed about not taking statins if I have thyroid problem. She said the Dr probably looked at the result and flagged it up without looking at my notes. Great!
I won’t comment on anything else as I see you’ve got loads of helpful information already 😊. But just wanted to say my cholesterol was fairly high pre diagnosis but has come down every time I’ve had a levo increase. So I personally see a massive link between being under medicated and raised cholesterol levels. xx
Thanks Cat013 - my cholesterol has come down since my last levo increase but it's still over the NHS guideline level. The nurse rang me after I had posted this yesterday and I explained about the thyroid link and she said under the circumstances she thought it was fine not to take statins. x
Read some of Dr Kendrick’s books/blog; he is totally against statins, as am I. According to studies ‘higher’ cholesterol is linked to longevity. Statins can have nasty side-effects and do not increase life-span.
Can I just say this puts my mind at ease enormously. All the advice you have all given is brilliant and I am going through something very similar at the moment. I am considering some kind of dietary change but I don't know what at the moment as I do love yoghurt and rarely eat bread or cereals. Thank you and here's to avoiding the stations, healing the thyroid and getting healthy.
hI,I'd like to follow this, I have the same issue, was offered statins in May with a lower reading, think they will really push hard with this reading. If the hashimoto is affecting the cholesterol, there must be another way to deal with it. I too am gluten and dairy free, I have very little flare ups now, although, had one not long before this test, so could be my argument to stall their drug push.
any suggestions or findings would be greatly appreciated.
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