Raised cholesterol and hashimotos

[Cecilbenhard]

What experience do people have of raised cholesterol? I’ve been shocked to be told I have this. I don’t yet know at what level as I have yet to speak to my doctor next week. I’m 66 on low levothyroxine as I find it hard to tolerate much above 38 mg dose. I’m 5 foot five height and around 8 stone or just below all my adult life. I’m vegetarian with occasional fish eating.

[MichelleHarris]

Yes I found out I had high cholesterol, 7, for a least 10 yrs but was never told!

I was also undiagnosed hypothyroid. Again neglected as I was classic.

Now I’m being treated for that, cholesterol is coming down nicely.

I also take Omega 3 but always did do. Its meant to help.

Are you being adequately treated for your Hypothyroidism?

You can find out all your results through Open Access to Patients. They cant not give you them so dont be worrying for a week.

If they offer you Statins have a good look into it. I personally would not have them x

[Cecilbenhard in reply to MichelleHarris]

Thanks Michelle, I will not have statins either but I have had palpitations even on such low Thyroxine and I've tried T3 and nature thyroid! I can't find one that works.

[SlowDragon Administrator]

High cholesterol is linked to being under medicated and still 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.

[SlowDragon Administrator]

Previous posts show you were experimenting with NDT

Are you now back on just levothyroxine

To tolerate any replacement thyroid hormones we need OPTIMAL vitamin levels

As a vegetarian what vitamin supplements are you currently taking?

We need OPTIMAL vitamin D, folate, ferritin and B12

Obviously non meat eaters are frequently low in B12 and iron/ferritin

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

First thing is, do you have any actual blood test results? if not will need to get hold of copies.

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone 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.

Link re access

healthunlocked.com/thyroidu...

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.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

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

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)

If/when also on T3, or NDT make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

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 antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

[SlowDragon Administrator]

guidelines on dose levothyroxine by weight

Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on, or near 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.

Also here

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

gp-update.co.uk/Latest-Upda...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

8 stone = 50 kilo x 1.6 = 80mcg per day as likely dose you may need.

80 x 7 days = 560 = 6 x 75mcg per day and 1 x 100mcg per day

Some people need more, some find it hard and very slow journey to tolerate small increases over many months

Which brand of levothyroxine are you currently taking

Do you always get same brand

[Cecilbenhard in reply to SlowDragon]

thanks for this reply it's much appreciated. I have read lots and seen two private practitioners. I am now on bio identical levothyroxine in olive oil gel capsules. I take 25mg and 12.5 mg per day but get palpitations and breathlessness if I continue at this dose so currently I am alternating daily between 25 one day and 25+12.5 the next day which prevents the breathlessness and palpitations. I have had full bloods and all vitamins/minerals are optimal but I take multiple vitamins/min (lamberts) high potency + Vit D, fish oils and Vit C. Find increasing doses highly problematic and it makes me feel really unwell. Help!!

[SlowDragon Administrator in reply to Cecilbenhard]

Palpitations are frequently due to being under medicated

If been under medicated a long time it can be extremely difficult to increase dose upwards

Breathlessness often low ferritin/iron

Please add actual results and ranges on vitamin D, folate, ferritin and B12

Multivitamins are never recommended on here. Most contain iodine not recommended for anyone on levothyroxine, especially if you have Hashimoto’s

[Cecilbenhard in reply to SlowDragon]

Thanks so much this is so useful. I will post results later. What do you recommend to help tolerate dose increase?

[SlowDragon Administrator in reply to Cecilbenhard]

what are most recent vitamin results and ranges

[Cecilbenhard in reply to SlowDragon]

Hi - results from October Vitamin D 128 nmol/L 50

Serum TSH 6.67 mu/L

Vit B12 1309 ng/L

Serum folate 16.6 ug/L

Serum transferrin 2.6 g/L

Serum iron level 20 umol/L

Transferrin saturation 31%

[SlowDragon Administrator in reply to Cecilbenhard]

Your TSH is extremely high

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

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

[SlowDragon Administrator]

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

Are you currently taking Teva?

Teva, Aristo and Glenmark are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[humanbean]

You might find this reply to another member of interest :

healthunlocked.com/thyroidu...