Hypo with worsening cholesterol and kidney func... - Thyroid UK

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Hypo with worsening cholesterol and kidney function

Buffstera profile image
Buffstera

Hi, 1month on levo so far at 25mcg and think I will need an increase at my next NHS review. My cholesterol and kidney function results are heading in the wrong direction, despite doing exercise and eating healthier with plenty of water. Has anyone had success improving these while hypo and without statins?

TSH 5.29

FT4 15.5

GFR 73

Non-HDL cholesterol 4.08

HDL/Total ratio 26%

13 Replies

Buffstera,

Most definitely. All my results relating to liver & kidneys eventually returned to normal when I reached optimal thyroid hormone levels.

Thyroid hormones controls the rate at which your kidneys do their filtration work (GFR) and liver detoxification pathways where cholesterol and other lipids are synthesised, broken down and the unneeded excreted.

With a TSH of 5.29 you are still very under medicated, and 25mcg levothyroxine is a very small dose, so your doctor should give you a dose raise, and probably another after another six weeks. The goal of Levothyroxine is to restore a euthyroid status but symptoms can lag behind biochemistry by several months or longer.

Buffstera profile image
Buffstera in reply to radd

Thank you. That’s reassuring to know that it can be done. My GP was fairly reluctant to medicate at all, until she agreed to speak to a specialist who told her to. So I took the 25mcg and figured one battle at a time! V glad to know the kidney/cholesterol does respond to thyroid level optimisation and will be ready to push for it

radd profile image
radd in reply to Buffstera

Buffstera,

A euthyroid status when medicating thyroid hormone replacement usually means reducing TSH to around 1 or below, with thyroid hormones kept within range. If your doctor is reticent in treating you, print off these papers to show her (links below). If she is still reticent then ask for a referral. .

The relationship between the thyroid gland and the liver (scroll down to hypothyroidism)

academic.oup.com/qjmed/arti...

.

Interactions between thyroid disorders and kidney disease

ncbi.nlm.nih.gov/pmc/articl...

Buffstera profile image
Buffstera in reply to radd

Brilliant. Thank you.

SlowDragon profile image
SlowDragonAdministrator

How old are you?

Standard starter dose of levothyroxine is 50mcg unless over 60

Levothyroxine doesn’t top up failing thyroid, it replaces it, so it’s important to get dose increased slowly upwards in 25mcg steps until TSH is ALWAYS under 2

Most/many people, when adequately treated will have TSH well below one

See GP, you need dose increase up to 50mcg.

Also important to test vitamin D, folate, ferritin and B12

Thyroid levels should be retested 6-8 weeks after each dose increase

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

guidelines on dose levothyroxine by weight

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Buffstera profile image
Buffstera in reply to SlowDragon

I’m 39, I’ve just been picking my battles as it took so long to get treated at all. Had B12 injections in Feb and she wants to wait 6months and retest (despite going against NICE guidance) but I’m planning on pushing for that earlier too because private tests show still in range but dropping. I’m taking ferrous sulfate daily and levels have gone from 21 to 60. Also supplementing folate and vit D, those are both now optimal.

SlowDragon profile image
SlowDragonAdministrator in reply to Buffstera

Sounds like you could do with better GP

Low B12 strongly linked to being hypothyroid

How low was B12

Were you tested for Pernicious Anaemia

If PA test was negative you could probably improve B12 with supplements

Low folate and low B12

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B is another option that contain folate, but is large capsule

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

If serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

Buffstera profile image
Buffstera in reply to SlowDragon

B12 was at 160, took supplements for 3 months and still at 160, so looks like I can’t absorb it. Then after injections at 850. Not sure why she thinks I will now suddenly be able to absorb it and just one set of injections would be enough. Folate supplements work though and levels fine now.

SlowDragon profile image
SlowDragonAdministrator in reply to Buffstera

Which B12 supplement did you try

Buffstera profile image
Buffstera in reply to SlowDragon

I honestly can’t remember now

SlowDragon profile image
SlowDragonAdministrator in reply to Buffstera

Try this one ...

healthunlocked.com/thyroidu...

Plus daily vitamin B complex

SlowDragon profile image
SlowDragonAdministrator

High cholesterol will reduce as levothyroxine dose is increased

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.

Similarly low GFR should improve as levothyroxine dose increased

ncbi.nlm.nih.gov/pmc/articl...

Important to get thyroid antibodies tested if not been tested yet

About 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies or by thyroid ultrasound

Just remember, if your doctor starts telling you to take statins, that he/she can't force you to take anything. You can refuse and, in theory, it should have no impact on your dealings with doctors in any other way.

I told my GP 5+ years ago that I wouldn't take statins, and I also said I didn't want my cholesterol measured. It's worked okay for me so far, and my cholesterol is a lot higher than yours.

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