Statins and levo

[Moomin1961]

I have been treated for hypothyroidism for several years now and have been stable for the last few. Given my latest cholesterol results - 8.2 mmol/l, up from 6.2 three years ago, of which HDL is 2.1 - I’m assuming my GP is going to want me to take statins. I was shocked as I have been eating all the right things and also taking plant sterols so I had expected a reduction. A quick google has revealed some research findings that statins reduce serum TSH significantly so I’m wondering if any of you lovely folk can give me some advice before I speak to her. With thanks as always xx

[SeasideSusie Remembering]

Moomin1961

What the NHS says about statins

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.

[Ukie in reply to SeasideSusie]

I am about to have the 'statins conversation' with my doctor, so thanks a lot for the NHS link.

[Moomin1961]

Thanks SeasideSusie. Rather worried now!

[SlowDragon Administrator]

So how much levothyroxine are you currently taking

When were thyroid levels and vitamin levels last tested

High cholesterol levels suggest you are under medicated for thyroid and therefore still hypothyroid

Do you always get same brand of levothyroxine at each prescription

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 at least annually

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

About 90% of primary hypothyroidism is autoimmune thyroid disease

Ask GP to test vitamin levels (and thyroid antibodies if not been tested yet)

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)

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/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[humanbean]

Plant sterols aren't recommended by the NHS.

If your doctor has told you that you have high cholesterol and you can lower it by changing your diet, there's no need to buy special products to lower your cholesterol.

These products are not recommended by doctors and are no substitute for a healthy, balanced diet.

There are foods specially designed to lower your cholesterol, such as certain dairy spreads and yoghurts containing added ingredients called plant sterols and stanols.

There's some evidence these ingredients may help reduce the cholesterol in your blood, but there's no evidence they also reduce your risk of a heart attack or stroke.

Source : nhs.uk/live-well/healthy-bo...

Personally I wouldn't take a statin if you paid me, and my total cholesterol is similar to yours.

Take a look at these links :

drmalcolmkendrick.org/2012/...

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

diabetes.co.uk/forum/thread...

The last link above is for a diabetes forum thread which has dozens of links on statins and cholesterol.

[SlowDragon Administrator]

Important for many thyroid patients to always get same brand of levothyroxine at each prescription

guidelines on dose levothyroxine by weight

Even if we frequently 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 eventually 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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Guidelines are just that ....guidelines.

Some people need more, some need less

healthunlocked.com/thyroidu...

[greygoose]

Just because your doctor wants to prescribe statins, doesn't mean you have to swallow them. There's no law that says you have to take everything your doctor prescribes.

Cholesterol has little to do with diet. It is made in the liver, and the more you consume, the less it makes. The less you consume the more it makes, so as to keep a constant level of cholesterol in the body. However, when T3 is low, the body is unable to process and eliminate cholesterol normally, and it tends to build up in the blood.

I don't know what you mean by 'eating all the right things' - I didn't know there were right things to eat as far as cholesterol is concerned - but I do hope you don't mean you gone low-fat/fat-free. Firstly, there is no connection between fat and cholesterol, despite what the NHS says! They are two entirely different substances and fat does not turn into cholesterol when you eat it. Secondly, the body needs fat. Fat-free diets are very dangerous for both your physical and mental health. Thirdly, eating fat does not make you fat. So, feel free to eat fat!

[Moomin1961 in reply to greygoose]

Thanks Greygoose - by the right foods I mean oats, nuts, seeds, fruit and vegetables - the only things I try to avoid are processed meat, salt and sugar. Perhaps I’ve watched Dr Michael Mosley too much. However you explain very simply why cholesterol isn’t influenced by diet.

I’ve been feeling well on 100 micrograms of levothyroxine so haven’t argued too much with my GP about only having TSH measured. I had it tested last week and at 1.3 mIU/L (0.3 - 4.5 range) it’s higher than 18 months ago when it was 0.3 - and I have always followed the advice here about having the blood taken early in the morning before taking levothyroxine. Both you and Slowdragon have now got me thinking about having private tests done, although I would have thought I wouldn’t be feeling well...?

[greygoose in reply to Moomin1961]

Funnily enough, the way we feel doesn't always correspond to the results of our blood tests. But, it would be a good idea to get them done privately, anyway.

Not a good idea to avoid salt. Our adrenals need salt, as does the rest of our body. The main thing to avoid is soy.

[jjf255 in reply to Moomin1961]

This is going to sound so contrary to what so many think raises our bad cholesterol, but do yourself a favor and read up on the benefits of lowering bad carbs and raising your "GOOD" fat consumption. It's really quite interesting. Do this before jumping into taking statins. That's a whole other story. For those with hypothyroidism, it is very important for all body functions to have T4 and T3 in optimal range and a low TSH. Many hypo sufferers do have high cholesterol when these #s are not in range.

[userotc in reply to greygoose]

100% agree!!

[FancyPants54]

I'm with greygoose on this. I wouldn't swallow a statin if you paid me a large sum of money. Cholesterol is not the devil it was made out to be. I'm so swift with anyone who looks at my blood and mentions my cholesterol that they rarely get to finish the sentence. I have "drug averse" written in my notes. Too right I'm drug averse! My cholesterol is there for a reason. It's high because my thyroid level isn't right. I'm working on that.

[userotc]

Spot on! Especially being drug averse!