Even in subclinical hypothyroidism, T4 therapy can lower unhealthy fat levels

[diogenes]

This is a rather old paper, but it shows very clearly that even in what is termed subclinical hypothyroidism, unhealthy levels of lipoproteins (potential harmful fats containing cholesterol) can happen. And these are mitigated by low dose T4 therapy. Haven't got a doi number but it is downloadable. It does question why, if this is a general finding with SCH, that low dose T4 isn't used to lower cholesterol levels.

Lipoprotein(a) Concentration in Subclinical Hypothyroidism Before and After Levo-Thyroxine Therapy

Metin Ozata

1996, Endocrine Journal

[knitwitty]

I think we can safely say that the reason Levothyroxine is not used to lower cholesterol is because there wouldn't be as much money to be made by the statin producing pharmaceutical companies and also someone taking levothyroxine might qualify for free prescriptions going forward. I get more cynical the older I get !

[greygoose in reply to knitwitty]

Just what I was going to say! Absolutely certain it's because of that.

[knitwitty in reply to greygoose]

Great minds think alike Greygoose, though I would suggest that your superior knowledge puts you in a much higher category than me !

[greygoose in reply to knitwitty]

Aw, don't be so modest! I just had a head start on you, that's all.

[buddy99 in reply to knitwitty]

I'm also getting more cynical with age. I wonder whether it has anything to do with our experiences with the medical system When my meds are upped my LDL goes down; and so does the TSH. This is where the problem lies as well. The medical accountants have to balance the TSH numbers separately from the lipid numbers.

[tattybogle]

Nice find . Thankyou "It does question why, if this is a general finding with SCH, that low dose T4 isn't used to lower cholesterol levels...."Good point.

[Kimmie4]

I'm curious about this finding as my experience shows the opposite. My cholesterol levels have increased since being on thyroxine (HDL has fallen, LDL and trig risen). Fatty liver on ultrasound.I've been advised to cut out bad fats, increase olive oil, avocados, sardines and take bran every day, then review. My GP doesn't want to prescribe statins yet due to familial trait to react badly. Sorry I don't have blood test levels to post as I'm away.

Have Hashimoto's and been much improved on Eutroxsig 75mcg, other than cholesterol levels which keep rising.

[Nat107 in reply to Kimmie4]

Hi kimmie, sounds exactly like me and I have been on thyroxine for many years. But my diet does consist of avocado olive oil tuna salads chicken etc so I don’t really think it’s my diet either. Could be my lack of exercise as not do active now but it’s so frustrating and worrying isn’t it

[SlowDragon Administrator in reply to Kimmie4]

Kimmie4

Likely to need dose increase in levothyroxine

75mcg is only one step up from starter dose

Likely under medicated

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

Essential to regularly retest vitamin D, folate, ferritin and B12 and maintain all four at OPTIMAL levels

[RedApple]

Nat107 , For help with your blood results, please start a new post of your own, as this thread is for discussion of the paper that diogenes has found. (You can copy and paste what you've written here into a new post).

[Nat107 in reply to RedApple]

Sorry yes I will do that Redapple

[Nat107 in reply to RedApple]

Iv deleted and started a new post 👍

[Noelnoel]

Not sure I fully understand the paper but is it possible that euthyroid restoration is the factor in reducing cholesterol

[diogenes Remembering in reply to Noelnoel]

That's the idea. Of course, no treatment wqorks the same for all, and resistants are quite possible. Also SCH is a very nebulous catchall concept. Whether one has it or not depends on how you measure it, and how you treat the results in the best way.

[Noelnoel]

What I meant was: is it in fact being euthyroid that reduces cholesterol and not levo that reduces the cholesterol? Given that having a healthy thyroid gland prevents all sorts of health problems could it be that just having a healthy thyroid prevents high Cholestid the first place

[diogenes Remembering in reply to Noelnoel]

I'm unsure what you mean. Taking T4 if you need it should promote a euthyroid response that results in lowered cholesterol.

[Noelnoel in reply to diogenes]

Apologies for being unable to make myself clear

Is it being in a euthyroid state that lowers the cholesterol? In other words, if one could, let’s say become euthyroid by other means; being optimally nourished for instance. Would that promote lower cholesterol? I understand that taking levo increases thyroid hormones and can be responsible for the euthyroid state but is it the levo creating lowered cholesterol or the euthyroid state?

Don’t know how else I can explain it. Perhaps someone else can do a better job than me

Of course I may be thinking absolute nonsense and I’m sure someone will put me right

[diogenes Remembering in reply to Noelnoel]

The term euthyroid means that you feel well enough whether you take T4 by mouth or make it normally as in untreated health. So the system is:T4 is converted to T3; the T3 then promotes the cell reactions that are typical of health; thus if the T4/3 were too low, specially by too little T4 taken by mouth, then cholesterol is raised. This is just one of several indications and responses to inadequate T4 in different markers typical of the state of hypothyroidism

[Noelnoel in reply to diogenes]

Oh, I thought the term euthyroid meant a well-functioning gland that was responsible for “normal” amounts of thyroid hormones. I didn’t think it mattered how euthyroidism was arrived at

[diogenes Remembering in reply to Noelnoel]

Very strictly speaking,"euthyroid" should be limited to health and normal thyroid. But because the added T4 in thyroid deficiency has the same object of regaining health, then euthyroidism could include the term given a restoration of health to something like it was before.

[Noelnoel in reply to diogenes]

Let’s take pharmaceuticals out of the equation and one question at a time because I’m starting to feel like an idiot

Could one or or could one not, experience raised cholesterol simply by being deficient in said hormones

[diogenes Remembering in reply to Noelnoel]

Yes

[Noelnoel in reply to diogenes]

So if a thyroid gland was slightly underperforming but within ranges, cholesterol was found to be high and nutrients low and by taking carefully chosen quality supplements thyroid levels rose and cholesterol declined, to what might we attribute the rise in thyroid hormone levels and the lowered cholesterol levels

One sentence answer if possible

[diogenes Remembering in reply to Noelnoel]

To the nutrients originally in inadequate supply eg selenium, vit D and others. They help the thyroid and lead on to increased T4 + probably lower cholesterol. Thyroids have the key role to play in the human body, but require continual help from many sources to perform optimally. I say optimally, which true for both full health and deficient thyroid activity, but where there in every case is a ceiling of how much boosting is possible.

[Noelnoel in reply to diogenes]

Thank you

[jimh111]

Only skimmed the paper, it's rather old but is an intervention trial that shows even a small dose of levothyroxine has profound effects in assisting the thyroid to cope. Four of the patients had radioiodine therapy so it seem criminal that they were not better cared for. All the subjects had a TSH > 6.5 with an average of 22.0! It's possible that levothroxine would not be beneficial in people with a TSH between 5.0 and 10.0 (I think it would but I'm just pointing out the possibility).

There have been other studies. One of my favourites is this oney academic.oup.com/jcem/artic... which looks at TSH in patients taking levothyroxine. This defines suppressed TSH (≤0.03 mU/L), low TSH (0.04–0.4 mU/L) and high TSH (>4.0 mU/L).

Many doctors panic when TSH is around e.g. 0.07 but send their patients packing if their TSH is 7.0. The evidence shows that for - cardiovascular, dysrhtythmia and osteoporotic fracture hospital admission or death - a TSH between 0.04 and 0.4 carried NO extra risk as compared to euthyroid subjects. On the other hand a TSH above 4.0 carried substantially greater risk than a suppressed TSH. Some patients will have had very high TSH levels but we can see from the plots in Fig. 2 that a TSH of 10 carries a similar risk to a fully suppressed TSH.

These are the values for people taking levothyroxine, things might be a little different for people without a diagnosis of primary hypothyroidism. However, it is plainly clear that a TSH a little above the reference interval carries much greater risk of cardiac or bone damage than does a TSH a little below the reference interval.

[lynmynott Partner Thyroid UK]

Here is the full paper in case anyone wants to read it - jstage.jst.go.jp/article/en...