Hypo and cholesterol advice please: Hello I’m... - Thyroid UK

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Hypo and cholesterol advice please

Loubylou17 profile image
25 Replies

Hello

I’m looking for some advice please prior to a GP appt. I’ve had a phone call with the GP and said how tired I’m feeling but I also had raised cholesterol (no numbers GP test). I said this could be due to under medication take Levo 75mg. Was then told I need to pass a risk test for statins. Had more blood tests with GP ‘to rule out anything else’. Since my Oct results I’ve supplemented some iron and Vit D

Any thoughts please on my ft3 level. GP says my TSH is ‘normal’, I have said this could be lower.

Many thanks

October 22

TSH 1.06 mIU/L (.27 - 4.2) 20.1%

Free T4 (fT4) 15.2 pmol/L (12 - 22) 32.0%

Free T3 (fT3) 4.11 pmol/L (3.1 - 6.8) 27.3%

T4:T3 Ratio 3.698 

C-Reactive Protein (CRP) .51 mg/L (0 - 5) 10.2%

Folate - Serum 3.78 ug/L (≥ 3.89)

Vitamin B12 (active) 115 nmol/L (37.5 - 150) 68.9%

Vitamin D 38 nmol/L (50 - 200) -8.0%

Ferritin 12 ug/L (13 - 150) -0.7%

February 23

TSH 1.19 mIU/L (.27 - 4.2) 23.4%

Free T4 (fT4) 16.5 pmol/L (12 - 22) 45.0%

Free T3 (fT3) 4.03 pmol/L (3.1 - 6.8) 25.1%

T4:T3 Ratio 4.094

 Vitamin B12 (active) 141 nmol/L (37.5 - 150) 92.0%

Vitamin D 23 nmol/L (50 - 200) -18.0%

Ferritin 21 ug/L (13 - 150) 5.8%

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Loubylou17
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25 Replies
Jaydee1507 profile image
Jaydee1507Administrator

What time were these tests taken and did you stop biotin supplements for 5-7 days before and levo for 24hrs before?

Your folate was deficient in October. Did you get 5mg folic acid prescribed? It's not been retested? No result in February for folate.

Vit D has gone down. What and how much are you taking. You need D3 with K2 to help it go to the bones and enough of it. Use this calculator to work out how much to get it to 100. grassrootshealth.net/projec...

Ferritin has gone up, well done, long way to go but it can be very slow. Keep eating chicken livers etc

Thyroid wise you have plenty of scope for a 25mcg dose increase. Your free's are pretty low and multiple low vitamin levels likely keeping your TSH low too. Raising vit levels will help your TSH.

Working on all these + a dose increase will help your cholesterol.

Loubylou17 profile image
Loubylou17 in reply to Jaydee1507

Thank you, all tests early am no Levo for 24hrs and no vit supplements for a few days. The Vit D maybe isn’t high enough dose 400iu. No prescribed iron or vits as didn’t go to GP in Oct. Another topic for the GP can’t add K vits as take Warfarin.

I’m aiming for a dose increase rather than adding yet another drug.

Jaydee1507 profile image
Jaydee1507Administrator in reply to Loubylou17

I think you are misunderstanding the role of vitamins in hypothyroidism and what they are. They help your body make red blood cells to stop you being anaemic for one, amongst a host of other functions. If we have low vitamins then our thyroid hormone cannot work properly. So that it is why they are important to raise to OPTIMAL levels so Levo can do its thing well. They are not drugs. They just replace what your body is missing like Levo does.

webmd.com/a-to-z-guides/fol...

400iu of vit D is not enough to do anything, not even minimum government recommended dose. Use the calculator to work out accorording to your weight how much you need. This range works well for many people.

betteryou.com/collections/v...

Yopu really need to make an appointment with your GP to discuss your vitamin deficiencies, they may want to run their own tests.

Loubylou17 profile image
Loubylou17 in reply to Jaydee1507

Thanks again, I wasn’t suggesting vitamins were drugs and I do understand their role. It was the addition of statins to reduce cholesterol if metabolism isn’t at an optimal level which would be adding another drug. I’ll use the calculator to check the suggested Vit D supplement. Thanks again

Regenallotment profile image
Regenallotment in reply to Loubylou17

Hey,

I’m sure I’ve read here that statins are not recommended (by NHS) for women with hypothyroidism here is an NHS link from a quick Google.

nhs.uk/conditions/statins/c...

There are other links, I could be wrong about who posted but I think tattybogle knows more. 🌱

Loubylou17 profile image
Loubylou17 in reply to Regenallotment

Thanks for the link I’m new to studying statins👍

Doris11 profile image
Doris11 in reply to Regenallotment

Thank you too I’ve been recommended to take Statins as a preventative measure 🙈

Tulipgrower1 profile image
Tulipgrower1 in reply to Jaydee1507

Your vit D is very low given those ranges. Re your cholesterol I have high 8.7 and have just been referred to the lipids clinic. Apparently if you are over 8 you should be referred to a specialist according to my GP.

SlowDragon profile image
SlowDragonAdministrator

75mcg levothyroxine is only one step up from starter dose levothyroxine

Your vitamin levels are terrible because you are highly likely not on high enough dose levothyroxine

Low vitamin levels tend to lower TSH

Approx how much do you weigh in kilo

Unless extremely petite, most people when adequately treated will be on at least 100mcg levothyroxine

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...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

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.

Partner20 profile image
Partner20 in reply to SlowDragon

In actual fact 75mcg is a sufficient dosage for many people, particularly if they are of slight build. Even the guidelines have this figure in their suggested ranges. One of my daughters is hypothyroid and maintains optimal TSH, FT4 and FT3 levels with 75mcg levo. The dosage according to weight guidance is for use only when initiating treatment to try to minimise the time needed to achieve the optimal dosage, but from what I have seen this has resulted in a large number of people being overmedicated at the start, resulting in additional problems. Some people need to reduce dosage after losing weight, some do not, so the weight/dosage ratio is rather arbitrary. Being so dogmatic about describing 75mcg as low/only a step up from a starter dose can have a negative impact on those seeking advice, perhaps making them think that dosage is the cause of all their problems, when it so often isn't.

SlowDragon profile image
SlowDragonAdministrator in reply to Partner20

if over 47-48 kilo (7st 6lb) then 75mcg levothyroxine may not be high enough dose

If over 63 kilo (9st 12lb) then 100mcg levothyroxine may not be high enough dose

SlowDragon profile image
SlowDragonAdministrator

Vitamin D 23 nmol/L (50 - 200)

vitamin D is deficient

GP obligated to prescribe LOADING dose vitamin D

That’s total of 300,000iu over 6 or 8 weeks

5000iu per day for 8 weeks

Or

7,000iu per day for 6 weeks

Retesting vitamin D at end of the course

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with thyroid disease, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

SlowDragon profile image
SlowDragonAdministrator

Ferritin 21 ug/L (13 - 150)

Ferritin is deficient

GP must do full iron panel test for anaemia

Any obvious reason for low iron/ferritin

Are you vegetarian or vegan

Or heavy periods

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Look at increasing iron rich foods in diet 

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

List of iron rich foods

dailyiron.net

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron 

Medichecks iron panel test 

medichecks.com/products/iro...

Links about iron and ferritin

An article that explains why Low ferritin and low thyroid levels are often linked 

preventmiscarriage.com/iron...

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin 

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

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.

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin 

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Excellent article on iron and thyroid 

cambridge.org/core/journals...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron 

healthline.com/nutrition/he...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Ferritin over 100 to alleviate symptoms 

healthunlocked.com/thyroidu...

Low Iron implicated in hypothyroidism 

healthunlocked.com/thyroidu...

Ferritin range on Medichecks 

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes: 

Males 16-60: 30-400 ug/L

Female's: 16-60: 30-150

Both >60: 30-650 

The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘

SlowDragon profile image
SlowDragonAdministrator

Oct 22

Folate was deficient

Did GP prescribe folic acid

No folate test from Feb 23?

Loubylou17 profile image
Loubylou17 in reply to SlowDragon

Thank you

That’s an amazing amount of info to read.

I’m not vegetarian or vegan, nor could I be called petite. 🤣 Losing weight is impossible!

I do take antacids which can affect absorption of vits and minerals.

Feb - Serum Folate 6.03  ug/L (≥ 3.89)

I’ve only spoken to GP who wanted to retest everything, so not actually seeing her until next week.

The GP surgery don’t have any old medical records for me because I moved from England to Scotland 12 months ago. This seems to be standard by what the surgery are telling me.

SlowDragon profile image
SlowDragonAdministrator in reply to Loubylou17

Do you mean GP prescribes omeprazole or Lansoprazole or similar….or you take over the counter Gaviscon or similar

Most hypothyroid patients have LOW stomach acid which can cause acid reflux, bloating, etc

Low stomach acid can be a common hypothyroid issue

Thousands of posts on here about low stomach acid 

healthunlocked.com/search/p...

But never assume you have low stomach acid 

healthygut.com/4-common-bet...

Web links re low stomach acid and reflux and hypothyroidism 

nutritionjersey.com/high-or...

stopthethyroidmadness.com/s...

thyroidpharmacist.com/artic...

 How to test your stomach acid levels 

healthygut.com/articles/3-t...

meraki-nutrition.co.uk/indi...

huffingtonpost.co.uk/laura-...

lispine.com/blog/10-telling...

Protect your teeth if using ACV with mother 

healthunlocked.com/thyroidu...

Ppi 

Omeprazole will lower vitamin levels even further 

gov.uk/drug-safety-update/p...

webmd.com/heartburn-gerd/ne...

pharmacytimes.com/publicati...

PPI and increased risk T2 diabetes 

gut.bmj.com/content/early/2...

Iron Deficiency and PPI 

medpagetoday.com/resource-c...

futurity.org/anemia-proton-...

onlinelibrary.wiley.com/doi...

sciencedirect.com/science/a...

SlowDragon profile image
SlowDragonAdministrator in reply to Loubylou17

Essential to get all four vitamins to optimal levels to help tolerate higher dose levothyroxine

Folate also too low

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

This can help keep all B vitamins in balance

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. 

If you want to try a different brand, one with virtually identical doses of the ingredients, and bioavailable too, then take a look at Vitablossom Liposomal B Complex. Amazon sometimes has it branded Vitablossom but it's also available there branded as Yipmai, it's the same supplement

amazon.co.uk/Yipmai-Liposom...

or available as Vitablossom brand here

hempoutlet.co.uk/vitablosso... &description=true

Or 

Igennus Vitamin B complex. Nice small tablets. Full dose is 2 tablets per day. Most people are fine with just single tablet 

igennus.com/products/super-...

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...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement

SlowDragon profile image
SlowDragonAdministrator in reply to Loubylou17

Weigh yourself in kilo

Take the weight in kilo x 1.6mcg - that’s the likely approx daily dose levothyroxine required

So for example if weigh 10st 8lb = 67kilo approx

67kg x 1.6mcg = 107mcg levothyroxine per day as likely daily dose

107kg x 7 days = 750mcg per week

So dose might be

100mcg x 3 days week and 112.5mcg x 4 days week

SlowDragon profile image
SlowDragonAdministrator

Have you had BOTH thyroid antibodies tested for autoimmune thyroid disease (hashimoto’s)

NHS only tests thyroglobulin (TG) antibodies if TPO antibodies are high. Significant minority of Hashimoto’s patients only have high TG antibodies

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

Also 20% of Hashimoto's patients never have raised antibodies, so if both antibodies are negative get ultrasound scan of thyroid

healthunlocked.com/thyroidu...

 

Paul Robson on atrophied thyroid - especially if no TPO antibodies 

 paulrobinsonthyroid.com/cou...

Loubylou17 profile image
Loubylou17 in reply to SlowDragon

I have Lansoprazole prescription take daily otherwise acid reflux makes me sick.

Medichecks results for Thyroglobulin 14 IU/ml (<115)

TPA <9 IU/ml (<34)

Thanks I’ll get onto buying a Vit B complex. Lansoprazole will be reducing absorption of all vits and iron.

I’ve been just living with the fatigue now for too long.

SlowDragon profile image
SlowDragonAdministrator in reply to Loubylou17

Getting vitamin levels improved so that you can get levothyroxine dose increased and then can ween off PPI

Strongly recommend trying strictly gluten free diet too

But only make one change at a time

StanleyThyroid profile image
StanleyThyroid

I have a similar situation where my TSH increased over the last 24 months and my cholesterol, weight and BP have also gone up. I went to the doctors fully expecting to be given a statin prescription (which I am keen to avoid) but instead had a good discussion about sorting out my levels and vitamins as well as increasing my levo. I am now awaiting my next set of bloods in a couple of weeks to see how things are progressing.

Loubylou17 profile image
Loubylou17 in reply to StanleyThyroid

Great this is what I’m hoping for too, :-)

buddy99 profile image
buddy99

A pubmed thought on statins for women: ncbi.nlm.nih.gov/pmc/articl...

Batty1 profile image
Batty1

I just had my cholesterol checked and my doctor phone which I was surprised but Im still (waiting for final results) she said Im still making butter “just kidding” not really Im a freaking butter factory and I can’t take statins they just about killed me anyway I have for the past month prior to the cholesterol test decided to clean up my diet by removing junk and adding ground flaxseed and spinach back to my morning smoothie and taking (without my Endo’s knowledge) more T4 and T3 not a lot just nibbling a little off each pill when I take my regular script…. Anyway my LDL has dropped 12 points.

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