Hypothyroidism and Statins

[Walk2Run]

Diagnosed with hypothyroidism 25+ years ago which has been successfully managed since then (75mcg Levothyroxine.) After many years of resistance to taking statins took the plunge and began medication in the springtime of this year - 20 mg Atorvastatin. All ran smoothly for 3 months with no side-effects. Then, at the point where I’d been asked to book in for a 3-month post-statin blood test I began to experience debilitating side-effects - aches in my back, hips and feet and then when they began to subside tiredness and fatigue. Blood tests saw an improvement in cholesterol - down to 4.7 - but elevated liver enzymes -

AST serum level 57iu/L (0-40)

Serum alanine aminotransferase 92iu/L (0-40)

Serum gamma-glutamyl transferase 84iu/L (0-55)

As a result, I was sent for a liver ultrasound which thankfully came back showing no damage/issues.

At appointment with doctor to discuss results and symptoms, I told her that I was going to discontinue Atorvastatin which I did - that was about 5 weeks ago. I asked for thyroid function test as I’d read that statins could interfere with absorption of Levothyroxine (and was therefore the most likely cause of my fatigue) and she also added in folate and vitamin B. All the results are in now -

Pre-statin TFT

T4 19.3 pmol/L (10-20)

TSH 0.2 mu/L (0.2-6)

Latest results

T4 23.5 pmol/L (10-20)

TSH 0.1 mu/L (0.2-6)

And

Serum folate 2.43 ng/mL (>5.4)

My general wellbeing has gradually improved over the last 5-6 weeks - more back to ‘my normal’ but I’m still having the occasional day of tiredness/fatigue so progress is not linear which is puzzling me (I’d have thought that now that Levothyroxine was being absorped again properly there would be a steady improvement in energy levels not an improvement for a few days followed by a dip.)

I’ve not yet been able to get back to the doctor to discuss latest results.

What thoughts/insights do you have?

[arTistapple]

WalkRun on symptoms - having been well established on your medication for many years, it must be upsetting giving into the push for statins, to see your FT4 levels rising above the so-called range and worse, the development of symptoms associated with statins. Many of these symptoms are also recognised hypo symptoms of course. So it seems after being well established, what are the chances it’s the statins? High.

Symptoms from statins vary, especially when you stop them. I would think this is because ‘statins’ would prefer not to have ‘bad press’. So little or no research into that aspect. I have no idea about how long it takes for those symptoms to improve. As you have been wise enough to spot this problem early on, hopefully the symptoms will go soon. I only improved on a very short episode of taking T3. However I am unable to take T3 presently.

It might take longer than you hope to get rid of the symptoms. Not saying this to deflate you, just to kind of prepare you.

[Walk2Run in reply to arTistapple]

I’m normally a very active person - run and hike - but am having to take each day at a time. It’s very frustrating and has affected my mental health but I’m asking questions, requesting tests and doing my own research so although it’s out of my hands I’m doing all I can to get back to where I’d like to be.

[greygoose]

I don't think it has anything to do with statins affecting your absorption of levo - you haven't given a result from during the time you were taking them so difficult to know if they actually did affect absorption. But to have an FT4 that high:

FT4: 19.3 pmol/l (Range 10 - 20) 93.00%

and

FT4: 23.5 pmol/l (Range 10 - 20) 135.00%

more than likely means that you are not converting your T4 to T3, the active hormone, and your FT3 is very low - which is why you had the high cholesterol in the first place. Plus the low T3 is causing your fatigue. T4 is basically a storage hormone that doesn't do much until it is converted to T3.

The solution to both 'problem's' - although I do not consider high cholesterol to be a problem - is not statins, it's T3. First of all you need full thyroid testing to highlight your poor conversion, and then you need to add T3 to a possibly reduced dose of levo.

Your high FT4 level is actually more problematic than your high cholesterol.

[Walk2Run in reply to greygoose]

Can you explain what you mean by ‘full testing’? When I’ve submitted bloods over the years TSH and T4 are the only entries on the results sheet.

[Marz in reply to Walk2Run]

You also need the FT3 testing along with TSH & FT4 for full testing. Anti-bodies ?

[FallingInReverse in reply to Walk2Run]

A compete picture of your thyroid health comes from these tests:

1) TSH

2) Free T3

3) Free T4

Plus these vitamins

4) ferritin

5) folate

6) B12

7)Vit D3

****Consistently test all at the same time, around 9 am is best if you can. Fasting before. No biotin for 3-5 days before. Last dose of Levo exactly 24 hours before. Wait a full 6-8 weeks after a dose change ****

These should be tested to see if an autoimmune cause to any thyroid issues can be identified:

1) TRab

2) TSI

3) TPOab

4) TGab

[Walk2Run in reply to FallingInReverse]

I did have B12, Ferritin and Folate tested. First 2 were within range.

Thanks for info re names of. I’ll research those.

[FallingInReverse in reply to Walk2Run]

In range is useless for these vitamins. They have to be optimal. Let us know your results - actual numbers and ranges - when you find them.

[Walk2Run in reply to FallingInReverse]

B 12 - 337 ng/L (180-910)

Ferritin - 45.4 uh/L (10-291)

Folate - 2.43 ng/mL (>5.4)

[FallingInReverse in reply to Walk2Run]

All too low.

B12 should be a minimum of 500

Folate top of range

See here for great advice and options for vitamin B supplements: healthunlocked.com/thyroidu...

Ferritin is too low and requires a full iron panel to see how you might address it. An iron panel generally consists of:

-Iron

-Total iron-binding capacity (TIBC)

-Transferrin saturation

-Ferritin (note - also in thyroid panel, needs to be included in the same draw, esp CRP-hs)

-High Sensitivity CRP (CRP-hs)

[Walk2Run in reply to FallingInReverse]

I’ve got some of those. Let me check.

[Marz]

Low folate could well cause fatigue.. are you supplementing ?

[Walk2Run in reply to Marz]

Just been put on Folic Acid for 4 months.

[Walk2Run]

Call from surgery pharmacist yesterday. I’m now over-medicated re levo - hence the above/below readings above and so the doctor has changed my dosage to lower one day and then usual dosage the next. I’m really surprised that my thyroid appears to be working a bit better now after 25+ years of the same dosage. I’d have expected the opposite with age. Statin-related or just a coincidence? I may get an answer when I’m retested in 3 months.

Also been put on Folic Acid for 4 months followed by subsequent testing

Down the line, once thyroid function and folate have stabilised, I’ll have to decide what to do about cholesterol.

Thanks to those who replied.

[Marz in reply to Walk2Run]

You are only over-medicated when your FT3 is over range - which was not tested ?? So when did you take your Levo dose prior to your test ?

Btw - Folic Acid is synthetic - you maybe better with Folate. 🌻

[Walk2Run in reply to Marz]

Ok. It was the pharmacist who called who said I was slightly over-medicated. And no, not been tested for T3.

I take Levo 7:30-8:00 and then wait 30-60 minutes before food/drink. Last test was taken around 13:20 so 5ish hours later.

[FallingInReverse in reply to Walk2Run]

How long before the blood test was your last dose of Levo? Was it the same for both?

[Walk2Run in reply to FallingInReverse]

Latest result was for bloods taken about 5 hours after Levo dose. Previous bloods were about 7 hours after.

[FallingInReverse in reply to Walk2Run]

Your tests are a false high.

Your last Levo dose should be consistently 24 hours.

Doctors either won’t mention this or will tell you to take it before. This will not lead to an optimal dose, or consistent assessment of optimal dosing.

Chances are you do not need a dose decrease. But without testing done under the recommended circumstances it’s impossible to say.

[Walk2Run in reply to FallingInReverse]

I’ll make sure to take meds after any future tests.

[FallingInReverse in reply to Walk2Run]

it’s also very likely that if/when your thyroid numbers optimize your cholesterol will go down on its own. Mine did m, as does many others on this board.

[Walk2Run in reply to FallingInReverse]

My cholesterol has been considered high for almost as long as I’ve been been treated for hypothyroidism. I’ve also over the years upped intake of all the foods/remedies (almonds, stenol drinks, porridge, okra water etc) that are suggested to help lower cholesterol as well as increasing exercise. There has been little effect.

[FallingInReverse in reply to Walk2Run]

Low Free T3 is correlated to high cholesterol. Diet won’t help if that’s the cause for you.

You need to get a FT3 reading - at the same time as all the others for a full picture.

[Walk2Run in reply to FallingInReverse]

Why isn’t this done as standard in UK? Especially if it’s the key to resolution of the problem.

[FallingInReverse in reply to Walk2Run]

Welcome to the thyroid forum! I see now this is your first post!

The answer to your question is a long story, which you will hear repeated over and over on this forum.

It’s pretty much why this forum exists with nearly 140,000 members.

The explanation is that the NHS (and much of healthcare around the world) is completely broken.

I encourage you to browse the forum and post as much as you need with your questions. You will find the collective wisdom of this group’s shared experiences invaluable

[Marz in reply to Walk2Run]

It's mentioned on the NHS website that the Thyroid should be well treated before taking a statin. So GOOD levels of T3 are needed - the active hormone needed in every cell of your body...

[jgelliss in reply to Marz]

👍👏👏👏👏

[greygoose in reply to Walk2Run]

Cholesterol levels have nothing to do with diet or exercise. It is made in the liver (because the body needs it!) and the liver keeps levels steady by making more when you ingest less and vice versa. However, when T3 is low, the body cannot process cholesterol correctly, and it tends to build up in the blood.

But cholesterol itself if not any sort of problem. It doesn't cause heart attacks or strokes, quite the contrary. It's Big Pharma that tell doctors that to scare people into taking statins. High cholesterol is a symptom, not a disease.

Taking statins will not only lower your cholesterol levels, it will also lower your sex hormone levels, because sex hormones are made of cholesterol. Lowering sex hormones puts you at greater risk for hormone-dependent cancers, like breast cancer. Most of your body is made up of cholesterol: your brain and your cell walls. If your cholesterol is too low then your body can no-longer repair and regenerate itself, putting you at greater risk of heart attacks and strokes. People with higher levels of cholesterol tend to live longer than those with low levels.

I’m really surprised that my thyroid appears to be working a bit better now after 25+ years of the same dosage.

That would be surprising, yes. Because after 25+ years on thyroid hormone replacement, your thyroid isn't working at all. Levo reduces your TSH, and without the TSH to stimulate it, the thyroid cannot produce hormone. With a TSH of 0.1, your thyroid is fast asleep and has been for some time.

Levo does not make your thyroid work better, it doesn't cure anything. It is thyroid hormone replacement, replacing the hormone that your thyroid can no-longer make enough of to keep you well. But due to the way you've been doing your tests, you've probably always been under-medicated, which is why you've always had high cholesterol. Testing before 9 am will give you the highest TSH, and leaving a gap of 24 hours between your last dose of levo and the blood draw will give you the level of your normally circulating T4, rather than the false high given if you take your levo before the blood draw. Do the testing correctly and you might even find yourself with an increase in dose!

[Walk2Run in reply to greygoose]

Food for thought. Will be interesting to see results in 12 weeks. (I’ll try to follow the 24-hour post-levo regime.)

[FallingInReverse]

I also encourage you to retest that full thyroid panel leaving 24 hours exactly from your last Levo dose and test as close to 9 am; doing medichecks if you need to.

I encourage you to do this immediately before you do your dose reduction .

Did you already reduce? If you didn’t hold off until you can test if at all possible.

It is essential for you to know what your actua results are now. Once you change your dose, you will need to wait 6-8 weeks before you test again.

Also - what exactly did the doctor recommend as your dosing schedule?

[Walk2Run in reply to FallingInReverse]

What do you mean by ‘medichecks?’

Not easy to time things exactly as I’m at the whim of when I can get an appointment for bloods.

I’ve already started the new regime -75/50mcg on alternating days. Retest in 12 weeks.

[FallingInReverse in reply to Walk2Run]

What country are you in?

edit - I see now, you’re in the UK.

There are a number of private blood testing companies. Medichecks seems to be mentioned/used here a lot. But I’m in the US so you can start a new post but also probably search the forum for the word medichecks and find related info.

If someone in the UK reads this, please help out with some of the standard private blood test options.

Also, how many days into the new regiment are you exactly?

[Walk2Run in reply to FallingInReverse]

I’m 2 days in.

[FallingInReverse in reply to Walk2Run]

So you’ve had one dose of 50? And you’ve been on 75 steady for 25+ years.

If you were inclined to get an accurate blood test under the right conditions before you go further, you could figure out the right timing for that.

It would be really good to know what your test results are on the dose that you felt good on for so many years.

But since this is all new to you, and youre just rolling with the dose change, keep us posted on how it goes.

[Marz in reply to Walk2Run]

Look at thyroiduk.org where you will find Medichecks and other on-line testing companies. Used by 100's of us here.

[Walk2Run in reply to Marz]

Will do.

[FallingInReverse in reply to Walk2Run]

Just saw this in another post of it helps. But keep

In mind once you’ve changed your Levo dose - it’s pointless to test any sooner than 6-8 weeks due to Levos 7-day half life that takes that long to build up to a stable level.

So if you’re going to stick it out with the new dose, you won’t need these just yet.

Test info

There's Randox, Medichecks, Monitor my Health, Blue Horizon. On the Thyroid UK website they have discount codes for some of the companies.

thyroiduk.org/testing/priva...

[Walk2Run in reply to FallingInReverse]

I’ll stick with the new dose and retest at some future date. And yes, I saw that list of testers after checking out the link Marz added.

[Walk2Run]

Ok, so have another question now. Should I test and there’s something significant (what would that be?) about the T3 score, what then? I’m thinking about this in the light of the UK not testing routinely so may not respond to the result especially one from an outside body.

[FallingInReverse in reply to Walk2Run]

The first step is knowing.

The second step is navigating the NHS to get what you need. For that there are NHS guidelines that can help to reference, sometimes people switch GPs, and there’s a whole lot of strategizing for how to have the conversation to get the dose you need. For example, you have a right to refuse a dose reduction. Some gps are better than others, and sometimes it’s a bit of a fight. But the more educated you are about yourself, the mote able you are to advocate for what you need.

But in all cases it starts with you knowing what you need. So private testing is sometimes the only way to do that.

If you continue to be symptomatic, and continue to read this forum, you’ll see just how common your experience is, and begin to learn so you can advocate for your self.

[Walk2Run in reply to FallingInReverse]

Thanks for your input.