The Dangers Of Statins In People With Thyroid Dysfunction
If youve been following my work for a while, you probably know my opinion of statin drugs. Here are just a few of the articles Ive written on statins:
But it turns out that statin use is particularly concerning when the cause of high cholesterol is poor thyroid function. This is due to the effects of statins on creatine kinase levels.
Creatine kinase is an enzyme expressed in many different tissues throughout the body, though its probably most well-known for its action in muscle cells. CK is responsible for adding a phosphate to creatine to form phosphocreatine, which serves as an energy reservoir and allows for the quick release of energy in times of need.
Both statins and hypothyroidism result in CK release into the blood, and the cumulative effect is severe CK elevation . This can potentially amplify the adverse side effects of statins.
Yet, in reviewing the relevant medical records of 77 patients treated receiving statins in a hospital, a team of medical researchers discovered that only 23 percent of patients had received a thyroid panel before beginning statin treatment. Worse yet, 12 percent of patients with overt hypothyroidism received statins without receiving a thyroid panel or hypothyroid diagnosis .
The authors commented on their findings, emphasizing the need for routine thyroid screening in patients with lipid abnormalities:
What You Can Do To Improve Symptoms
Eating a proper diet, with a focus on calcium and sodium, is important, especially in preventing hyperthyroidism. Work with your doctor to create healthy guidelines for your diet, nutritional supplements, and exercise.
Hyperthyroidism can also cause your bones to become weak and thin, which can lead to osteoporosis. Taking vitamin D and calcium supplements during and after treatment can help strengthen your bones. Your doctor can tell you how much vitamin D and calcium to take each day. Learn more about the health benefits of vitamin D.
Treatment Options For High Cholesterol With Hypothyroidism
For information about best treatment options, Dr. Pearce told EndocrineWeb, In patients with both hypothyroidism and hyperlipidemia, the hypothyroidism should be treated first, and, for patients with optimally treated hypothyroidism who still require treatment for high cholesterol, the options are the same as those for patients with hyperlipidemia but without thyroid disorders.
Also, it is possible, even more likely, to have overt hypothyroidism and primary hyperlipidemia, in which case both conditions should be treated separately, she said.
Hyperlipidemia can also be a considerable risk for people with subclinical hypothyroidism. While there is less consensus regarding the treatment of high cholesterol in people who have subclinical hypothyroidism, several studies point to possible links.4,5
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The Association Between Thyroid Hormone Levels And Cholesterol
Today, a PubMed search for thyroid and cholesterol yields more than 3,000 articlesyet few people, and even few doctors, are aware of how various thyroid conditions can impact cholesterol levels.
Lets review the four major types and how they impact basic cholesterol measurements:
Hypothyroidism: People with an underactive thyroid, or hypothyroidism, often have increased levels of total cholesterol and LDL cholesterol and may have elevated triglyceride levels as well . Thyroid medication can significantly improve lipid profiles. A study in newly diagnosed hypothyroid patients found that total cholesterol and LDL cholesterol levels decreased after T4 treatment. Those with higher TSH levels at baseline saw a more dramatic reduction in cholesterol levels with T4 therapy .
Subclinical hypothyroidism: Subclinical hypothyroidism is characterized by elevated serum TSH with normal levels of free T4 and free T3. Subclinical hypothyroidism is far more common than overt hypothyroidism and may affect up to 9 percent of the population . Studies are mixed on the effect of subclinical hypothyroidism on lipid profiles, but even within the normal range of values, increasing TSH is associated with an increase in total cholesterol and LDL cholesterol . One systematic review found that T4 substitution therapy on average resulted in an eight mg/dL decrease in total cholesterol and a 10 mg/dL decrease in LDL cholesterol in people with subclinical hypothyroidism .
Treating High Cholesterol And Thyroid Disease
The good news is, treating thyroid disease may improve your cholesterol levels. Doctors treat hypothyroidism with thyroid replacement hormone medications. Thereâs no cure for hypothyroidism. Thatâs why improving your cholesterol levels doesnât improve your thyroid hormone levels. Experts recommend that adults whoâve been diagnosed with high cholesterol levels get tested for an underactive thyroid.
If youâre being treated for an underactive thyroid, your doctor will monitor your cholesterol levels. Some people with hypothyroidism may not lower their cholesterol levels enough with thyroid replacement hormones. If that happens to you, your doctor may recommend you take other measures, such as eating healthier, exercising regularly, and taking a cholesterol-lowering medication.
JAMA Internal Medicine, 2014: âThyroid Function Testing in Patients with Newly Diagnosed Hyperlipidemia.â
UpToDate: âLipid abnormalities in thyroid disease.â
Mayo Clinic: âHigh cholesterol.â
Pharmacy Times: âThyroid Problems and Cholesterol are Connected.â
American Heart Association: âCholesterol and Diabetes.â
Cleveland Clinic: âTriglycerides and Heart Health.â
Endocrine Practice: âAmerican Association of Clinical Endocrinologists And American College Of Endocrinology Position Statement On Thyroid Dysfunction Case Finding.â
The Open Cardiovascular Medicine Journal: âEffects of Thyroid Dysfunction on Lipid Profile.â
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The Thyroid And Ferritin Connection
How does proper thyroid gland function factor in with low ferritin? Iron is absorbed in the small intestine. Women with thyroid dysfunction often have a chronic infection of some type that can be driving the thyroiditis.
In fact white blood cells that fight infections can sap iron stores in the body which could lead to low ferritin. Also, parasites can take iron from the body and cause low ferritin and anemia-like symptoms.
These are the same types of infections that can contribute to irritable bowel syndrome and other digestive disorders.
In my clinic, I not only test my patients ferritin levels, I understand how to interpret the total serum iron, total iron binding capacity, % transferrin saturation and other tests to find what could be contributing to low iron stores.
Its not enough to look at one marker on a lab test and say that everything is okay. Its impossible to get a complete picture of iron metabolism by just checking serum iron alone.
Some common causes of low iron storage could be: iron deficiency anemia, pregnancy, severe protein deficiency, cancer, antacid use, chronic blood loss, copper deficiency, vegetarian and vegan diets, and heavy menstrual flow.
Check Your Thyroid Function And Body Temperature
Current medical practice guidelines recommend that people newly diagnosed with high cholesterol get their thyroid gland checked by having a Thyroid Hormone Stimulating test. This test will show if their thyroid gland is under-performing. But research shows that this guideline is followed only about half the time.
Thats a shame, because research shows that people with high cholesterol are more likely than normal to have low thyroid gland function. And they are way less likely to have to go on cholesterol-lowering statin drugs if their low thyroid function is corrected. Thats because thyroid hormone is directly involved in helping your body to clear cholesterol out of your body.
I believe an even larger percentage of people with high cholesterol have low thyroid function that is not detectable by the standard TSH test. They have low activity of thyroid hormone in their body. Either they are not converting T4, the inactive form of the hormone, secreted by the gland, to T3, the active form Or their cells are resistant to taking in T4, a condition similar to insulin resistance.
Thats why I recommend that anyone with high cholesterol, newly diagnosed or not, take their body temperature. If it is consistently low chances are good you have slow metabolism, which may be caused by low thyroid hormone activity in your body. This condition is called Wilsons Temperature Syndrome.
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Association Between Thyroid Disease & Cholesterol
Association between thyroid disease and cholesterol
The composition and transport of cholesterol is severely disrupted with thyroid dysfunction. As discussed above, cholesterol is mostly synthesized in the liver. In order to ensure proper functioning, this process is heavily regulated by thyroid hormones. Thyroid-stimulating hormone increases the activity of an enzyme called HMG CoA reductase, which helps control the rate of cholesterol synthesis. Because you have increased TSH with hypothyroidism, the amount of cholesterol produced in the liver is increased. This is then taken out into the bloodstream via VLDL cholesterol.
VLDL travels in the bloodstream until it encounters an enzyme called lipoprotein lipase . T3 stimulates LPL to break down the VLDL, turning it into low-density lipoprotein , once the majority of triglycerides are removed. With hypothyroidism, there isnt enough T3, which will increase the amount of VLDL in the bloodstream as there wont be enough LPL enzymes available.
The VLDL-turned-LDL cholesterol circulates in the blood until it finds cells that have LDL receptors. Once it binds to the cell, the LDL is used for cell membrane maintenance or converted to other steroid hormones to be used elsewhere in the body. T3 increases the number of LDL receptors, which reduces the total amount of LDL cholesterol in the bloodstream. With hypothyroidism, the number of LDL receptors will be reduced, increasing the amount of LDL in the bloodstream.
Age Lipid Metabolism And The Thyroid
While age is an established risk factor for dyslipidemia and thus for CVD, the increased proportion of cardiac events in later life may also be attributed to the presence of other comorbidities . Nevertheless, despite the lack of pertinent data and the risk of adverse effects from lipid-modifying therapy, the latter approach is generally deemed worthwhile in elderly patients . In these subjects, it is particularly important to rule out secondary dyslipidemia, such as hypothyroidism, to avoid unnecessary statin treatment in polymedicated individuals. Notably, it has been reported that hypothyroidism frequently occurs in dyslipidemic patients and several guidelines recommend case-finding with TSH determination in such a setting. However, given that slightly higher TSH values are considered physiological as age advances, care has to be taken to distinguish between the two conditions, i.e., physiologic or pathologic TSH elevation, especially when replacement with L-T4 is being considered . To make this decision, it is helpful to check for the presence of dyslipidemia, while also taking into account the levels of TSH elevation together with positive thyroid peroxidase antibody titers.
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Low Thyroid & Elevated Ldl Cholesterol
As if the madness regarding the efforts made to lower ones cholesterol wasnt at an all time level of illogical hysteria, there are more logs to throw onto the fire. One often forgotten fact is that the cellular uptake of LDL cholesterol will diminish if there is inadequate thyroid hormone in the cells. Consequently, LDL levels in serum may rise significantly due to poor LDL utilization.
The allopath, with his mind in a symptom-based and number-oriented reality, may be totally unaware of the low thyroid/LDL connection. He will harp and protest and threaten the patient with a statin drug, if the patient is unable to lower their LDL. In a tizzy, the patient tries all of the initial remedies: niacin flushes, garlic, red rice yeast and the silly extraction of cholesterol and fats from the diet. All to no avail. Finally the doctor in all his allopathic furry unleashes the cholesterol-reducing medication. The patient immediately feels horrible, heavy arms and limbs, a terrible weakness making it seem as if he has aged 50 years.
Nowhere along the way does the doctor consider running a thyroid panel. And even if he does run it, hes probably only running the TSH value, and not running the all important Free T3 and Free T4 measurements.
And if this poor fellow is eating a standard American diet, one loaded with unsaturated vegetable oils and trans fats, these toxic lipids will be like explosive devices waiting to generate massive oxidative fires.
Low Thyroid & High Cholesterol
One measurement of thyroid function is a hormone called thyroid-stimulating hormone . Made by a small gland at the base of the brain called the pituitary, TSH tells your thyroid how hard to work.
High TSH levels mean you have an underactive thyroid. Symptoms include:
- Weight gain
- Slow heart rate
Studies show that people with high TSH levels have much higher total cholesterol and LDL levels than people with normal thyroid tests.
Any of these can be fatal.
High cholesterol raises heart disease and stroke risk even more.
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Hypothyroidism And High Cholesterol: A Look At The Relationship
Most of the cholesterol circulating in your blood is produced in your body, specifically the liver. The body needs cholesterol to carry out all sorts of important functions, such as: strengthen cell membranes, make hormones, fat-soluble vitamin, and bile acids that are needed to help digest fat. But like all good things, too much cholesterol can become a bad thing, even deadly. You may have heard that there are two types of cholesterol. The so-called bad cholesterol is known as low-density lipoprotein and high-density lipoprotein, or HDL, is the kind of blood cholesterol you want more of since it is protective. Too much bad cholesterol or not enough good cholesterol typically leads to a buildup of the cholesterol plaque in the arteries, which raises your risk for heart disease and stroke.
So, what does this have to do with your thyroid?
The effect of overt hypothyroidism on cholesterol has been well documented for years. At an American Thyroid Association Symposium, John H. Lazarus, MD said, There is a huge emphasis on lipid screening, and one cannot assume that all of this is just due to a rise in lipids for no obvious reasonyou might be uncovering a thyroid problem. It is very important to appreciate that.
According to Dr. Bano, our findings suggest that thyroid hormone measurement can help identify individuals at increased risk of atherosclerosis.
How High Cholesterol May Be A Sign Of Imbalanced Hormones
Cholesterol is the building block of hormones such as testosterone, estrogen, progesterone, cortisol , and aldosterone . Cholesterol is comprised of a number of particles that each serve a function such as: -LDL .-HDL .-Triglycerides . There are a few more cholesterol markers such as particle sizes and the ratio, but these are the main ones.
Healthy cholesterol levels are commonly seen in premenopausal women as estrogen is in proper balance, however, LDL tends to increase and HDL tends to decrease upon peri/menopausal women due to estrogen decline. Estrogen helps blood vessels expand and contract, and cleans up free radicals that can damage arteries and other tissues. However, too much can be a good thing as elevated estrogen can hinder thyroid function leading to hypothyroid, where cholesterol levels climb as metabolism slows. In addition, constipation allows for toxins and estrogens to recirculate, creating additional stress on the body . Progesterone helps balance the effects of estrogen, and helps improve cholesterol markers like HDL and LDL, but actual progesterone therapy can raise triglycerides.
In men, a healthy testosterone level is the main player to help keep optimal cholesterol numbers and mitigate risk actors for cardiovascular disease like stroke and heart attack, but testosterone replacement therapy in the case of low testosterone may actually have the opposite effect . In other words, too high or too low is no bueno.
In the meantime, start with these:
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Lifestyle Changes To Help High Cholesterol
If you still have cholesterol issues after your thyroid is optimally treated, there are dietary and exercise changes that may help get your cholesterol back into balance, and help you avoid the need for prescription medication. Specifically:
Substitute monounsaturated fats such as olive oil for saturated fat, choose leaner cuts of meat and poultry, and opt for lower-fat dairy products.
Eliminate trans fats also known as partially hydrogenated oils found in many processed foods and commercial baked goods.
Get enough omega-3 fatty acids, which help increase your HDL good cholesterol and reduce triglycerides. Salmon, walnuts, almonds, and flax seeds are all good sources. You can also add an omega-3 supplement.
Increase the soluble fiber in your diet. Soluble fiber comes from foods like oats, fruits, beans, and vegetables.
Get enough exercise. It can help raise your HDL good cholesterol and control your weight. Experts recommend around 30 minutes per day of moderate-intensity exercise.
Do You Have Persistently High Cholesterol Even On Thyroid Medication
I’ll never forget this important lesson that I learned while in residency:
One old school but very smart attending physician told me that unexplained high cholesterol is almost always a sign of early hypothyroidism and is best treated by thyroid medications like NDT.
This flies in the face of conventional wisdom in the thyroid community but it’s something that has served me well.
Let me explain what she meant:
Medications, such as NDT, are often MUCH better at controlling cholesterol levels compared to levothyroxine even though almost EVERY doctor puts patients with low thyroid function on levothyroxine.
We even have studies showing that this is the case !
Take this study, for instance, which showed that thyroid patients taking levothyroxine did NOT have normal cholesterol levels even though they had a normal TSH.
The TSH is the test that most doctors use to determine whether or not you are taking ‘enough’ thyroid medication.
What can we infer from these results?
Well, for starters that using levothyroxine is probably not sufficient to help MOST thyroid patients feel better and to improve their thyroid function by itself.
If it were then we would see the cholesterol levels normalize as they started taking their medication.
If this doesn’t happen then we can only assume that their thyroid was not adequately treated by whatever therapy they were using.
This study just proves what my attending told me long ago:
That you are on the wrong type of thyroid medication.
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