Testing For Thyroid Problems
So how can you ensure that your high cholesterol isn’t from your thyroid?
It starts with testing.
It is possible to rule out your thyroid as the cause of high cholesterol provided your doctor orders the right tests.
Just looking at the TSH is not sufficient to say if your thyroid is working or not.
When you go to your doctor to check your thyroid make sure you ask for these tests:
- Thyroid Stimulating Hormone – Your TSH should be less than 2.5.
- Free T3 – Look for a free T3 which is in the top 50% of the reference range provided
- Free T4 – Look for a free T4 which is in the top 50% of the reference range provided
- TPO antibodies – The presence of these antibodies may mean that you have an autoimmune disease known as Hashimoto’s thyroiditis
- Thyroglobulin antibodies – The presence of these antibodies may mean that you have an autoimmune disease known as Hashimoto’s thyroiditis
It is particularly important that you ask your doctor to order all of these tests but pay close attention to your TPO antibodies and your thyroid peroxidase antibodies.
If either of these tests is positive then it may mean that you have an autoimmune thyroid disease known as Hashimoto’s thyroiditis.
Women with this autoimmune condition often have normal other thyroid lab tests and the only sign of this condition is the elevated antibodies.
It’s also possible for women with this condition to have thyroid problems even though their thyroid lab tests look “normal”.
A Quick Review Of Thyroid Physiology And Lab Panels
The thyroid is a small butterfly-shaped gland that sits at the front of the neck. It receives a hormone signal from the pituitary and secretes other hormones into the bloodstream. You might be familiar with these hormones, which are included in a full thyroid panel:
Thyroid-stimulating hormone : This hormone is released by the pituitary gland and reflects the bodys need for thyroid hormone. This means that when TSH is high, not enough thyroid hormone is being produced . When TSH is low, there is more than enough thyroid hormone in the body .
Do you have heart disease or high cholesterol? You might want to get your thyroid checked
Thyroxine : The thyroid gland releases large amounts of this largely inactive form of thyroid hormone, which must be converted into the more active T3 by deiodinase enzymes. Low amounts of T4 may indicate hypothyroidism high amounts may indicate hyperthyroidism.
Triiodothyronine : This is the active form of thyroid hormone, secreted in small amounts by the thyroid gland and formed from the conversion of T4 to T3. T3 is the primary thyroid hormone that will act on cells all over the body to regulate metabolism. Low amounts of T3 may indicate hypothyroidism or low T3 syndrome high amounts indicate hyperthyroidism.
If thyroid medication is given for hypothyroidism, it is usually in the form of T4, T3, or a combination of the two.
Other Causes Of High Cholesterol
People are often surprised to find out they have high cholesterol or triglycerides in their blood.High levels of blood fats which include cholesterol and triglycerides can have many causes. These include your lifestyle, genes, age, gender and ethnic background and these can all add up. Here you can take a look at some of the lesser-known causes, which include other health problems and certain medicines. Doctors might call these ‘secondary causes’ of high cholesterol.
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The Various Mechanisms Connecting Thyroid Hormone To Lipids
Cholesterol is generated in the liver by the enzyme 3-hydroxy-3-methylglutaryl-CoA and is transported through the circulation by lipoproteins, these being classified according to their size and density. Among the various lipoprotein subfractions, LDL-C has attracted much attention due to its atherogenicity, susceptibility to oxidation and potential to predict risk for CHD. Meanwhile, also of interest is high-density lipoprotein cholesterol , due to its mediation of cholesterol reverse transport from the circulation to the liver and the cardiovascular protective effects that it exerts. Thyroid hormone is the main regulator of lipid metabolism by stimulating the mobilization and degradation of lipids as well as de novo fatty acid synthesis in the liver . T3 actions are mediated via modulation of gene expression and cell signaling pathways, while cholesterol synthesis is mediated by the sensing of intracellular cholesterol in the endoplasmic reticulum via sterol regulatory element binding proteins 1 and2, the transcription factor that positively regulates the expression of LDL receptor and cholesterol synthesis . After cleavage by specific proteases, SREBP migrates to the nucleus and acts as a transcription factor binding to the sterol regulatory element which stimulates the transcription of the LDLR and HMG-CoA reductase genes.
The effects of thyroid hormone on the various fractions of lipids are presented in Table 1.
Thyroid Hormone And Your Heart
It is well known that thyroid hormone influences your heart.
And, because your heart pumps blood throughout your body, any changes to your heart rate or force of contraction can also cause changes to your blood pressure.
We also know, from plenty of studies, that maintaining a healthy blood pressure is absolutely vital to leading a long life and avoiding complications such as stroke, end-organ damage, kidney failure, and heart disease.
Doctors go through great lengths to help manage blood pressure because of these negative side effects!
So, why then does taking thyroid medication cause high blood pressure in some situations?
It has to do with how thyroid hormone interacts with cardiac tissue .
In almost every cell in your body thyroid hormone works by entering into your cell and changing genetic transcription .
This process results in changes to your DNA which take weeks to kick in.
But in your heart cells, thyroid hormone activates receptors on a different part of the cell.
This means that the effects of thyroid hormone occur much faster when compared to the genetic changes that occur in other cells in your body.
Through this mechanism, thyroid hormone medication can potentially lead to elevated blood pressure even though you might feel great otherwise.
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Some Less Common Conditions
We have two kidneys, and they’re responsible for cleaning our blood by filtering out waste products which are then removed from the body as urine.
Chronic Kidney Disease . This is the name for a gradual decline in kidney function. People with CKD often have abnormal blood fats raised LDL cholesterol and triglycerides, and lower HDL cholesterol. Heart and blood vessel diseases are common in people with CKD so statins and other cholesterol-lowering treatments are recommended if you have CKD.
Nephrotic syndrome. This happens when our kidneys become leaky. It results in protein leaking into the urine. People with nephrotic syndrome often have raised levels of cholesterol and triglycerides too.
The liver is a very important organ. It is where cholesterol and triglycerides are processed, made or broken down. Bile, a breakdown product of cholesterol, is made in the liver, stored in the gall bladder and released into the gut when we eat a meal. Its role is to help break down fat from food into small drops which can then be easily digested.
Sometimes the production of bile or its release into the gut can become blocked, for example, if gall stones develop from crystallised cholesterol. Symptoms include pain, especially after a fatty meal. The medical name for this is cholestasis, where bile is unable to flow from the liver, and it can cause blood cholesterol levels in the blood to rise.
What Are The Main Kinds Of Thyroid Conditions
There are two main kinds of thyroid conditions:
If you have a thyroid condition during pregnancy, treatment can help you have a healthy pregnancy and a healthy baby.
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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.
Better Markers Of Cardiovascular Risk
Wait, but I thought cholesterol tests were outarent lipoprotein particle numbers what we really care about?
Yep. Ive discussed in several articles and on my podcast why lipoprotein particle numbers are much better predictors of cardiovascular risk than cholesterol levels. However, there are few studies that have assessed the effects of thyroid hormones on lipoprotein particle number, compared to the number of studies that have assessed standard cholesterol measurements. Still, we see similar effects:
- LDL particle number : Subclinical hypothyroidism has been associated with higher levels of ApoB-100, a surrogate marker for LDL particle number. T4 treatment significantly reduced ApoB-100 levels .
- Oxidized LDL: Decreased thyroid function increases the number of LDL particles and promotes LDL oxidizability .
Thyroid health also impacts other cardiovascular risk factors:
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High Thyroid & Low Cholesterol
While it’s usually good, sometimes low cholesterol is a bad sign. A sudden drop can be a sign of an overactive thyroid.
In hyperthyroidism, your thyroid produces too much T3 and T4. High levels of these hormones speed up processes in your body, leading to:
- Sudden weight loss
- Rapid heartbeat
Interestingly, while hyperthyroidism is linked to low cholesterol, high cholesterol may be linked to a hyperthyroidism-related complication.
Graves’ disease is an autoimmune condition that causes hyperthyroidism. It sometimes involves an eye disease called orbitopathy. Increased levels of LDL and total cholesterol are risk factors for orbitopathy.
Cholesterol And Your Thyroid
Hypothyroidism can cause levels of total cholesterol, LDL bad cholesterol, and triglycerides to rise. Even subclinical or borderline hypothyroidism can cause high cholesterol. Two Chinese studies, for example, found that having a thyroid stimulating hormone level in the upper end of the reference range makes you more likely to have a high cholesterol level.
If you do not have a diagnosed thyroid problem, high cholesterol levels are supposed to automatically trigger screening for hypothyroidism, according to many medical guidelines. Doctors are also advised to test thyroid function before prescribing any cholesterol-lowering medications. Unfortunately, this does not happen consistently, and many people with undiagnosed hypothyroidism are given cholesterol-lowering medication without any thyroid screening.
The take home message? Its especially important for you to ask your physician to do a comprehensive thyroid evaluation, including, at minimum, a TSH test. If you are borderline or overtly hypothyroid, your next step is thyroid hormone replacement therapy.
Proper thyroid diagnosis and treatment of your hypothyroidism could resolve your high cholesterol and allow you to avoid taking prescription medication. One recent study found that more than 60 percent of people with high cholesterol and untreated hypothyroidism saw their cholesterol levels normalize once hypothyroidism was treated.
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Anemia And Low Ferritin
Many people are familiar with the term anemia. Most people think of anemia as low iron. What low iron really means is low oxygen.
Its possible for serum iron to be normal and ferritin to be low. This can be a sign that your body is depleting your iron storage in order to maintain the iron levels in your blood.
Ive seen many blood tests where serum iron was tested and looked normal. Thats good. You always want a normal lab test, right? Of course!
But, you dont want your body to rob Peter to pay Paul. That is often what goes on inside of the body. Your body is always looking to create and maintain a balance.
A great example of that is sodium and potassium. When one goes high, the other tends to go low. That is what our bodies are always doing non-stop, 24/7 maintain a balance.
Thyroid Hormone: How It Affects Your Heart
The thyoid gland, which wraps around the windpipe, releases hormones that have wideranging effects on the body.
Too little or too much of this crucial hormone can contribute to heart problems.
Located at the base your throat, the butterfly-shaped thyroid gland releases hormones that affect every organ in your bodyespecially your heart. Thyroid hormone influences the force and speed of your heartbeat, your blood pressure, and your cholesterol level. As a result, a malfunctioning thyroid gland can cause problems that masquerade as heart disease or make existing heart disease worse.
An estimated 6% of people in the United States have thyroid disease. Most of themabout 80% have an underactive thyroid, or hypothyroidism. When thyroid levels drop, all the systems in the body slow down, triggering a range of symptoms that include fatigue, weight gain, cold intolerance, constipation, and dry skin. But these symptoms are very common in people as they grow older, including those with normal thyroid levels.
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How Does Thyroid Affect Cholesterol Levels
Q. For the last six years Ive been taking levothyroxine for hypothyroidism. However, over that time my cholesterol has been slowly creeping up. My doctor didnt feel I needed a statin because my HDL and LDL are at good levels. Nonetheless, when my total cholesterol reached 235, it bothered me because I really watch what I eat.
I was talking with a friend about this, and she suggested taking a daily dose of Metamucil. Although I was skeptical, I decided to try it. Sure enough, my cholesterol dropped 30 points in six months! Could my thyroid medicine have caused an increase in cholesterol levels?
A. Undertreated hypothyroidism can raise total cholesterol. Even when the underactive thyroid gland is adequately treated with levothyroxine, cholesterol levels may not normalize completely .
If Your Thyroid Is Not Being Properly Managed You Are Increasing The Likelihood Of Having A Heart Attack By As Much As 50
The thyroid is a gland located in the middle of your neck. It produces two main hormones. The main hormones include triiodothyronine , which is the active form of thyroid hormone, and thyroxine , which is inactive. Your body Takes T4 and converts into T3.
When the thyroid does not produce enough thyroid hormones, it is underactive, which is called hypothyroidism. Thyroid hormones, especially T3, play an essential role in helping the liver process and remove any excess cholesterol from the body.
When the body does not produce enough thyroid hormones, the liver cannot process as much cholesterol as it should. According to research, up to 13 percent of people with high blood cholesterol also have a problem with their thyroid.
The same research notes that societies, such as the American Association of Clinical Endocrinologists and the American Thyroid Association, recommend that people newly-diagnosed with high cholesterol get tested for an underactive thyroid.
The research also suggests that a persons cholesterol levels may improve once they have received treatment for an underactive thyroid, even if they do not require cholesterol-lowering medications.
Even mildly low thyroid hormone levels can lead to high cholesterol. According to 2012 research, elevated TSH levels can also cause high cholesterol, even if T3 and T4 are not elevated.
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How Are Thyroid Conditions Treated During Pregnancy And While Breastfeeding
Many medicines used to treat thyroid conditions during pregnancy are safe for your baby. Thyroid medicines can help keep the right level of thyroid hormones in your body. Your provider gives you blood tests during pregnancy to check your TSH and T4 levels to make sure your medicine is at the right amount . T4 is a hormone made by your thyroid.
If youre taking medicine for a thyroid condition before pregnancy, talk to your provider before you get pregnant. Your provider may want to adjust or change your medicine to make sure its safe for your baby. If youre already taking thyroid medicine when you get pregnant, keep taking it and talk to your provider about it as soon as possible.
Treating hyperthyroidism. If you have mild hyperthyroidism, you may not need treatment. If its more severe, you may need to take an antithyroid medicine. This medicine causes your thyroid to make less thyroid hormone.
Providers sometimes use radioactive iodine to treat hyperthyroidism. Pregnant women shouldnt take this medicine because it can cause thyroid problems in the baby.
Antithyroid medicines are safe to take at low doses while youre breastfeeding.
If you had hypothyroidism before getting pregnant, you most likely need to increase the amount of medicine you take during pregnancy. Talk to your health care provider about your medicine as soon as you find out youre pregnant. Your provider can check to make sure youre taking the right dose by checking your TSH levels during pregnancy.