Most people have a sense that elevated cholesterol levels can contribute to an increased risk of heart disease. And the medical community’s interest in reducing cholesterol levels has led to unprecedented sales for the heavily advertised and highly profitable “statin” drugs. Some brand name statins you might recognize include Lipitor, Pravachol, Zocor and Crestor.
But did you know that before a doctor prescribes any of these popular cholesterol-lowering drugs for you, you should be tested for thyroid disease?
This is because after diet, thyroid disease is the most common cause of high cholesterol. Proper diagnosis and treatment of an underactive thyroid may restore cholesterol levels to normal, or lower them to the point where diet, exercise and supplements are sufficient, and prescription medication is not needed.
Testing the Thyroid before Prescribing Cholesterol-Lowering Drugs
The National Cholesterol Education Program and the Food and Drug Administration recommend thyroid testing in all patients with high cholesterol levels. And, the top-selling statin drug, Lipitor, indicates this quite clearly in their official “Prescribing Information” for physicians:
“Prior to initiating therapy with LIPITOR, secondary causes for hypercholesterolemia (eg, poorly controlled diabetes mellitus, hypothyroidism, nephrotic syndrome, dysproteinemias, obstructive liver disease, other drug therapy, and alcoholism) should be excluded…”
Dr. Stanley Feld, a former president of AACE, has said: “Clinical experience shows that an estimated 10 percent of patients with elevated cholesterol levels have an underactive thyroid. For these patients, treatment of hypothyroidism with thyroid replacement hormone will restore the body’s metabolism to normal levels and increase the ability to clear cholesterol from the blood, resulting in lower cholesterol levels and a decreased risk for heart disease.”
And Dr. Feld’s estimates were based on the “old” AACE-approved normal range. Under the new AACE-recommended range, which estimates that some 59 million Americans have a thyroid condition, the percentage of people with high cholesterol who also have hypothyroidism will be much greater.
Unfortunately, many people whose regular blood tests pick up high cholesterol never get the required thyroid test before the doctor writes a prescription for a statin drug. Not only are some doctors failing to follow the prescribing instruction, but patients don’t know to ask.
In one survey conducted by the American Association of Clinical Endocrinologists, less than half of the adults who had high cholesterol levels even knew if they had ever had a thyroid test. Even worse, nearly ninety percent of the survey participants were not aware of the thyroid gland’s impact on cholesterol regulation.
The AACE president at the time, Dr. Richard Dickey, said: “For the millions of Americans actively trying to reduce their cholesterol levels by eating right, increasing physical activity and taking medication, understanding the role of secondary medical conditions, such as thyroid disease, is essential. Patients who have been diagnosed with high cholesterol should ask their physician about having their thyroid checked. If they have an underlying thyroid condition in addition to their high cholesterol, the cholesterol problem will be difficult to control until normal levels of thyroid hormone are restored.”
What Should You Do?
If you are told that you have high cholesterol, and you have not had a thyroid test, before you agree to go on any medication, you should insist on a thorough thyroid evaluation. This should include a clinical examination, as well as TSH, T4, T3, Free T4, Free T3, and thyroid antibody tests. The practitioner should be using the new recommended AACE TSH guidelines of .3 to 3.0 — not the older guidelines of .5 to 5.0 that exclude millions from legitimate diagnosis and treatment.
If you have high cholesterol, and are being treated with a statin drug, and your cholesterol levels are not responding to the drug, you should also make sure that you have a thorough thyroid evaluation. Undiagnosed hypothyroidism is a common cause of treatment-resistant high cholesterol.
If you are told that you have high cholesterol, and you are already being treated for a thyroid problem, you need to make sure that your thyroid treatment is optimized. Are you still suffering from other thyroid-related symptoms such as weight gain or inability to lose weight, fatigue, depression, hair loss (especially in the outer edge of ding to the American Heart Association, an estimated 99.9 million American adults have cholesterol levels that are elevated, and put them at risk of heart disease. This is defined as a total cholesterol value of 200 mg/dL and higher. The “Total” cholesterol level gives you a reading of the total of all of the types of cholesterol in your blood.
Within this group, some 34.5 million people have levels of 240 or above, which is thought to put them at even higher risk of heart disease, while 200 to 239 is are considered to be borderline-high risk.
A specific type of cholesterol, high-density lipoprotein (HDL) cholesterol, is also called “good cholesterol.” HDL cholesterol helps to clean fat and cholesterol from your arteries. The higher your HDL cholesterol level, the lower your chance of getting heart disease.
Another type, low-density lipoprotein (LDL) cholesterol, is referred to as the “bad cholesterol.” High LDL leads to increased deposits of cholesterol in your arteries, clogging them, and increasing your risk of developing heart disease.
Triglycerides are the most common type of fat in the body, and they serve as an energy source. The body manufactures them from the food we eat. High blood triglycerides are, however, a risk factor for developing heart disease.
the eyebrows), feeling cold, or brain fogged? helps you evaluate your options.
Cholesterol is transported through the body via the bloodstream, where it helps make and maintain nerve cells and manufacture natural hormones. But when the body becomes less able to metabolize cholesterol, or foods containing too much cholesterol are consumed, cholesterol can build up in the bloodstream — a condition known as hypercholesterolemia, or “high cholesterol.” This can cause cholesterol deposits to form on the walls of the arteries, in particular, those around the heart. The deposits can block blood flow, and cause strokes, or heart attacks.
Here are the standard blood test levels and ranges for the various tests. Note however, that specific labs may have values that vary, so always be sure to look at your lab results yourself, so you can see the “normal ranges” used to evaluate your test results.
Total Blood Cholesterol
•Desirable: Less than 200 mg/ dL. (Some doctors are even suggesting that optimal cholesterol should be lower than 170-180)
•Borderline: 200-239 mg/ dL.
•High: 240 mg/ dL or higher.
•Normal: 35 mg/ dL or higher
•Desirable: Less than 130 mg/ dL
•Borderline: 130-159 mg/ dL
•High: 160 mg/ dL or more
•Desirable: Less than 150 mg/dL are normal
•High: 200 mg/dL or higher
Mary Shomon is an internationally-known thyroid patient advocate, and is author of a number of best-selling health books, including Living Well With Hypothyroidism and The Thyroid Diet. Since 1997, she has run the Internet’s most popular thyroid patient sites: About.com Thyroid Site and Thyroid-Info.com