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Medical Edge Newspaper Column from Mayo Clinic

LINKED TREATMENT FOR LOW HORMONE, HIGH CHOLESTEROL

DEAR MAYO CLINIC: I have been diagnosed with abnormally high cholesterol and a deficiency of the thyroid hormone thyroxine. Can you tell me if that deficiency might be the cause of my cholesterol problem? Either way, what steps can I take to reduce it? — Steilacoom, Wash.

ANSWER: An abnormally high cholesterol level in the blood can be brought about by various factors. The primary cause is genetic: Some people inherit this tendency from family members. There are also secondary causes, i.e., “the three Ds” — Diseases (such as diabetes or hypothyroidism), certain Drugs (such as corticosteroids), or Diet (high fat content) — which, consequentially or secondarily, produce abnormally high cholesterol levels. Prior to determining a cholesterol treatment plan for a patient, I always look for these kinds of secondary causes.

You also have an underactive thyroid gland (hypothyroidism). With the production of too little thyroxine — a hormone that, among other basic functions, controls how your body uses fats and carbohydrates — abnormally high cholesterol levels can occur. Other symptoms of hypothyroidism include constipation; an increased sensitivity to cold; pale, dry skin; and a hoarse voice.

Although some cholesterol is vital to the structure and function of the body, excess amounts can cause fatty deposits (plaques) to build up in the blood vessels, eventually narrowing arteries, impeding blood flow and preventing oxygen-rich blood from getting to vital organs. High cholesterol can increase your risk of heart attack and stroke, for example.

When a patient has a secondary cause of high cholesterol (like you, with hypothyroidism), we treat that condition first, aiming to reduce or even eliminate both problems at the same time. Standard treatment for an underactive thyroid involves taking a daily pill containing the synthetic thyroid hormone levothyroxine (brand names include Levothroid and Synthroid). This medication restores adequate thyroid hormone levels, shifting your body back into a normal state. It may take a little trial and error to determine your correct dosage of levothyroxine, but once established, the dosage tends to remain stable. You will generally need to be checked with a thyroid blood test just once or twice a year.

Thyroid replacement treatment will very likely reduce your cholesterol level; it almost always does among hypothyroidism patients. If the reduction is insufficient, however, then the cholesterol problem should be addressed in the usual way: 1) lifestyle changes, such as eating a low-fat diet and increasing amounts of exercise; and 2) taking a cholesterol-lowering (statin) drug such as atorvastatin or simvastatin (brand names are Lipitor and Zocor).

Your doctor can best advise you on how to proceed through each successive step, if appropriate.

— Scott C. Litin, M.D., General Internal Medicine, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treating High Cholesterol
Appointment Information
More Information on Cholesterol
Cholesterol and Thyroid Disease

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More Information on Stress

Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.