Need some Bro Science Advice (High TSH/Cholesterol bloods)

[lvdesertsquid]

OK, so I'm fixin' to see my primary doc in about 2 weeks. He'll go over my recent labwork which showed the following issues.

Total Cholesterol 226, LDL Cholesterol 152, Non-HDL Cholesterol 178 (all MG/DL).
Of more concern, my TSH was high at 5.42 mlU/L (Quest range is 0.40-4.50). T4 was normal 1.1 ng/dl (Quest range is 0.8-1.8)

So, Dr, Google calls this subclinical hypothyroidism. My entire family is currently on Levothyroxine (Mom/Dad 25mcg/day, Younger Bro 300mcg/day). So I'm likely swimming in a shallow gene pool.

Before I knew my results, I'd already been noticing some lethargy, weight gain and constipation, which appear to be common hypothyroidism systems.

I'm currently 51 years old, 195# at 6'0", about 23% bodyfat. I'm currently running 100mg Test E/wk and 0.5mg Anastrozole/wk. 5mg Cialis/day and 2mg doxazosin/day (both for prostate).

Since all my primary care doc will do is likely Rx me some levothyroxine and/or punt me to an Endocrinologist, is there anything I need/should ask him to do/prescribe, etc. in my 10 minutes of face time? Anymore tests I should ask for, or any specific drugs? Does anything I'm currently doing seem to be causing the problem? Would cutting down to lower BF% fix the TSH levels, or any hereditarily challenged?

I know that the "Doctor knows best", but frankly, this guy bangs out 25 appointments a day, and probably learned everything he needed to know about hypothyroidism in the course of 2 days of lecture at med school...there's alot of smart dudes (and dudettes) on here, and I'd appreciate any insights.

Cheers, and thanks alot!

 

[thebsac]

Hypothyroidism runs in your family, your TSH is up, and you are experiencing symptoms of hypothyroidism. All signs point to a low dose of T4.

Just an FYI, the data says otherwise, but first hand experience, some people respond better to branded T4 (synthroid) much better than generic.

Hypothyroidism besides making your quality of life crappy, increases your risk of coronary artery disease.

• Ask to get a coronary calcium score. If you have a measurably elevated score, it will give you a ballpark of your 10-year risk.
• Ask for a Lipoprotein(a) test. Lp(a) SIGNIFICANTLY increases your risk of coronary artery disease. It is almost always genetically predetermined (~80%). If death from cardiovascular disease, especially at a young age, does not run in your family then the odds are in your favor that you don't have the Lp(a) gene. It's a one time test that is relatively cheap.
• Ask your doctor if you can start having your LDL particle number measured instead of LDL cholesterol. LDL-P is a greater predictor of cardiovascular disease risk.
• Ask to have your vitamin D checked. There's some very loose, hand-wavy data that says that vitamin D deficiency increases cardiovascular disease risk. I don't know how I feel about that, BUT vitamin d deficiency is very common and does have downstream health effects. If it's normal, I wouldn't bother checking again for another 10 years or unless you present with clinical symptoms of deficiency.
• Ask for an HbA1C if your triglycerides are elevated. If they were fine, don't bother.
• At 51, if you haven't had a colonoscopy yet, ask to get one scheduled. Colon cancer is no joke.
• Some people on this board have strong opinions on vaccines. I don't give a fuck, it's your body do what you want. If you do want to get the shingles vaccine, Shingrix, it's amazingly effective (~90%) and shingles is MISERABLE.

And always keep your blood pressure in check.

 

[lvdesertsquid]

Hypothyroidism runs in your family, your TSH is up, and you are experiencing symptoms of hypothyroidism. All signs point to a low dose of T4.

Just an FYI, the data says otherwise, but first hand experience, some people respond better to branded T4 (synthroid) much better than generic.

Hypothyroidism besides making your quality of life crappy, increases your risk of coronary artery disease.

• Ask to get a coronary calcium score. If you have a measurably elevated score, it will give you a ballpark of your 10-year risk.
• Ask for a Lipoprotein(a) test. Lp(a) SIGNIFICANTLY increases your risk of coronary artery disease. It is almost always genetically predetermined (~80%). If death from cardiovascular disease, especially at a young age, does not run in your family then the odds are in your favor that you don't have the Lp(a) gene. It's a one time test that is relatively cheap.
• Ask your doctor if you can start having your LDL particle number measured instead of LDL cholesterol. LDL-P is a greater predictor of cardiovascular disease risk.
• Ask to have your vitamin D checked. There's some very loose, hand-wavy data that says that vitamin D deficiency increases cardiovascular disease risk. I don't know how I feel about that, BUT vitamin d deficiency is very common and does have downstream health effects. If it's normal, I wouldn't bother checking again for another 10 years or unless you present with clinical symptoms of deficiency.
• Ask for an HbA1C if your triglycerides are elevated. If they were fine, don't bother.
• At 51, if you haven't had a colonoscopy yet, ask to get one scheduled. Colon cancer is no joke.
• Some people on this board have strong opinions on vaccines. I don't give a fuck, it's your body do what you want. If you do want to get the shingles vaccine, Shingrix, it's amazingly effective (~90%) and shingles is MISERABLE.

And always keep your blood pressure in check.

Thank you very much thebsac! My A1C and Triglycerides checked out OK.

Just did the colonoscopy a few months back. A few diminutive polyps that tested negative. Was interesting actually as I opted to do the colonoscopy unsedated. Didn't hurt as bad as it sounds like, and was able to see exactly what the doctor was looking at, including watching him lasso a few polyps.

Got the Shingrix vac. I've had 2 family members get shingles and its was not fun. I got chicken pox as a kid so I was primed for Shingles.

Good info on the coronary calcium score, Lipoprotein(a), LDL and Vitamin D tests. I'll bring that up with him during my appt.

Thanks again!

 

[achba]

Ldl is an excellent predictor by itself for cardiovascular disease. Get a apolipoprotein a done like the other poster mentioned. Particle size is not that important. There is extremely clear data showing ldl being the cause of athersclerosis and raising your chance of heart attacks and strokes. Calcium score only tells you whether you have end stange athersclerosis.

Your ldl is dangerously high and needs to be treated quickly and aggressively. Cut your intake of saturated fat and see a cardiologist or lipidologist ASAP, a statin can bring you back to the normal range, rosuvastatin has less muscle related side effects than others but they generally pretty rare. If you dont have a lot of risk factors then your ldl needs to be below 93 at least.

 

[thebsac]

Ldl is an excellent predictor by itself for cardiovascular disease. Get a apolipoprotein a done like the other poster mentioned. Particle size is not that important. There is extremely clear data showing ldl being the cause of athersclerosis and raising your chance of heart attacks and strokes. Calcium score only tells you whether you have end stange athersclerosis.

Your ldl is dangerously high and needs to be treated quickly and aggressively. Cut your intake of saturated fat and see a cardiologist or lipidologist ASAP, a statin can bring you back to the normal range, rosuvastatin has less muscle related side effects than others but they generally pretty rare. If you dont have a lot of risk factors then your ldl needs to be below 93 at least.

Incorrect. LDL particle size is important because of its relationship with particle number. Smaller LDL particles transport a smaller volume of lipids, therefore, a greater number of LDL particles are required to transport the same volume as another individual with a larger LDL particle genotype. Why is this important? Each LDL particle is wrapped with 1 apoB which is the athersclerotic particle, not cholesterol. That's why an LDL particle number (LDL-P) is a much better predictor of risk UNLESS your LDL-C and LDL-P are concordant, in which case LDL-C is adequate. ApoB is a better predictor but it's usually easier to get physicians to switch to LDL-P instead.

OP's LDL-C is high but not dangerously high, BUT he also has untreated subclinical hypothyroidism. Treat the hypothyroidism first. If LDL-C/P is still elevated after stable therapy, then I would look into a low intensity statin. If Lp(a) is elevated then it's an entirely different game.

That being said, I agree that medicine does not treat LDL-P/C aggressively enough and the guidelines should recommend a much lower apoB (<60-70) for everyone regardless of risk factors.

LDL-C and LDL-P Discordance
ApoB and Athersclerosis

 

[lvdesertsquid]

T

Incorrect. LDL particle size is important because of its relationship with particle number. Smaller LDL particles transport a smaller volume of lipids, therefore, a greater number of LDL particles are required to transport the same volume as another individual with a larger LDL particle genotype. Why is this important? Each LDL particle is wrapped with 1 apoB which is the athersclerotic particle, not cholesterol. That's why an LDL particle number (LDL-P) is a much better predictor of risk UNLESS your LDL-C and LDL-P are concordant, in which case LDL-C is adequate. ApoB is a better predictor but it's usually easier to get physicians to switch to LDL-P instead.

OP's LDL-C is high but not dangerously high, BUT he also has untreated subclinical hypothyroidism. Treat the hypothyroidism first. If LDL-C/P is still elevated after stable therapy, then I would look into a low intensity statin. If Lp(a) is elevated then it's an entirely different game.

That being said, I agree that medicine does not treat LDL-P/C aggressively enough and the guidelines should recommend a much lower apoB (<60-70) for everyone regardless of risk factors.

LDL-C and LDL-P Discordance
ApoB and Athersclerosis

Thanks again. I've ordered an LP(a) test from Discounted Labs to have in time for my appointment.

From what I've read, a high LP(a) hasa high correlation to atherosclerosis, but it's primarily hereditary without alot of treatment options other than diet, exercise, etc.

I'm curious about your comment re: treat the subclinical hypothyroidism first. Is there a chance that normalizing TSH levels would improve cholesterol?

I think the approach I was leaning towards is to request treatment for both the subclinical hypothyroidism as well as cholesterol. (Cholesterol issues are also hereditary with everyone including my younger brother currently on atorvastatin). If im able to clean up diet and exercise more effectively, I can possibly look to titrate down on the meds to see if I'm able to still maintain decent levels.

If LP(a) comes back high, I'm guessing all bets are off and statins will be a lifetime commitment.

Seem a reasonable approach?

Thanks again!

 

[thebsac]

T

Thanks again. I've ordered an LP(a) test from Discounted Labs to have in time for my appointment.

From what I've read, a high LP(a) hasa high correlation to atherosclerosis, but it's primarily hereditary without alot of treatment options other than diet, exercise, etc.

I'm curious about your comment re: treat the subclinical hypothyroidism first. Is there a chance that normalizing TSH levels would improve cholesterol?

I think the approach I was leaning towards is to request treatment for both the subclinical hypothyroidism as well as cholesterol. (Cholesterol issues are also hereditary with everyone including my younger brother currently on atorvastatin). If im able to clean up diet and exercise more effectively, I can possibly look to titrate down on the meds to see if I'm able to still maintain decent levels.

If LP(a) comes back high, I'm guessing all bets are off and statins will be a lifetime commitment.

Seem a reasonable approach?

Thanks again!

Yes LP(a) is almost always hereditary. As I said, if heart disease does not run in your family you most likely do not have the gene but there are some people who produce LP(a) de novo so everyone should get screened once in their life as a precaution. LP(a) is basically treated by aggressively minimizing apoB through diet, exercise, statins, and if your insurance covers it PCSK-9 inhibitors.

If elevated LDL-C runs in your family, and your family is reasonably healthy, it’s possible you have familial hypercholesterolemia but if that was the case I would expect your LDL-C to be more in the range of 200-250 but still certainly possible.

Yes, it is possible that treating your hypothyroidism may correct your elevated LDL-C. I wouldn’t be entirely opposed to starting a statin, they’re fairly well tolerated medications and there’s no lower bound to which you can unsafely lower LDL-C/P.

If you have the funds, for individuals interested in their cardiovascular health, I recommend purchasing an automated blood pressure cuff. Elevated BP (SYS > 120 or DIA > 80) is not something to take lightly.

Hypothyroidism and Elevated LDL-C

 

[Deleted member 21405]

If you aren't currently, start taking citrus bergamot, resveratrol and astragalus. Should help with the cholesterol/ lipids a bit, but still follow up with doc.

 

[lvdesertsquid]

Yes LP(a) is almost always hereditary. As I said, if heart disease does not run in your family you most likely do not have the gene but there are some people who produce LP(a) de novo so everyone should get screened once in their life as a precaution. LP(a) is basically treated by aggressively minimizing apoB through diet, exercise, statins, and if your insurance covers it PCSK-9 inhibitors.

If elevated LDL-C runs in your family, and your family is reasonably healthy, it’s possible you have familial hypercholesterolemia but if that was the case I would expect your LDL-C to be more in the range of 200-250 but still certainly possible.

Yes, it is possible that treating your hypothyroidism may correct your elevated LDL-C. I wouldn’t be entirely opposed to starting a statin, they’re fairly well tolerated medications and there’s no lower bound to which you can unsafely lower LDL-C/P.

If you have the funds, for individuals interested in their cardiovascular health, I recommend purchasing an automated blood pressure cuff. Elevated BP (SYS > 120 or DIA > 80) is not something to take lightly.

Hypothyroidism and Elevated LDL-C

Hey thebsac,

Thanks for all the info!!! Really appreciate it!

Just wanted to follow-up on my results. My LP(a) came back at 149 (high). Told the doc and he acted like why did I even bother to test it.

He put me on atorvastatin 20mg/day for now. I asked about the subclinical hypothyroidism and he basically said to wait and see what follow-on labs look like in 3 and 6 months.

I do check BP regularly. I average around 125/75. I was measured at 120/82 at the doctor office, so he didn't seem to be concerned. I do take 2mg of doxazosin daily (self prescribed). I did a lot of ncbi study research and found that it was a good option for both BPH as well as BP. Both parents are currently on amlodipine, so I think this is another hereditary issue that I'm trying to stay in front of.

Appreciate anymore insight you might have. With the high LP(a) I'm really trying to get my diet dialed in better to clean up all the saturated fats and bump up fiber.

Thanks! LVDS

 

[thebsac]

THIS THREAD SHOULD BE STICKIED AS A PERFECT EXAMPLE OF WHY EVERYONE SHOULD GET LABS FOR AAS RELEVANT RISK FACTORS.



What units were your LP(a) measured in? mg/dL or nm/L?

I am not surprised your physician was also not surprised about your elevated LP(a). Only over the last 5-10 years has LP(a) and it's impact on ASCVD risk started to gain traction in the field of medicine.

First off, elevated LP(a) is not some kind of cardiac death sentence, it only confers an increased risk (ex. APOE4 confers an increased risk of Alzheimers/dementia but does NOT determine if you get dementia). It would be interesting to see whether your mom and/or dad have elevated LP(a).

Your goal is not to lower LP(a). Significantly lowering LP(a) is incredibly difficult aside from PCSK-9 inhibitors which can lower LP(a) by ~30% (at the expense of your wallet). Your goal is to lower apoB/LDL-P because without apoB, LP(a) has nothing to bind to (LP(a) essentially supercharges the athersclerotic activity of apoB).

Your apoB target is somwhere around 30-40 mg/DL ideally. Diet + exercise + statin therapy will get you there.

Check your apoB/LDL-P in 3 months (6 if you can't afford it). If you do not have any side effects at that time (most commonly muscle soreness), talk to your physician about increasing your atorvastatin to 40mg.

I can't speak to the efficacy of any of the supplements mentioned by other users.


You sound like someone who is very interested in their health/life span which is more than I can say about a lot of people. Stay on top of your BP, bloodwork, and meds, and you'll be in great shape.

 

[Deleted member 21405]

Was reading b complex too. I ordered some for myself.