Tuesday, May 13, 2008

Hypothyroidism and Heart Disease: The Plot Thickens

Wow! This rabbit hole goes a lot deeper than I could have ever imagined. It seems hypothyroidism is clearly connected with heart disease, is largely undiagnosed/misdiagnosed, and generally misunderstood. If anything, the real problem is, because thyroid hormones are used in just about every body tissue, hypothyroidism is connected with a huge list of symptoms and conditions. Now, on to my sad story.

Here I am, feeling like crap, disgestive problems, myalgias, fatigue, anemia, rising lipoprotein(a) and homocysteine, palpitations, mild depression, lack of concentration - yeah all that fuzzy, amorphous, undifferentiated, "feel like a truck hit" me stuff. One day I am so fatigued that I drop by the local walk-in clinic (because I can't get a freakin' appointment with my internist for a month - sound familiar) where they find me to be anemic. I luck out and finally get in to see my "regular" doc and he orders tests that show I have a moderately high TSH (4.5) and a lower (but in range) Free T4 (1.0ng/dl) and T3 (2.68 pg/ml). Of course, the internist's staff won't give me the results because they want me to schedule another appointment in ANOTHER MONTH! With a little subterfuge, I get them to fax the results "elsewhere" for "continued care" (the magic words) where I retrieve them. (DON'T GET ME STARTED ON THIS PET PEEVE - THAT WAS MY GODDAM BLOOD AND MY TEST RESULTS THAT I PAID FOR. HOW DARE THEY WITHHOLD MY HEALTH DATA FROM ME!)

So armed with this data I start my investigation. It seems that the new upper limit for TSH is really around 3.0 (not 4.5 or 5.5). Upper and lower limits form test "Reference ranges" and are not absolutes. They are set by testing lots of people who are categorized as "healthy" and determining their blood levels. The problem is you can have a lot of people who are subjectively categorized as healthy but are really not. That appears to be the case with hypothyroidism. It is likely there were numerous undiagnosed subjects included in the old "normal" range. As I mentioned in my last post on this subject, the more enlightened docs in the medical community now use these tests as guides rather than absolutes and treat based on symptoms rather than blood levels.

Now here is where it gets good (or bad depending on whether you are manic or depressive today). I also mentioned that hypothyroidism is connected with rising Lipoprotein(a) and now discover it is also connected with rising homocysteine (that would be me on both counts) as well as other hyperlipidemias. It also seems that certain drugs and supplememts can interfere with thyroid production (like niacin - also me). The link in the previous sentence is a multi-page article I would recommend reviewing. I also recommend this well-reasoned discussion on the treatment of hypothyroidism (especially the undiagnosed and border-line variety).

Hypothyroidism, it is real and it can screw you up. But it is easy to detect and treat. If you have symptoms or suspect it, get a doc to test your TSH, T4 and T3. To reduce delays try to get them done all at once. Many docs will do just the TSH and then only do T4 and T3 if your TSH is elevated. This is just medical "crank turning" by docs who don't like to think. In my NOT so humble opinion, you really have to look at all three and interpret the results. I'll post my results once I start treatment.

Regards from the human guinea pig,



Anonymous said...

HH - Please keep us posted. My wife has hypothyroidism and takes a regular dose of levoxyl each morning at least one hour before eating any food. (Apparently food can interfere with the absorption of the synthetic hormone.) Also, it is worth noting that many doctors consider a TSH level above 2 to be a "watch and wait" situation as it suggests that a breakdown of thyroid function is more likely to occur. At that point it is probably particularly useful to have the full battery of tests (not just TSH) conducted just to make sure there isn't a sub-clinical problem lurking.

I know that G has been suggesting on her blog and in TYP posts that treating thyroid problems can have a significant impact on heart health. It sounds like you may have found a root cause for some of what is going on. I am also quite curious about the negative relationship between niacin and thyroid hormone production. I hadn't heard of that before and since I take niacin I guess I need to be more vigilant about TSH, T3 and T4 levels.


Stephan said...


Just reading through some of your posts. Do you eat wheat, rye or barley? You sound like a classic case of gluten sensitivity or celiac. Anemia, autoimmune disorders, digestive problems. All typical.

If you haven't already, you should be tested for antigliadin IgG and/or tissue transglutaminase antibody (tTG). A gut biopsy could be useful as well, but keep in mind a negative biopsy doesn't exclude gluten sensitivity.

If you are celiac or gluten-sensitive, as around 20% of N Americans are, going on a gluten-free diet could resolve the thyroid and other problems, including CVD risk.

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