Cholesterol and Thyroid Post TX: What's this mean (JmJm? Anyone?)

[Algernon]

My cholesterol level and LDL have always been very low (my doctor has always been proud of me...).   My TSH always in normal range.

12 weeks post TX.  Viral load UND (<5).  Everything else in normal range.

Now 17 weeks post:
Cholesterol is 236 (always been around 150)
Triglycerides now 140 (always around 60)
TSH is <.1 (I guess that means zero...) (always around 1.2)
And my ALT/AST were a bit higher (ALT went from 13 to 18 and AST went from 14 to 18).

What up?  I feel like I'm turning into an old lady when I look at these labs (hey, I won't be 50 for another 10 months!  

I'm especially concerned about the Cholesterol and Triglycerides.  (Milkshakes R Us...).  What's this mean?

I'm 5'3" and weigh 106 (lost weight POST TX because of jaw pain).  Yep, she's fallin' apart.

(I know the TX could've killed my Thyroid but wouldn't that make my TSH go up?)  (Doc has ordered more labs, included another PCR).

Bottom line.  A bit frightened by these changes.  Do you have ideas about the cholesterol, the TSH being zip, am I doomed?

[Kalio1]

I was told that some HCV virus infected people often do have low cholesterol readings. Mine is also very low. Maybe because you cleared the virus now you are showing "normal" readings?
Tx can affect the thyroid too. What did your doc say about it? My hubby had some high cholesterol issues but he altered his diet and it is fine now but the doc said if the diet changes didn't "fix" it, he would have to go on cholesterol lowering meds. Is the thyroid issue making you feel symptoms? I think lots of people here have dealt with thyroid issues, hope they weigh in.
Sorry you got this shock but they are both things that can be dealt with.

[DoubleDose]

My Cholestorol and my Triglycerides both have elevated dramatically since finishing therapy three years ago.  I routinely have higher blood pressure readings as well.  My thyroid was also damaged, and now, without synthroid supplementation, reads about 6.0 to 8.0.  I take synthroid to keep the TSH at or near 1.0 to 1.25.

Yes, I do believe that the interferon tends to cause some systemic changes that are of concern.  Whether they will ever return to more normal values is anyone's guess.  Maybe the autoimmune stimulation caused by all the interferon might be the culprit in changing many of our test numbers.  If you look at Lupus, or other autoimmune diseases, there is often an impact on the functioning of the body and its systems.  I also believe that some or many of us become prone to autoimmune issues after tx.

Other post-tx issues often include: sun sensitivity, rashes, fatigue, lymph node swelling, brain fog, depression, sexual dysfunction, joint problems, etc.  All of these are often connected to autoimmune disease.

DoubleDose

[NYgirl]

Your number is .01 right? The TSH?

If it's .01 then it's HYPER but the bad thing is it can spin around to HYPO really really FAST.

I take Synthroid too.

I was very hyper and then bam by the time I got my test I was very hypo.

It's not the end of the world...just a little pill every day.

[NYgirl]

PS The TSH and thyroid numbers are completely backwards to how we think they should be logically.  It makes it very confusing.

But HYPER is more dangerous than HYPO.

You need to make an appt. with an Endocronologist asap to discuss.  I'm surprised this wasn't flagged by your doctor for BIG discussion RIGHT AWAY!!!!!!!!!!!  Why is he writing tests if he's not acting on the results?

[Algernon]

The TSH is LESS than .l.

My hep dr didn't figure any of this out.  I only got the labs because I asked for them from my OB-GYN doc!!  I'm seeing an endocrinologist next Tuesday.  NY:  Why is hyper dangerous?

CHOLESTEROL EXPERTS:  Does the rise in cholesterol occur because it's a side effect of TX or because the TX worked (I'm really hoping it's the latter...).

[Kalio1]

I was told it is because the virus is gone and you are "normal"
I have no clue as to how HCV suppreses cholesterol, but it appears in some it does.
Are you feeling good other than ealing with these issues?

[GoofyDad]

Algie,

Try to relax. I wouldn't get excited yet. I had the wonky thyroid at 24 weeks post. Pretty much the same deal. Normal, normal, normal, then TSH = .003

Liverhead told me to see PCP and have TSH retested along with free T3. 3-4 weeks after funky test, PCP retested TSH (normal), free T4 (normal), free T4 (slightly low). Will now wait 2 mos and test again. BTW, PCP said TSH is generally not a number that bings around like say glucose, it moves in trends - though my experience was totally counter to that. Possibly bad test? I dunno.

[NYgirl]

I used to have some links on hyper vs. hypo etc.  I googled and read everything I could.  Hyper is more dangerous because I believe you can have a heart attack or stroke out.

Also with hyper you have a bigger chance of having to have the thyroid radiated and then removed. With hypo not so much.

But it is all manageable with Synthroid.  Most likely (insist) someone send you for a Nuclear Imaging Scan.  You take two iodine pills and then 24 hours later it takes pictures...its a nice little nap really.  That is the way you find out exactly what is going on.

My bloodwork said I was hyper (TSH 0.001) and when they did the scan the tech said WOW looking at you I assumed you were hyperr and I was like well I am and she said uh no most definitely you are not you are extremely hypO.  I was shocked. It totally switched over in only TWO weeks!

I take the pills and have my levels monitored every two months now.  

I'd advise googling thyroid and learning about it, asap.  You can see that the sx REALLY mirror the sides from treatment so it's just about almost impossible to detect them on your own...that is why thank GOD they do monitor the TSH level.

Good luck!

[Algernon]

Actually, I feel really good--even with the wonky thyroid.  I have incredible insomnia but I think that that may be explained by being hyperthyroid--so, in a way, it will be good to have an explanation/solution to the insomnia if my thyroid is a goner.

POST TX recovery definitely takes a while and it's looking like I may have some new health issues (high cholesterol, etc.) but I feel like most of the meds have left the building--and that's great.  I may be kidding myself (due to TX dementia) but I think that even the brain fog has lifted.

Hope you're well.  I feel a lot of empathy with all those on TX.  Tough road but it does eventually end.

Algie.

[jmjm530]

Alg: What up?
-----------------
First, congratulations on what appears to be your SVR! The 12-week post tx PCR correlates very closely with the 24 week. The change in ALT/AST seems like a normal variation and not to be concerned.

As to cholesterol and tx/interferon, ask a dozen doctors and you're going to get a dozen opinions. They just don't know but what else is new :)

What we do know is that LDL (bad cholesterol) and the virus share the same receptors. We also know that a low pre-tx LDL is negatively associated with SVR, but obviously in your case it didn't make any difference since it looks like you are going to SVR.

I had an elevated LDL going into treatment and it dramatically dropped after my first shot. Stayed low all througout treatment. Likewise, my triglicerides were elevated prior to tx and they also dropped during treatment.

My NP gave me the "receptor" story, but to me that would argue that LDL would *risen* during tx, not dropped. I did find one study that suggested interferon can dramatically lower LDL. I'm going with the interferon theory because both my LDL and Tri's shot right back up a few weeks after my last shot.

Now, seven months post treatment, both my cholestol and tri's are still up -- in fact somewhat higher than pre-tx. Hard to tell for sure, cause I've always been diet sensitive. Although I will mention this to my doc, I am under no illusion that he will have any better idea why than if I asked my plumber. Unfortunately, there are just so many things not known about what these drugs do long term to the immune system, metabolism, etc. Double Dose posted a list earlier and I'm sure it can go on and on.

Probably best advice is to see a cardiologist and based on a whole host of factors they'll tell you how concerned you should be with your new numbers.

My cardiologist wanted me to start statins based on my numbers but I suggested we wait until six months post treatment to give the tx drugs time to clear the system and maybe get a better cholesterol reading. They said fine let's give it a chance cause again, their guess was as good (or bad) as mine.

Anyway, and your doctor might want to wait six or twelve month post treatment before making decisions such as taking statins. Or you may not want to. If my case is any example, your cholesterol isn't going to go down in the next three months, but I'm not you.

Meanwhile, you might try the lifestyle changes -- diet, exercise, etc, and monitor those changes with monthly cholesterol tests. I wish my cholesterol was sensitive to lifestyle changes, unfort not everyone's is.

Anyway 236 isn't necessarily terrible and neither are your tri's. Do you know your HDL and LDL? Those numbers are much more important than total cholesterol.

Don't know much about the thyroid as I've never had a problem but
did remember reading that sometimes thryorid issues during tx return to normal post treatment. Of course you want to discuss this with your tx doctor and probably a specialist.

Take care and be well.

-- Jim

[Algernon]

Thanks, guys.

Jim.  Thanks for all the thinking.  My LDL is high (went from consistently around 60 to 140) but my HDL is staying within range of what it's typically been (now 68, been 68-80).  I've never paid any attention to these numbers before.  Unfortunately, bad genes on one side of the family...so this may be the new me.  A whole new area of study awaits.  Dang, I'm tired of trying to read medical articles.  

Goof.  You're right.  I need to calm down.  I think at the base of all my anxiety is the fear of relapse.  I can deal with these new items if my liver just behaves itself.

Unfortunately, I have to go teach a class.  What I'd really like to do is drive around aimlessly and listen to Huckleberry Finn (I'm on disk 4 of 9...).

Love y'all, Alg

[FlGuy]

My ldl, over the past 20 years, has been in the 60's and on tx it crept up to 105.  Back in the 60's again.  It was never clear what impact hcv had on it but I am aware, based on Jim's mention, that low ldl is a negative predictor.  The good news is that you are approaching svr and rising ldl would be good new to me.  When you get tired of all this medical reading and want to come to a firm resolution Tom and Huck had a good idea.  Find yourself a dead cat and a cemetary and give the dead kitty a good swing about your head a midnight - should take care of it.

[amirtracy]

hi there. i wanted to say CONGRAULATIONS on your SVR! couldn't happen to a nicer guy. gives us hope and that ain't bad.
Secondly,
wanted to ask you about uric acid levels. my PA left a message and said my levels were high, 7.8, and to drink more. Of course, noones there now that i can speak to. Can you tell me should i be concerned? my hmg is 10.3. my alt/ast has also risen but is still within normal range. from 17 to 22 and 16 to 20. (my dr. did 200mg dose reduction @ week 24 and that's always had worried...)
thanks is advance Jim and congraulations again!  
tracy week 33/48

[copyman]

hi jim, my tri's(200) & LDL (117) are also high before i start tx in a week. my primary doctor wrote me a script for niaspan a few months back and i never started taking it because i had read it was bad for the liver. did i read your post right that a high LDL can help with tx? you mean for once i hear something positive about my labs? thanks for all the great info you provide here.

[jmjm530]

NIASPAN for someone with liver disease and about to start treatment, HUH ???????? Personally, I'd run that one by a seasoned hepatologist or two. I was advised not to take any of that stuff until after treatment.

Your lipid profile isn't all that terrible -- compared to mine -- but yeah, in a weird way a higher LDL is a positive indicator of SVR but by no means a free pass. But heh, take any little edge you can.

BTW, why Niaspan anyway as opposed to a statin? How low is your HDL because that's what Niaspan is for. You'd probably want a statin like Lipitor to lower that LDL, but if it were my doctor, he'd tell you to wait until after treatment.

Be well.

-- Jim

[Algernon]

Sure would be cool for rising LDL to be good news.  

I'll go sit in the car and listen up to the dead cat bit.  I'm sure that my son will want to go to the cemetary with me.  I can't believe that I never read Huckleberry Finn before.  I'm loving it.  And, just in case you forgot, DO NOT touch a snakeskin.  It brings very bad luck.

I know that you're about to do battle again.  Thinking about you and wishing you easy success this time around.  Let me know if I need to sling any dead cats for you.

Alg.

[FlGuy]

The dead cat may have been a Tom thing, but Huck may have been with him at the time.  So, it may not be on the CD.  May have to go and get more classics.  I'm a little rusty on them.  Bet your kids are glad to have you back.

[jmjm530]

Alg,

I would die for your HDL. Mine is 31 (:
HDL is protective, that's good. Are you seeing a good internist or cardiologist? They can explain things more.

Amir,

Yes, Uric acid is associated with dehydration which  is very common on treatment. Beyond that don't know much.

Your hgb seems OK for week 33 as long as you don't have any serious anemic symptons. The changes in your ALT and AST are insignificant. Mine bounced around even more within the normal limits.

When did you clear the virus and when was your last Viral load test? If you haven't had one since week 12, I'd definitely ask for one now, or at the very least at week 36 which is coming up soon. Best to take sensitive VL test that goes down to at least 50 IU/ml. One good test is HEPTIMAX by Quest labs. It goes down to 5 IU/ml. If your doctor tells you it's not covered by your insurance, don't take his word but double check for yourself. In many cases the insurance companies will cover frequent Viral Load tests as long as the doctor writes an rx. It's too bad that some doctors aren't aware of this.

All the best.

-- Jim

[amirtracy]

Thanks again.
Did a heptimax @ 12 and 24. Undetectable for both. don't think my doc will order another until 48 but he isn't the sharpest tool in the shed either. Uninsured so if I want to pay out of pocket i could probably get one. Do you think it's neccessary w/ an undie @ 24? This **** drives me nuts.
Thanks for your knowledge.   tracy

[jmjm530]

Given your non-detecible via Heptimax at weeks 12 and 24, it's highly unlikely there would be a change at week 36. So, if your insurance doesn't cover the 36 week test, I wouldn't sweat it.

You do want a 48 week test, however, and then at weeks 4, 12 and 24 post treatment. If insurance of finances are an issue, then you can skip week 4 and even week 12, however then you won't know if you made SVR for six months. The week 4 post treatment test will let you know with around 90% accuracy and the week 12 post treatment test is almost as reliable as the 24 week test in terms of confirming SVR.

All the best.

-- Jim

[amirtracy]

My doc has NEVER HEARD of a 4 week post-tx pcr! He insisted I was wrong. UGh. He will do a 48 week and then a 6 month post. I'm gonna make him do the 12 week post just because the curiousity will kill me. if I DO relapse I'm not txing again until there's PI's or something better. I think. I'm not sure. At least that's the way i feel today. geez....

[copyman]

hey jim, maybe i should have been more clear, my primary prescribed the niaspan before i found out about the hcv. i did not start taking it becasue after some research about the effect it has on the liver ( i only knew i had gallstones) i never started taking it. my hdl was low 27 (40-59 normal). the only good thing about my lipids was my total cholestrol was 184(100-199 norm). i have not had the lipids tested again since june, found out about the hcv shortly thereafter and have been having all the tests for that. kind of put the cholestrol stuff oo the back burner. what do you think about taking a statin with tx since the studies are positive about them helping with fighting hcv? i still think there is a direct correlation between abnormal lipids and hcv. i was hoping for them to normalize after tx, but if your went back up i guess maybe that is not the answer. i have changed my diet quite a bit so who knows maybe they are better now, maybe next labs i will have them done. thanks again

[jmjm530]

I was advised by my first hepatologist not to take statins during treatment but it was OK to take before or afterwards. This was a couple of years ago and therefore I assume before the statin/hcv connection articles, etc. I could have started statins right after treatment but decided to wait at least six months so as not to tax my liver any more. This was my decision/reasoning, not my doctors.
Personally, I wouldn't go on any statin or niacin-type drug during treatment without consulting one or two hepatologists.

Your HDL is a bit lower than mine but so is your total cholesterol. I don't know your triglicerides but I'm assuming you have a decent LDL?

According to early research by the late Nathan Pritikin, New Guinea tribesman with low HDLs had remarkably low rates of cardiovascular disease.

Pritkin attritbuted this to the fact that they also had low LDLs. In other word, the reasoning was that while HDL is protective, that protection is only needed for those with higher LDLs

Pritikin was not a medical doctor and this theory has not been embraced by the medical establishment, nor to my knowledge has it been studied recently.

I personally buy into Pritkin's reasoning, after reading some of the source papers but unfortunatly it's too difficult for me to lower my LDL without fairly drastic dietary measures. So...I'll probably end up on Statins in another month or so.

From the little I've read , Niacin can be some pretty nasty stuff even if you don't have liver disease. So definitely get a green light (preferably more than one) before taking it.

-- Jim

[jmjm530]

To clarify, I think Pritkin was using total cholesterol in those days and the "magic" number was somewhere between 100-160, really can't remember. I believe those studies were cited in his original book no longer in print. I do remember going to the library (no internet to speak of then) and looking up some of the citations. Really fascinating work but probably not very relevant to a society that dines at MacDonalds and at the time though a cholesterol of 200 was pretty good.