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levothyroxine for Cholesterol, wrong treatment? plz help!
I need some help to understand the medication prescribed to my mother due to her high cholesterol (for last 2 years).
Patient information: 60 years old, Female, 5 ft height, 81 lb weight.
The issue in nutshell "Is Levothyroxine right medication for high cholesterol, when the thyroid results (serum T3, T4, TSH) are normal ? If it is wrong treatment will it lead to lasting health effects, currently we are seeing about 17 lb wt loss in 6-8 months. Her weight went down from 97 lb to 81 lb."
Long story:
Two years ago my mother's cholesterol levels were found to be elevated (Total = 274, HDL = 65, LDL = 182, TriGLY = 134). She was prescribed Eltroxin (Levothyroxine 50 mcg) by "Doctor A" and she has been taking the same dosage for the duration.
Recently (within last 2 months) she complained about stomach ache, loss of appetite, bloated feeling, other times feeling hungry but wouldn't be able to eat much. She has lost weight from 98 lb to 81 lb. Her weight has always stayed between 97-100 lb but I am unable to tell when this slide exactly started (sorry I do not stay in my home country).
My mother consulted Doctor A who had originally prescribed Levothyroxine and he did regular blood, urine work. Surprisingly he didn't recommend a Cholesterol checkup. Urine test results were normal. Only abnormal value in blood work was C-reactive protein = 26.4 mg/ml, which is very high I suppose (recommended 0-6 mg/ml according to report). Eltroxin was stopped due to high weight loss.
My questions about cholesterol treatment after I did some reading.
1. Eltroxin (Levothyroxine) is supposed to treat hypothyrodism, Is it ever prescribed for cholesterol control ?. Her thyroid hormone results were normal 2 years ago, she only had elevated cholesterol.
2. If Levothyroxine was prescribed to reduce the high cholesterol values, the doctor never asked for periodic cholesterol check-up to monitor it. I think that was necessary, am I correct?
3. From reading about Levothyroxine, it seems it can cause bone density decrease. What tests can be done to check this ?
4. If Eltroxin was prescribed incorrectly, I see there are host of other problems/ side effects that can arise. Also is it wise to stop Levothyroxine suddenly ? There is conflicting information online.
5. What all tests you would recommend she should do now. I am asking for cholesterol, bone density measurement (not sure how it is done), Thyroid hormone values. Anything else ?
6. What does high CRP values in recent blood tests indicate ? Does antibiotic treatment for high CRP values make any sense at all ?
My mother lives in developing world, south asia. Getting 2nd and 3rd opinion is not always easy. I only looked up Levothyroxine recently when I heard about such drastic weight loss. I had no reason to doubt the prescribed medicine 2 years ago. I want to get some answers before I either confront doctor A or find someone else.
If you have any questions I will try to answer them. Thank you for your help.
Patient information: 60 years old, Female, 5 ft height, 81 lb weight.
The issue in nutshell "Is Levothyroxine right medication for high cholesterol, when the thyroid results (serum T3, T4, TSH) are normal ? If it is wrong treatment will it lead to lasting health effects, currently we are seeing about 17 lb wt loss in 6-8 months. Her weight went down from 97 lb to 81 lb."
Long story:
Two years ago my mother's cholesterol levels were found to be elevated (Total = 274, HDL = 65, LDL = 182, TriGLY = 134). She was prescribed Eltroxin (Levothyroxine 50 mcg) by "Doctor A" and she has been taking the same dosage for the duration.
Recently (within last 2 months) she complained about stomach ache, loss of appetite, bloated feeling, other times feeling hungry but wouldn't be able to eat much. She has lost weight from 98 lb to 81 lb. Her weight has always stayed between 97-100 lb but I am unable to tell when this slide exactly started (sorry I do not stay in my home country).
My mother consulted Doctor A who had originally prescribed Levothyroxine and he did regular blood, urine work. Surprisingly he didn't recommend a Cholesterol checkup. Urine test results were normal. Only abnormal value in blood work was C-reactive protein = 26.4 mg/ml, which is very high I suppose (recommended 0-6 mg/ml according to report). Eltroxin was stopped due to high weight loss.
My questions about cholesterol treatment after I did some reading.
1. Eltroxin (Levothyroxine) is supposed to treat hypothyrodism, Is it ever prescribed for cholesterol control ?. Her thyroid hormone results were normal 2 years ago, she only had elevated cholesterol.
2. If Levothyroxine was prescribed to reduce the high cholesterol values, the doctor never asked for periodic cholesterol check-up to monitor it. I think that was necessary, am I correct?
3. From reading about Levothyroxine, it seems it can cause bone density decrease. What tests can be done to check this ?
4. If Eltroxin was prescribed incorrectly, I see there are host of other problems/ side effects that can arise. Also is it wise to stop Levothyroxine suddenly ? There is conflicting information online.
5. What all tests you would recommend she should do now. I am asking for cholesterol, bone density measurement (not sure how it is done), Thyroid hormone values. Anything else ?
6. What does high CRP values in recent blood tests indicate ? Does antibiotic treatment for high CRP values make any sense at all ?
My mother lives in developing world, south asia. Getting 2nd and 3rd opinion is not always easy. I only looked up Levothyroxine recently when I heard about such drastic weight loss. I had no reason to doubt the prescribed medicine 2 years ago. I want to get some answers before I either confront doctor A or find someone else.
If you have any questions I will try to answer them. Thank you for your help.
COMMUNITY LEADER
If the report doesn't specify "Free" or "FT", then the test done are Total T3 and Total T4... They aren't the same tests as Free T3 and Free T4 and don't provide the same information. Free T3 and Free T4 are the hormones that are actually available for use, while the majority of Total T3 and Total T4 are bound by proteins and can't be used. We need to know the the unbound (Free) portions, but if you don't have those, we'll make do with what you have...
Are the ranges for the tests done in 2014 the same as the ones done in 2013? Ranges vary from lab to lab and sometimes, a lab will change their ranges. We have to compare the results with the ranges on each report.
Most of us find that Free T4 has to be about mid range; your mother's T4 was only at 5% of its range in 2013 and only 19% in 2014. We also find that Free T3 has to be in the upper half to upper third of its range; hers was only 25% of the range in 2013 and 42% of the range in 2014... I'd say the doctor was justified in starting her on the Eltroxin, intitially, but levels certainly need to be monitored periodically and dosages adjusted, according on symptoms and labs...
These results don't indicate over medication, but if she hasn't been tested since 2014, there's no telling what her levels are now... does she have any other symptoms of over medication, such as diarrhea, rapid heart rate, heart palpitations, hand tremors, etc?
Do you know what dosage of Eltroxin your mother is taking?
You said your mother is in a 3rd world country... not all countries have Free T3 and Free T4 tests available, so make sure she asks for them.
Are the ranges for the tests done in 2014 the same as the ones done in 2013? Ranges vary from lab to lab and sometimes, a lab will change their ranges. We have to compare the results with the ranges on each report.
Most of us find that Free T4 has to be about mid range; your mother's T4 was only at 5% of its range in 2013 and only 19% in 2014. We also find that Free T3 has to be in the upper half to upper third of its range; hers was only 25% of the range in 2013 and 42% of the range in 2014... I'd say the doctor was justified in starting her on the Eltroxin, intitially, but levels certainly need to be monitored periodically and dosages adjusted, according on symptoms and labs...
These results don't indicate over medication, but if she hasn't been tested since 2014, there's no telling what her levels are now... does she have any other symptoms of over medication, such as diarrhea, rapid heart rate, heart palpitations, hand tremors, etc?
Do you know what dosage of Eltroxin your mother is taking?
You said your mother is in a 3rd world country... not all countries have Free T3 and Free T4 tests available, so make sure she asks for them.
1 Comments
Thank you again for reply. Yes the range is same for both tests and it was done in same lab. And I see how the values are on lower side of spectrum.
I will have to check for the symptoms you have asked. But 2 months ago she started complaining about stomach ache, loss of appetite, bloated feeling, other times feeling hungry but wouldn't be able to eat much. Sorry I had left that out.
Another thing I did not mention as my messages were getting too long: Recently while her Eltroxin was stopped by Dr. A he also prescribed her : Vitamin D3, Vitamin B and the soluble form of Vitamin B1, benfotiamine.
Also he prescribed her Bucklizine HCL (apparently appetite stimulant, but very less evidence), Selegiline hcl (MAOI which is prescribed for early parkinson's symptoms) and Baclofen (muscle relaxant) . I didn't want to over complicate my original message. but these last 3 things are complete left- field for me. The only tests she had done was blood and urine tests, I am completely lost where the selegiline comes from (he never said anything about Parkinson's to her).
Anyhow, I felt I should update the info, I didn't intent to leave it out, just was worried I will make too long an original post.
I will have to check for the symptoms you have asked. But 2 months ago she started complaining about stomach ache, loss of appetite, bloated feeling, other times feeling hungry but wouldn't be able to eat much. Sorry I had left that out.
Another thing I did not mention as my messages were getting too long: Recently while her Eltroxin was stopped by Dr. A he also prescribed her : Vitamin D3, Vitamin B and the soluble form of Vitamin B1, benfotiamine.
Also he prescribed her Bucklizine HCL (apparently appetite stimulant, but very less evidence), Selegiline hcl (MAOI which is prescribed for early parkinson's symptoms) and Baclofen (muscle relaxant) . I didn't want to over complicate my original message. but these last 3 things are complete left- field for me. The only tests she had done was blood and urine tests, I am completely lost where the selegiline comes from (he never said anything about Parkinson's to her).
Anyhow, I felt I should update the info, I didn't intent to leave it out, just was worried I will make too long an original post.
COMMUNITY LEADER
1) Eltroxin is used to treat hypothyroidism... High cholesterol is, often, a symptom of hypothyroidism...
Please post your mother's actual thyroid hormone levels at the time she was started on the Eltroxin... Even though they were "in range", if they were too low in the range, she may have been hypo and that could have contributed to high cholesterol.
2) Thyroid levels should be monitored periodically, to make sure levels are where they need to be - not to high and not too low.
3) Thyroid medication does not cause bone loss, though some articles you'll find do say that... Thyroid medication controls metabolism and it's higher metabolism that may contribute to loss of bone density. A bone density scan (called a DEXA scan) will tell whether bone density is normal for the person's age.
4) If the patient does not need levothyroxine, she may stop taking it. Depending on whether she needed it at the time she began taking it, it may advisable to simply decrease dosage.
5) The tests your mother needs to check thyroid function are Free T3, Free T4 and TSH.
6) High CRP indicates that there is inflammation in the body, but can not tell where the inflammation is located. Treating with antibiotics will only resolve inflammation if it's caused by bacterial infection. Antibiotics will not resolve inflammation caused by a virus or things such as an autoimmune response, arthritis, etc. Best course, course of action is to find the cause of the inflammation, then decide on the treatment.
Please post your mother's actual thyroid hormone levels at the time she was started on the Eltroxin... Even though they were "in range", if they were too low in the range, she may have been hypo and that could have contributed to high cholesterol.
2) Thyroid levels should be monitored periodically, to make sure levels are where they need to be - not to high and not too low.
3) Thyroid medication does not cause bone loss, though some articles you'll find do say that... Thyroid medication controls metabolism and it's higher metabolism that may contribute to loss of bone density. A bone density scan (called a DEXA scan) will tell whether bone density is normal for the person's age.
4) If the patient does not need levothyroxine, she may stop taking it. Depending on whether she needed it at the time she began taking it, it may advisable to simply decrease dosage.
5) The tests your mother needs to check thyroid function are Free T3, Free T4 and TSH.
6) High CRP indicates that there is inflammation in the body, but can not tell where the inflammation is located. Treating with antibiotics will only resolve inflammation if it's caused by bacterial infection. Antibiotics will not resolve inflammation caused by a virus or things such as an autoimmune response, arthritis, etc. Best course, course of action is to find the cause of the inflammation, then decide on the treatment.
1 Comments
Thank you so much for your response. I am giving the original thyroid values below
June 2013:
Serum T3 = 1.1 (range 0.8 to 2.0)
Serum T4 = 5.94 ( 5.5 to 14.1)
Serum Ultra TSH = 4.291 (0.3 to 6.02)
There was one more test done in January 2014:
Serum T3 = 1.30
Serum T4 = 7.15
Serum Ultra TSH = 1.732
This is all I have, I getting scanned reports from home, so it may take me sometime to find any more information. But thank you again for your response.
I hope "Free T3, Free T4 and TSH" are same as above, I will be asking her to get this checked soon, along with bone density scan and I suppose cholesterol values can also be checked, its been 2 years since last time.
If you have any more comments please let me know, I will keep you updated when I learn more.
June 2013:
Serum T3 = 1.1 (range 0.8 to 2.0)
Serum T4 = 5.94 ( 5.5 to 14.1)
Serum Ultra TSH = 4.291 (0.3 to 6.02)
There was one more test done in January 2014:
Serum T3 = 1.30
Serum T4 = 7.15
Serum Ultra TSH = 1.732
This is all I have, I getting scanned reports from home, so it may take me sometime to find any more information. But thank you again for your response.
I hope "Free T3, Free T4 and TSH" are same as above, I will be asking her to get this checked soon, along with bone density scan and I suppose cholesterol values can also be checked, its been 2 years since last time.
If you have any more comments please let me know, I will keep you updated when I learn more.
COMMUNITY LEADER
I think you've done the right thing in telling her to get a second opinion about the 3 meds, since she doesn't seem to have symptoms for which she would need those.
Do be sure that she doesn't just stop the Baclofen... that sounds like a nasty drug and one I'd probably want off from, but as I mentioned it sounds like it must be tapered down...
It's important to note that some meds are worse than the conditions they're meant to treat...
Do be sure that she doesn't just stop the Baclofen... that sounds like a nasty drug and one I'd probably want off from, but as I mentioned it sounds like it must be tapered down...
It's important to note that some meds are worse than the conditions they're meant to treat...
COMMUNITY LEADER
Thank you for confirming the ranges for me...
You did mention those symptoms in your original post; I was just asking if she had any other symptoms that we'd normally associate with too much thyroid medication (hyperthyroidism), such as the ones I listed...
I'm quite familiar with the vitamins prescribed and those are all things we would, typically, suggest someone with hypothyroidism should often take... especially, vitamin D and B12. I take Benfotiamine, also, so there's nothing harmful there.
Not being familiar with the medications, a quick search tells that Bucklizine HCL is used for motion sickness. It's not commercially available in the U.S. and Canada and constipation, dryness of mouth, and urinary retention (especially in males) are more likely to occur in the elderly. If she has any of these, they could account for the bloating...
Selegiline hcl - side effects include nausea/vomiting which could cause her to not want to eat or to feel hungry, but not be able to eat.
Baclofen - muscle relaxant used to treat pain, spasm and stiffness of Multiple Sclerosis... side effects can include nausea, constipation, diarrhea, loss of appetite, plus many more... This drug should NOT just be stopped as there seems to be serious withdrawal effects... it appears that it may require a taper down - be sure to check this out before stopping this and any other med.
Do a search in www.drugs.com for each of these medications, then look at the side effects. I've only listed the ones that pertain to what you told me she has, but each of these drugs can produce many other side effects. You should make sure she doesn't have other symptoms...
In addition, since the drugs all seem to cause similar side effects, combining them could be compounding the problem...
If she's taking these meds at the same time she's taking her Eltroxin, that could also be causing some issue... thyroid medication is to be taken first thing in the morning with 1 cup of water then wait 30 minutes to an hour before eating/drinking anything else. Other meds should be separated from the thyroid hormones by, at least an hour. She should read the instructions for taking all the other meds, as well to make sure there are no separation requirements.
Right now, it's very important that she get thyroid hormone levels tested to see what's going on there... then figure out why her doctor prescribed those other medications if she has none of those conditions.
If possible another doctor is certainly in order.
You did mention those symptoms in your original post; I was just asking if she had any other symptoms that we'd normally associate with too much thyroid medication (hyperthyroidism), such as the ones I listed...
I'm quite familiar with the vitamins prescribed and those are all things we would, typically, suggest someone with hypothyroidism should often take... especially, vitamin D and B12. I take Benfotiamine, also, so there's nothing harmful there.
Not being familiar with the medications, a quick search tells that Bucklizine HCL is used for motion sickness. It's not commercially available in the U.S. and Canada and constipation, dryness of mouth, and urinary retention (especially in males) are more likely to occur in the elderly. If she has any of these, they could account for the bloating...
Selegiline hcl - side effects include nausea/vomiting which could cause her to not want to eat or to feel hungry, but not be able to eat.
Baclofen - muscle relaxant used to treat pain, spasm and stiffness of Multiple Sclerosis... side effects can include nausea, constipation, diarrhea, loss of appetite, plus many more... This drug should NOT just be stopped as there seems to be serious withdrawal effects... it appears that it may require a taper down - be sure to check this out before stopping this and any other med.
Do a search in www.drugs.com for each of these medications, then look at the side effects. I've only listed the ones that pertain to what you told me she has, but each of these drugs can produce many other side effects. You should make sure she doesn't have other symptoms...
In addition, since the drugs all seem to cause similar side effects, combining them could be compounding the problem...
If she's taking these meds at the same time she's taking her Eltroxin, that could also be causing some issue... thyroid medication is to be taken first thing in the morning with 1 cup of water then wait 30 minutes to an hour before eating/drinking anything else. Other meds should be separated from the thyroid hormones by, at least an hour. She should read the instructions for taking all the other meds, as well to make sure there are no separation requirements.
Right now, it's very important that she get thyroid hormone levels tested to see what's going on there... then figure out why her doctor prescribed those other medications if she has none of those conditions.
If possible another doctor is certainly in order.
2 Comments
Thank you again. I have only skimmed thorugh (at work) but will do complete reading later in the day.
I will ask her about when she is taking the thyroid med and make sure its according to what you wrote above.
I will write more after better reading your message + drugs.com I suppose.
I will ask her about when she is taking the thyroid med and make sure its according to what you wrote above.
I will write more after better reading your message + drugs.com I suppose.
Hi there,
Bit update. So I checked with her to make sure she is taking the Eltroxin in right manner (first thing in morning. Then eating after 30 mins). I told her if she has any other medications ever added during her morning time, she has to separate it by 1 hour from Eltroxin (or at least always ask doctor!).
So the supplements I had given her go ahead to take. The other three Bucklizine, Seligeline, Baclofen I have asked her to get 2nd opinion about.
Buclizine as you said is not approved in US. It has very few studies and recently in developing countries its been touted as "appetite enhancer". No scientific proof for that.
Selegiline is one of older MAOIs, which are not really prescribed for depression as first option [even if she has it]. Secondly Selegiline was found to be useful in Early Parkinson's treatment, rather recent references are only for early Parkinson's management. But she had no such symptoms/ discussion with doctor. Its complete left field prescription even without considering its side effects.
Baclofen, if there is severe muscle spasms/ pain maybe can be taken (as needed). But I don't see any point in continually taking it for 30 days. And as you pointed out, you can't stop it suddenly.
This is what I found while looking up. On top of it you mentioned all the overlapping side effects. So I am going to ask her to tread with caution.
And our system is such that, Doctor tells you once how to take meds (what sequence, order etc). But when you collect it from pharmacy there is no instructions/ side effects/ cautions write up given like it is West. Any prescription here comes with tons of info from Pharmacist, not so in my country. If there is any miscommunication, she can easily take dose in wrong order. So thank you for bringing that up.
Bit update. So I checked with her to make sure she is taking the Eltroxin in right manner (first thing in morning. Then eating after 30 mins). I told her if she has any other medications ever added during her morning time, she has to separate it by 1 hour from Eltroxin (or at least always ask doctor!).
So the supplements I had given her go ahead to take. The other three Bucklizine, Seligeline, Baclofen I have asked her to get 2nd opinion about.
Buclizine as you said is not approved in US. It has very few studies and recently in developing countries its been touted as "appetite enhancer". No scientific proof for that.
Selegiline is one of older MAOIs, which are not really prescribed for depression as first option [even if she has it]. Secondly Selegiline was found to be useful in Early Parkinson's treatment, rather recent references are only for early Parkinson's management. But she had no such symptoms/ discussion with doctor. Its complete left field prescription even without considering its side effects.
Baclofen, if there is severe muscle spasms/ pain maybe can be taken (as needed). But I don't see any point in continually taking it for 30 days. And as you pointed out, you can't stop it suddenly.
This is what I found while looking up. On top of it you mentioned all the overlapping side effects. So I am going to ask her to tread with caution.
And our system is such that, Doctor tells you once how to take meds (what sequence, order etc). But when you collect it from pharmacy there is no instructions/ side effects/ cautions write up given like it is West. Any prescription here comes with tons of info from Pharmacist, not so in my country. If there is any miscommunication, she can easily take dose in wrong order. So thank you for bringing that up.
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