Patients who have thyroid disease are at an increased risk of high cholesterol, heart disease and strokes. Advanced Testing is essential. If a recent round of blood work has shown that you have high cholesterol, high triglycerides or high levels of “bad” cholesterol, it is time to refocus on the role your thyroid plays in cholesterol production. Doing so may have a profound impact on your heart disease.
Today’s article will review special testing to assess your risk of heart disease, ways in which thyroid disease can cause arterial plaque build up and what steps you should start taking if your bloodwork shows problems.
The link between thyroid disease and high cholesterol is well established and if you are someone who been diagnosed with lipid problems which include;
- High or Low cholesterol,
- High or Low triglycerides,
- High LDL’s (bad cholesterol),
- Low HDL’s (good cholesterol)
and you should know that thyroid disease is one the major causes of heart disease including cholesterol (dyslipidemia) problems.
Thyroid Disease- A Major Cause of Cholesterol Problems
Several studies show that that High cholesterol is an early marker of both sub-clinical hypothyroidism (also called mild thyroid failure) as well as overt hypothyroidism.
Subclinical Hypothyroidism and Overt Hypothyroidism- Both Cause Cholesterol Problems
If you are not familiar with either of these terms let’s break them down.
Subclinical hypothyroidism is an early, mild form of hypothyroidism, in which the body doesn’t produce enough thyroid hormones. It’s called subclinical because only the serum level of thyroid-stimulating hormone (TSH) is a little bit above normal. Its is sometimes referred to as mild thyroid failure.
Overt hypothyroidism is characterized by an increased TSH and a decreased T4 level. Patients with overt hypothyroidism are usually treated with thyroid hormone replacement.
Understanding cholesterol can be really confusing, but I’m going to make it really easy to understand so that when you look at your own bloodwork, you know what you are looking at and what to ask your doctor for on your next visit.
I also want you to know that the standard markers being used by most doctors during routine cholesterol screenings are garbage! And that you shouldn’t rely on them for any indicator for cardiovascular health. While that may seem harsh, you will see why my critique is as harsh as it is shortly.
Thyroid Hormones Effect Cholesterol Production
While you may be familiar with the symptoms of thyroid disease like fatigue, hair loss, depression, anxiety, cold hands and cold feet, what you might not know is that thyroid hormone receptors are found on every cell in the body.
Because thyroid receptors can be found on the hearts myocardium and endothelium, changes in thyroid hormones receptors can have significant effects in cardiac function. In addition Thyroid hormone levels also effect enzymes involved in cholesterol production.
Have You Been Told You Have High Cholesterol or Heart disease?
If you have been told you have high cholesterol or heart disease, It’s vital to have your thyroid properly evaluated with a full thyroid panel. The thyroid is a small butterfly-shaped gland that sits at the front of the neck. It receives a hormone signal from the pituitary gland (brain) and secretes other hormones into the bloodstream. You might be familiar with these hormones T3 and T4.
Thyroid-stimulating hormone (TSH): This hormone is released by the pituitary gland and reflects the body’s need for thyroid hormone. This means that when TSH is high, not enough thyroid hormone is being produced (hypothyroidism). When TSH is low, there is more than enough thyroid hormone in the body (hyperthyroidism).
If thyroid medication is given for hypothyroidism, it is usually in the form of T4, T3, or a combination of the two.
Thyroxine (T4): The thyroid gland releases large amounts of this largely inactive form of thyroid hormone, which must be converted into the more active T3 by deiodinase enzymes.
Low amounts of T4 may indicate hypothyroidism; high amounts may indicate hyperthyroidism.
Triiodothyronine (T3): This is the active form of thyroid hormone, secreted in small amounts by the thyroid gland and formed from the conversion of T4 to T3. T3 is the primary thyroid hormone that will act on cells all over the body to regulate metabolism.
Low amounts of T3 may indicate hypothyroidism or low T3 syndrome; high amounts indicate hyperthyroidism.
A Recent Blood Test of A Patient with Thyroid Disease
Let me show you what I mean and show you a test I recently ran on a patient. When you first look at this you will see that there are a lot of things that came back flagged.
This patient has Hashimotos Thyroid disease and what is happening with his cholesterol levels, triglycerides and LDL bloodwork is tied into his thyroid disease.
If we start at the top you will notice that his LDL- P. Now LDL and LDL- P are not the same and I will explain the difference in just a moment. If you look at his LDL-P you see it is 1702- this is the actual number of LDL particle in the blood.
This LDL particle number is now considered by many researchers to be the best indicator of cardiovascular disease risk more important than looking at just the total number of LDLs.
Next you will notice the LDL–C. This is the total number of cholesterol in the blood. This came back high at 126-
LDL Particle Size High Risk VS Low Risk…… Size DOES Matter.
LDL come in two major forms or sizes- and knowing which one you have more of- is an important risk factor for heart disease and stokes. And guess what…. Your thyroid levels affect this.
If you look here at this illustration below, you will notice that we have two kinds of LDLs
- Large LDL’s (pattern A) which are the good ones
- Small LDL’s (pattern B)- (BAD ones) You do not want a bunch of small LDLs
The one thing I want to point out is that most doctors NEVER run this special test. Most doctors look at your total LDL’s which is the sum of both pattern A and Pattern B). When you look at your LDL you nee know if you have more of the good ones or more of the bad ones.
I will say this again, if your total LDL levels come back high- you still have to know if you have the large ones (pattern A) or the Small ones (Pattern B).
If you have too many of the small ones (pattern B) you have problems! The good news is that with the right diet, the right testing, the right supplements, this is something you can improve in as little as 3-6 months.
The next thing you will see are the Triglycerides. When you eat, your body naturally converts any calories it doesn’t need to use right away into triglycerides.
The triglycerides are stored in your fat cells and are used for energy between meals. Think of triglycerides as stored energy.
Many times, triglycerides can be elevated in the case of insulin resistance, obesity, smoking, thyroid disease, high carb diets, alcohol, corticosteroids and estrogens.
In this patient, Triglycerides are 150 and were flagged as high. Optimal levels or Functional levels should be around 100.
The next thing you will want to look at are the HDLs (good cholesterol) this patients levels came back low at 40, optimally we want to see these above 55.
HDL Are Considered Your Good Cholesterol For Two reasons.
1- They are anti-inflammatory
2- Their job is pick up cholesterol from the peripheral tissues and transport it back to the liver.
Understanding HDL and LDL
When we talk about HDL and LDL it is important to realize that these HDL and LDLs are taxi cabs for cholesterol.
Cholesterol is either being brought to the heart which is what LDL do or they are brought away from the heart which is what HDL do.
This is why HDL’s and LDL’s are referred to as either being good or bad- but there is much more to this story.
If we come back to this patient’s bloodwork for just a moment, the next thing we see is that the small LDL- P came back very high at 1090. This is a BIG problem.
This means that this patient has a lot of the bad cholesterol or (Pattern B-) This patients has too many of small LDL particles, These are the ones that cause atherosclerosis, heart attacks, strokes.
How Does The Thyroid Tie Into High Cholesterol
Now how does low thyroid tie into problems with cholesterol. If you remember what I said earlier, I said we have thyroid receptors on every cell of the body including the heart and the liver. Remember your liver makes cholesterol.
What I find so disappointing in health care today is that while there are thousands and thousands of studies showing the relationship on how the thyroid impacts lipid HDL levels, triglyceride levels, particle number, very few doctors are interested in understanding this connection or improving thyroid function for the sake of the heart.
Most doctors today are not interested in getting to the root cause or asking why the cholesterol, Triglycerides are elevated, too many doctor are more interested in putting patients on statins, beta blockers and other medications for the heart rather than addressing the root causes. If you have a skewed lipid panel addressing poor thyroid function needs to be high up on the priority list.
In order to understand this relationship between thyroid disease, high cholesterol and heart disease l in the first place we need to understand a little about a very important enzyme called HMG-Co A reductase.
HMG-Co A reductase- The Gate Keeper in Cholesterol Production
HMG-Co A reductase is the enzyme that determines how much or how little cholesterol is made by your liver.
If you know someone who takes any of the cholesterol lowering drugs, the way these drugs lower cholesterol, is by inhibiting this HMG-Co A reductase Enzyme.
When you reduce the activity of the HMG-Co A reductase Enzyme you get less cholesterol production in the liver.
But remember taking the statin does not address “WHY” the liver is making too much cholesterol and statins come with lots of side effects.
5 Ways Low Thyroid Affects Lipid Metabolism and Puts You at Increased Risk of Heart Disease.
Thyroid hormones and Insulin both increase the number and activity of an enzyme called HMG CoA reductase, which controls the rate of cholesterol production.
This means that hypothyroidism (low Thyroid hormones) and high levels of insulin increases the amount of cholesterol produced in the liver.
If you are a woman with Poly Cystic Ovarian Disease (PCOS) or type II diabetes or you are taking too much insulin as in the case of a Type I diabetic, you high cholesterol in part is being caused by your high insulin levels. Here are 5 Ways Low Thyroid Affects Lipid Metabolism and puts you at increased risk of heart disease and strokes.
#1 Hypothyroidism Increases Heart Disease By Increasing The Amount of Cholesterol Produced In The Liver.
High levels of TSH like that seen in patients with hypothyroidism, increases the expression and activity of an enzyme called HMG CoA reductase, which controls the rate of cholesterol synthesis (Source)
This means that hypothyroidism increases the amount of cholesterol produced in the liver.
#2 Hypothyroidism Increases Heart Disease By Increasing Triglycerides and Decreases HDL Cholesterol (Good Cholesterol)
Low thyroid hormones (hypothyroidism) reduce the activity of an enzyme called lipoprotein lipase and hepatic lipase.
This is an enzyme that breaks down triglycerides as well as maintains levels of HDL and LDL.
When you have hypothyroidism (low thyroid hormone levels), you will have less lipoprotein lipase enzyme activity, and less hepatic lipase activity. This leads to increased Triglycerides and lower your HDL Good cholesterol.
#3 Hypothyroidism Increases Heart Disease By Increasing The Number of LDL Particles
LDL particles circulate around in the blood until they bind to LDL receptors in the liver and heart. In hypothyroidism, the Low Thyroid hormone levels T3 and T4 reduces the number of LDL receptors.
The less LDL receptors you have that can bind and take up cholesterol, the more LDL you have floating around in your blood and the higher your LDL levels are when your doctor runs bloodwork.
#4 Hypothyroidism Increases Heart Disease By Increasing Homocysteine Levels
Every single patient with thyroid disease should have their homocysteine levels checked- no exceptions!
Homocysteine is a sulfur-containing amino acid that has been shown to cause injury to the lining of our blood vessels, they cause oxidative stress and damage, and they have the ability to oxidize LDL cholesterol- all of these problems are part of the process involved in atherosclerosis, strokes and cardiovascular diseases.
Learn more about high Homocysteine here and some easy steps you can take to lower your homocysteine levels.
#5 Hypothyroidism Increases Heart Disease By Increasing LDL Particle Oxidation
Hypothyroidism is associated with increased LDL particle oxidation. To understand oxidation of LDL particles, we need to first define it.
The oxidation of LDL occurs when LDL cholesterol particles in your body react with free radicals.
Free radicals are unstable molecules that are produced as a result of normal metabolism, a disease, exposure to toxins and a low reserve of antioxidants.
Free radicals cause oxidation, a type of chemical destabilization of molecules such as LDL cholesterol.
Antioxidants prevent the damaging effects of free radicals. Back to Oxidized LDLs.
Oxidized low‐density lipoproteins (LDL) are highly suspected of initiating the atherosclerosis process.
It is now believed and widely accepted that excess LDL particles in the blood cause irritation and insult to the walls of the blood vessels.
Once in contact with the inner wall of the blood vessel, these LDL particles become oxidized where they cause the real damage.
These LDL particles once oxidized, damage the inner lining, triggering the inflammatory response.
It is this inflammatory response to the injury, that causes the initiating event of the plaque formation.
T3 acts as a free radical scavenger and may protect LDL particles from oxidation
Action Steps to Improve Your bloodwork and Reduce Your Chances Of A Heart Attack
- Proper treatment starts with proper testing. Talk with your Functional Medicine Doctor about the most appropriate tests for you. If you don’t have a Functional Medicine Doctor contact us.
- Increase your antioxidant level with foods and supplements – Antioxidants are substances that can prevent or slow damage to cells caused by free radicals, unstable molecules that the body produces as a reaction to environmental and other pressures. Here are some examples of foods high in anti-oxidants Broccoli, spinach, carrots and potatoes are all high in antioxidants, and so are artichokes, cabbage, asparagus, avocados, beetroot, radish, lettuce, sweet potatoes, squash, pumpkin, collard greens and kale. Using lots of spices in cooking is also recommended.
- Start Exercising- 35-45 minutes of cardiovascular training and strength training several times (3-5x) per week.
- Get Blood sugar and high level of insulin level under control – Insulin levels over 6 are a problem.
- Lose weight , quick smoking, quit alcohol consumption.
- Improve the health of your gut microbiome. The gut microbiome influences hormones, nutrient absorption as well as cardiovascular function.