More ‘aggressive’ thyroid management may help reduce risk of heart disease

The thyroid is a gland in the neck that regulates metabolism. Low thyroid function (hypothyroidism) can lead to diverse symptoms including weight gain, fatigue, sensitivity to cold, dry skin, dry hair, hair loss and constipation. In conventional medicine, the diagnosis of low thyroid function is usually made with a blood test. Here’s the classic picture:

Raised levels of ‘TSH’ (thyroid stimulating hormone, the hormone secreted by the pituitary gland at the base of the brain that stimulates the thyroid to produce thyroid hormones)

Low levels of thyroxine (one of the chief thyroid hormones – also known as ‘T4’)

My experience in practice tells me that the conventional way in which these blood tests are used to diagnose hypothyroidism is quite inadequate. The fact is, true hypothyroidism is not always reflected in a raised TSH and low thyroxine, and many individuals can suffer from hypothyroidism in the long term because their tests are ‘normal’. You can read about this here and here.

Even when tests yield abnormal readings, doctors can be reluctant to treat. For example, there is a recognised condition termed ‘subclinical hypothyroidism’ in which TSH levels are raised, but thyroxine levels are ‘normal’. Whether this condition should be treated with thyroid hormone is a moot point. Some doctors will treat. Many won’t, though, sometimes on the basis of the supposed risks associated with thyroid hormone treatment.

I was interested to read a recent study which looked women with subclinical hypothyroidism over time. Some of these women were treated with thyroxine, while some were not [1]. The researchers then looked at the women’s risk for ‘ischaemic heart disease’ events (fatal and non-fatal heart attacks). In women aged 40-70, thyroid treatment was associated with a 39 per cent reduced risk of heart events. In women over the age of 70, treatment was not associated with a reduction in risk.

Now this study was epidemiological in nature, and cannot be used to conclude that thyroid treatment reduces risk of heart attacks in ‘younger’ women. However, this idea is not far-fetched, seeing as subclinical hypothyroidism is associated with an increased risk of heart disease.

The results of this study suggest that treatment of subclinical hypothyroidism may benefit heart health, and that diagnosing the issue and initiating treatment earlier might be better than ‘watching and waiting’.

As will all things, there are risks associated with treatment. However, what sometimes is forgotten in thyroid management is that there is often a heavy price to pay for not treating too.


Razvi S, et al. Levothyroxine Treatment of Subclinical Hypothyroidism, Fatal and Nonfatal Cardiovascular Events, and Mortality. Arch Intern Med. Published online 23 April 2012

10 Responses to More ‘aggressive’ thyroid management may help reduce risk of heart disease

  1. Paleo Suz 27 April 2012 at 2:33 pm #

    I’m interesting in Thyroid issues – it seems that they are a lot more widespread than we’re lead to believe?

  2. CatUK 27 April 2012 at 3:47 pm #

    I have recently found that I have very high cholesterol (total 13.3, HDL 2.6) and looking on the internet it seems that hypothyroidism could be a cause. Any ideas of what else may be the cause? I used to take Simvastatin for 18 months but stopped a year ago.

  3. Maggie Turner 27 April 2012 at 5:32 pm #

    My mother died at 57 from a heart attack. I have arrythmia and palpitations, I am 63. I have asked for a thyroid function test as I have many of the symptoms you list associated with hypothyroidism. My doctor is sceptical. Is there any way of getting a test/diagnosis done privately. If positive then I would have the evidence to insist on NHS treatment.

  4. Galina L. 27 April 2012 at 6:09 pm #

    Sometimes you could have a normal lab result but continue to experience symptoms of hypothyroidism like fatigue, sensitivity to cold and so on. I benefited greatly from switching from Synthyroid to the natural form – desiccated natural thyroid. Fatigue and cold sensitivity are gone completely.

  5. Paul 27 April 2012 at 6:52 pm #

    Here is a link to presentation given by Dr Carole Spencer (via the American Academy for Clinical Chemistry).

    “Because subclinical thyroid disease is a biochemical diagnosis based on the detection of a TSH abnormality without a FT4 abnormality, the accuracy of the setting of the TSH reference range becomes critical. Unfortunately, because TSH measurement has a low “index of individuality” the TSH population reference range is an insensitive parameter to use for detecting thyroid dysfunction in individual patients.”

  6. Sally 27 April 2012 at 6:55 pm #

    I have been dealing with hypothyroidism for the last 16 years. For a long time, I was on “traditional” synthetic T4 therapy, which just seemed to make things worse. My doctor kept increasing the dose, but the higher the dose the worse I felt. I was lucky enough to find a naturopath in my area who ran some tests and found that my T3 was very low and reverse T3 very high. It seems I am one of perhaps many who cannot convert T4 to T3 very easily. Oddly, the specialist and general practioner I went to only ever looked at the TSH, paid a little bit of attention to the T4, but basically disregarded the T3. I have since changed to a low dose T4/T3 combination in the form of Armour Thyroid and supplement with Cytomel (T3), and things have improved tremendously. I am still having a few problems and recently came across the Wilson Temperature Syndrome which makes a lot of sense intuitively. I have started to take my temp and it is still a good degree below what it should be, so this is the next thing I would like to work on. The naturopath I go to is very open to trying new strategies within reason (unlike my traditional specialist and GP). I did find that changing my diet to a gluten free (and largely grain free) one really helped as well, but it is a work in progress.

  7. Karen McFarland, NTP, CGP 27 April 2012 at 8:06 pm #

    Broda Barnes, MD knew this years ago and wrote about it extensively…see his books “Heart attack rareness in thyroid-treated patients,” “Solved : the riddle of heart attacks ,”Hypothyroidism :
    the unsuspected illness,”

  8. Ben Plenge 27 April 2012 at 9:56 pm #

    There is also a lot of evidence to suggest that mercury fillings and root canals in people’s mouths allow the thyroid to be poisoned by this toxic heavy metal, causing numerous disorders that will remain practically incurable the whole time you have mercury fillings. Answer: Have fillings removed by a mercury safe dentist and complete a thorough heavy metal detox.

  9. helen 28 April 2012 at 5:58 am #
    if you are at all worried about your thyroid do not consume soy …..although sadly it is becoming as overused as sugar in just about every food that is manufactured.

  10. Chris Hilder 28 April 2012 at 12:05 pm #

    Not just women’s issues, John. I have had this problem for a number of years (er? ~ 15, but memory problems are associated with Hypothyroidism aren’t they ;-). I believe mine was an auto-immune reaction and was linked to the anaemia that I had too! Of course my GP and the consultant for these (treated separate problems and my many allergies did not seek to treat me holistically. Having lost 63 lbs (4.5 stone) on your diet (words cannot begin to express my gratitude – but thank you!) its now time for me to turn my spotlight onto this subject and see if I can learn enough to recover this aspect of my health. I have started basal temp recording this morning a la Dr Broda Barnes mentioned above.

    The allergies disappeared when I started following your diet btw.

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