The Good(HDL), The Bad(LDL), The Ugly(TG) and The Deadly (Lp(a)):

lipids and your dysfiunctional thyroid

(and what Drs from BHU, Varanasi have to say about it ...

Amit was a well settled, upwardly mobile, socially respected , family man. With all the trappings his position is life demanded - or expected.

A Chauffeur driven car, membership to 3 clubs (for himself and family), 6 credit cards, annual "stress-busting holidays " where you enjoyed with a vengeance indulging in indiscrimanate eating and yes, drinking; and your time was interspersed with desperate calls on your mobile from the office back home - (what a great feeling to know that you were so indispensable...). With a 7 am to 9 pm schedule, not to speak of the compulsion to hobknob with those that matter, this implied that his 3 clubs saw him only when he entertained business associates and, never, say, in the swimming pool or badminton court or gyms.

And yes, he and his family had medical coverage, all paid for at one of the best hospitals, in town . He often mentioned how he almost never went there ("just dont have the time..ah, excuse me while I attend to my cell phone...") , except when they had to investigate his wife's diabetes, and his sons occasional digestion related sicknesses.

In all this , there was one thing that never fit in. He insisted on often using and maintaining his decades old maruti car, the only one he bought with his own savings. Every dent was immediately attended to, every abnormal sound was investigated, changes in locomotion patterns were attended to with appropriate resetting of fixtures and engine cleaning and decarbonising was done more frequently , than , lets say, his annual physical doctor visits.

Unfortunately, he paid more attention to the carbonization of the engine of his maruti car than he did to the clogging of his own arteries with stuff worse than carbon; and so, at the age of 45, one day, his heart muscles screamed in anginal agony as he was rushing up the stairs at headquarters.

This could be anyones story.

Todays Indians lead in the Coronary Artery Disease Race. Its become fashionable to say that you are seeing your cardiologist. Everyone gets their HDL, LDL Cholesterol , and Triglycerides done, an ECG makes things look important and the stress test crowns the whole effort.

It is surprising , that the test for Lipoprotein(a) or lp(a) as it is called, seldom appears in the basic lipid checkups.

Thyroid dysfunction is very often the cause of lipid alteration.

A Hypothyroid person will show enhanced lipid values that do not respond to medicines easily. A survey of people sitting in line for the cardiologist's OPD indicates, that very few have had their thyroid tests done, and almost all, bar one never heard of lp(a).

It is imperative that anyone who is in particular, hypothyroid, pay great attention to his/her lipid values, and make an enlightened effort to get lipid values into range.

What "range" ? Remember, a woman with a cholesterol level of more than 265 mg/dl doubles her cardiovascular risk compared to those women whose value is less than sat 205.

You can try and raise your HDL close to 60 mg/dl by eating less fat, and exercising more.

Reduce your triglycerides by eating less suagr and cutting down on alcohol- try and keep it less than 190 mg/dl. However, you must remeber that you must not lower your cholesterol too much, as it can cause low serotonin levels in the brain leading to depression and agrressive behaviour. A good idea is to try and keep your cholesterol less than 200 for vascular benefit and more than 150 to avoid low mood and imapired cognition.

Keep your Homocysteine levels in check by regularly taking B1-B6-B12 vitamins. Accumulation of homocysteine in the body is commomn in hypothyroid individuals, and folic acid and B12 therapy is the answer.

And finally, keep your LP(a), values in control, if necessary by taking niacin. These should not ideally exceed 20 mg.dl.

Lp(a) is a variant of LDL cholesterol particle. While the "nurture " factor decides your good (HDL) cholesterol, bad(LDL) cholesterol, and ugly(triglycerides), it is the"nature" factor that shows up in your Lp(a). Indians, are genetically predisposed towards a high lp(a) value. Enas et al were the first to report high levels of Lp(a) in Asian Indians. Elevated Lp(a) level was the most common risk factor in the CADI Study. Subsequent studies have reported elevated Lp(a) levels in Asian Indians in the U.S., Canada, Singapore, U.K., and India. Numerous case control and angiographic studies have shown Lp(a) to be a powerful risk factor for CAD among Asian Indians.

Childhood levels of Lp(a) are a better predictor and marker for future CAD in young adult life than any other lipoproteins. Although the relationship of Lp(a) to CAD is continuous and graded, a level of 15-20 mg/dL is now considered the threshold.

Once you are detected with a thyroid dysfunction, in particular, a hypothyroid state, it is important that every effort is made to reduce cardiac risk factors, whether it is by increasing exercise, diet, appropriate medication, complemented by mind-body techniques, behaviour modification efforts and a general awareness of your body and its limitations.

An article in Jan 2004 (Thyroid Research and Practice) by Singh,Reddy & Unnikrishnan from the Benaras Hindu University, Varanasi, shows that proper thyroid hormone therapy modulates lp(a) levels. They show that mean serum lp(a) levels decreased significantly after thyroxine replacement therapy in hypothyroid patients, whereas, in the case of hyperthyroid patients, it increased significantly after treatment. We present the hypothyroid relevant observations herein. (SPSS statistical package was used for data analysis). :

Original article with other tables and details , may be viewed HERE

Parameters in Hypothyroidism and its therapy

Characteristics Before treatment After treatment
Pulse rate 74.33+/-5.73 82.91+/-5.98
BP Systolic 118.16+/- 12.94 112.9+/- 9.07
BP Diastolic 83.25+/- 9.09 78.75+/- 4.24
Weight (kg) 65.39+/-18.33 59.83+/- 16.71
BMI (kg/m2) 26.24+/-5.23 24.44+/-4.21
T3(ng/dl) 49.99+/- 27.73 149.34+/- 44.00
T4 ug/dl 1.65+/- 1.57 8.47+/- 3.08
TSH uu/ml 74.55+/-32.25 1.13+/-1.10
Serum Lp(a) (mg/dl) 54.48+/-43.89 39.73+/-39.53
Serum Cholesterol (mg/dl) 222.60+/-78.25 159.81+/-37.51
Serum Triglyceride (mg/dl) 208.37+/-124.79 134.10+/-77.76
Serum LDL (mg/dl) 141.15+/-63.31 97.92+/-31.76
Serum HDL (mg/dl) 40.52+/-11.59 36.67+/-9.84
Serum VLDL (mg/dl) 52.02+/-53.75 33.30+/-33.33
LTI 136221.21+/-09970.81 30834.04+/-46735.01