High cholesterol cases should be checked for low thyroid

Ask Dr. Keith Roach M.D

High cholesterol cases should be checked for low thyroid

DEAR DR. ROACH: My doctor has put me on atorvastatin 20 mg. I am 71, with high blood pressure, and my HDL (good cholesterol) is in the 30s. My total cholesterol is now good, at around 180.

After some research, I found out that if you have a thyroid condition, you might not need to take cholesterol medication. I am concerned about this, but I find it hard to get in contact with my doctor, since she works only two days a week now. Should I be concerned about this, or just keep taking the medicine? Any info would be appreciated. — A.C.

ANSWER: About 5 percent of all people with high cholesterol have unrecognized low thyroid levels, so everybody should get their thyroid checked before going on cholesterol medication. Sometimes, but not always, treating the underlying thyroid issue corrects the cholesterol issue. Hypothyroidism may have very subtle symptoms, such as fatigue, depressed mood or intolerance of cold temperatures. Treating low thyroid levels can improve symptoms attributed to getting older, as well as prevent the unnecessary expense and possibility of side effects associated with drug treatment of high cholesterol. Of course, some people still will need treatment of high cholesterol, but that doesn't necessarily mean drug treatment, which should be reserved for people at significant risk for heart disease. However, what 'significant' means depends on what the patient is concerned about, based on information provided by the doctor.

You definitely should check with your doctor to be sure your thyroid levels were checked, even if you have no symptoms.

DEAR DR. ROACH: Recently a reader asked about treatment and causes for erectile dysfunction. You did mention Viagra for the problem; however, you did not say that about 50 percent of men will have unpleasant side effects from Viagra and other like pills. Many men also find that the pills quit working after a while. A new alternative is available in shot form, and my husband's doctor claims it works at nearly 100 percent. My husband is on Trimix, and it does in fact work 100 percent of the time for him. Why didn't you offer that as a treatment? — L.N.B.

ANSWER: There are many treatments for ED. Treatment depends on the underlying cause, which was the focus of that column. I do think that, for those men who need medication treatment, medicines like sildenafil (Viagra) are the best choice, since they are effective for most men and — despite a 12 percent risk of flushing, 11 percent risk of headaches and 5 percent risk of stomach upset -most men want to keep taking the medications.

However, they do not work in other men. At that point, it is time to think about other options. One option is an injectable treatment. The most commonly used is alprostadil (Caverject), which is highly effective, with 87 percent of men (and 86 percent of their partners) satisfied with the results. However, some men have a real difficulty performing an injection into the penis, and 50 percent of men who stopped the treatment did so because of penile pain. Trimix is a compounded mixture of three medicines, but I don't recommend it because of the possibility of side effects, especially scarring, but also infection.

Other options for men who do not respond to oral or injection therapy, or who are unwilling to use injections, include vacuum devices and implantable prosthetic devices. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.