Are There Any Risks Of Thromboembolism Associated With Thyroid Hormone Replacement?

Question: I've just been diagnosed with Hashimoto's thyroiditis. Doctors considering standard thyroid hormone replacement, but I have an extraordinarily high risk of thromboembolism (23% on genetic testing), so are concerned about risks. Also mentioned LDN as an alternative/complementary approach. I am a 50 year old normal weight woman with low blood sugar, slightly elevated cholesterol, low Vitamin D, reasonably active and fit. The specific genetic anomaly is Factor V Leiden, with a CT (C to V) variant.

Thank you so much for your detailed replay. I will confess that I had low expectations of this model of online health care delivery (am a medical psychologist, myself) and as a result did not put as much information into the original query as would have been fair to you, or in my best interests. Only my apprehension about the LDN as a primary mode of treatment had me looking for credible resources on a Saturday night.

Here’s all the other information I think might be helpful.

Results:
Date      Result Name     Ind     Value     Ref Range
11/07/2014 10:03      Testost Total           <20 ng/dL     (14 - 76)
11/07/2014 10:03      Estradiol Level           23 pg/mL     
11/07/2014 10:03      Sex Hormone Binding Glob      66 nMol/L(18 - 144)
11/07/2014 10:03      Anti-TPO     (H)     >1000 unit(s)     ( - <=100)
11/07/2014 10:03      Progesterone Level           0.3 ng/mL     (*** - )
11/07/2014 10:03      Vit D25 OH, Total           46 ng/mL     (30-100 - )
11/07/2014 10:03      Vit D 25 OH, D3           46 ng/mL     
11/07/2014 10:03      Vit D 25 OH, D2           <4 ng/mL     

Date     Result Name     Ind     Value     Ref Range
11/07/2014 10:03     Sodium           139 mMol/L     (133 - 145)
11/07/2014 10:03     Potassium           3.9 mMol/L     (3.1 - 5.1)
11/07/2014 10:03     Chloride           103 mMol/L     (97 - 108)
11/07/2014 10:03     Bicarbonate           32 mMol/L     (22 - 32)
11/07/2014 10:03     AGAP           4.0 mMol/L     (4.0 - 16.0)
11/07/2014 10:03     Glucose Level     (L)     57 mg/dL     (70 - 100)
11/07/2014 10:03     BUN           18 mg/dL     (5 - 22)
11/07/2014 10:03     Creatinine           0.6 mg/dL     (0.4 - 1.2)
11/07/2014 10:03     GFR Calc           >60 mL/min/1.73 m2     
11/07/2014 10:03     Calcium           9.4 mg/dL     (8.4 - 10.2)
11/07/2014 10:03     Protein           6.9 gm/dL     (6.0 - 8.3)
11/07/2014 10:03     Albumin           4.5 gm/dL     (3.7 - 5.5)
11/07/2014 10:03     Bili Total           0.4 mg/dL     (0.3 - 1.4)
11/07/2014 10:03     Chol     (H)     206 mg/dL     (100 - 200)
11/07/2014 10:03     Tg           108 mg/dL     (40 - 150)
11/07/2014 10:03     HDL           62 mg/dL     
11/07/2014 10:03     LDL           128 mg/dL     
11/07/2014 10:03     Alk Phos           50 Units/L     (37 - 117)
11/07/2014 10:03     ALT           16 Units/L     (7 - 52)
11/07/2014 10:03     AST           21 Units/L     (12 - 39)
11/07/2014 10:03     FT3           3.0 pg/mL     (2.3 - 4.2)
11/07/2014 10:03     FT4           1.14 ng/dL     (0.62 - 1.57)
11/07/2014 10:03     TSH           1.372 mcIntUnits/mL     (0.350 - 5.500)
11/07/2014 10:03     WBC           6.30 10^3/cmm     (4.00 - 11.00)
11/07/2014 10:03     RBC           4.50 10^6/cmm     (3.80 - 5.20)
11/07/2014 10:03     Hgb           13.9 gm/dL     (11.3 - 15.2)
11/07/2014 10:03     Hct           41 %     (33 - 45)
11/07/2014 10:03     MCV           90 fL     (80 - 96)
11/07/2014 10:03     MCH           31 pg     (27 - 33)
11/07/2014 10:03     MCHC           34 gm/dL     (32 - 36)
11/07/2014 10:03     Platelet           199.0 10^3/cmm     (150.0 - 400.0)
11/07/2014 10:03     RDW           12.3 %     (11.0 - 16.0)
11/07/2014 10:03     MPV           9 fL     

Upon looking at the medical genetic profile run a year ago, I see another entry for a genetic alteration pertaining to VT, in addition to Factor V Leiden:

Prothrombin 20210A          G to A          GG Genotype

Looking at the genetic report, I see that I was mistaken. It did not predict a 23% risk of VT, but 26.9% risk.

Last note on labs: I did a cortisol sampling study a week ago (fasting/a.m., noon, afternoon, bedtime). Those results are still pending.

Brief history:

Yes, you are correct, I am supplementing with Vitamin D, which keeps me in the low normal range if I am quite diligent – as in this most recent study.

My family history is notable. No woman in my mother’s line has seen her 60th birthday, and relatively few of the men. All of them died of cardiovascular problems (heart attack/stroke), often with a chaser of diabetes and alcoholism.

My mother died of a heart attack at 36, though her circumstances were exceptional. She contracted rheumatic fever as a child and sustained kidney and heart damage requiring the use of dialysis in the 1970s, when the process was more difficult to tolerate. She died of perhaps her 5th or 6th heart attack. Because they all died when I was a child, I have no autopsy records to go on.

My father is still alive, but in his 70s has exhausted his potential to have future bypasses after four surgeries each involving multiple bypasses. He has also had several strokes. The history on my father’s line is less dramatic than on my mother’s, but is still quite strong.

In addition to all the cardiovascular risk, Type II diabetes runs on both sides of my family. I say this only because I have over decades clocked randomly low blood sugars (as in these Nov 7 labs), fasting, not fasting and with glucose challenge. (On one glucose challenge test 15 years ago, dropped into the 30s before they stopped that test.) Nothing has been done about this because my PCP/office partner does not believe in hypoglycemia, except that resulting from imperfect management of diabetes. The genetic testing shows me to be at elevated risk of Type II diabetes.

I have been largely vegetarian most of my life and exercised regularly in the face of all of this, and historically my BP, HR and cholesterol numbers have been enviably healthy. This began to change in the last few years as I approached menopause. The thinking has been that the numbers degraded as protective hormonal influences were lost with menopause - there were no corresponding changes in my lifestyle or diet to explain the declining numbers.

Noting these changes and the upcoming 50th birthday, I had genetic testing done as well as a cardiac stress test in February. No structural or functional cardiac anomalies were noted. That said, the test was aborted as my blood pressure increased rather dramatically on the treadmill. I was put on a low dose of propanolol BID, my only regular medication at this time.

I am aware that the overall thyroid hormone values are still in the normal range. That said, I have a wide array of symptoms I now realize are attributable to the combination of menopause/Hashimoto’s –

Low energy
Sleep disturbance
Low libido
Thinning hair
Hot flashes AND insensitivity to cold
Extremely dry skin
Weight gain (8 lbs in last 18 months)
Depression/anxiety
Constipation
Joint and muscle pain
Puffiness of the face
Tender and slightly swollen neck
Intermittently hoarse voice

I actually was beginning to be concerned I was developing obstructive sleep apnea, because of the visceral sense of an obstruction in the airway. The enlarged thyroid makes more sense, as my husband indicates no increase in snoring. My patients are the ones who picked up on the hoarse voice, frequently asking me if I had a cold when I did not. That did not register until the Hashimoto’s diagnosis.

Because the combination of all of this is intruding substantially into my quality of life, I would like to begin thyroid hormone replacement therapy, if it does not appreciably increase my risk of stroke.

With the additional information included, would you still recommend that course?

Are there any other medical treatment or lifestyle changes you would recommend?

Do you see any merit to the LDN that that has been recommended for me to start next week?

Finally, since all of this has been done through two exceptional PCPs who may have less than personal objectivity because they are also friends of mine, would you recommend an endocrinologist over a PCP to complete the workup and begin intervention? (And if so, can you recommend someone convenient to XXXXXXX AL?)

Thank you so much. I hope that all your other consults are less detail oriented than I am. Your response did impress me, which is why you "won" the full play version.

XXXXXXX