Understanding High TSH, Muscle Pain, and Lipid Levels: What Could It Mean?

Question
I have been experiencing severe muscle pain in my legs and feet at night, so I went to a physician for suggestions as to if taking a statin (Vytorin) for the last few years could be causing these symptoms.  He ordered full blood work, including CK levels, which came back at 162.  However, the surprising result was  TSH of 5.37.  My triglycerides are still high at 206 and HDL is too low at 36.  My MCH is also a little high at 33.7.  Other than these results everything else is within normal limits. I don't know what my doctor will say to my proposal to go off the statin for a few months to see if my pain will decrease, but before I see him I want to know the relationship between hypothyroidism and high cholesterol (my serum cholesterol is currently 133 and LDL is 56 with taking Vytorin).  What questions should I ask him?  I know some doctors are against discontinuing statins but I need some sleep--this pain keeps me up every night.  Any ideas for initiating the discussion with my doctor would be appreciated.  

Answer
Joseph,

Please be aware that the information provided is not a substitute for medical advice and should not be interpreted as medical advice.  This information is being provided for informational purposes only, as your own physician is the best resource to interpret your specific laboratory results and clinical symptoms and should be consulted for medical advice regarding your own specific health condition.

Question:  Do you recall if you had a thyroid panel before starting the Vytorin?  If so, was your TSH within the normal range then?  

You mention that your physician ordered full bloodwork, did this include a CBC and CMP (complete metabolic panel)?  

If your doctor ran a CMP, what were the results of your liver enzymes (bilirubin - especially bilirubin - AST, ALT, LD, ALP)?
If your doctor ran a CMP, were your BUN and Creatinine levels normal?  If not, what were they?

Did he/she run a myoglobin?

It sounds like a CBC was run since you mention your MCH but if a CMP wasn't run, I would also request that a CMP be run to cover all bases.

If it were me, in addition, I would make an appointment with my physician and show my physician the article below and ask if, in view of this article, it would be possible for him/her to run a myoglobin also in addition to the CK.  

If it were me, I would tell him/her that even though your CK levels are not out of range, since you are experiencing severe myalgia (muscle pain) that is keeping you awake at night, and in view of your co-existing TSH lab results, you'd like to get a myoglobin run just to cover all bases to rule out rhabdomyolysis which is a rare but serious side effect of statins and presents with muscle pain.

If the myoglobin levels come back normal, and your physician does not want to take you off statins, I would ask my physician about the possibility of changing to another Rx statin medication since one patient may experience adverse side effects from one Rx medication but not on another Rx medication prescribed to treat the same condition even though the mechanism of action of both drugs is the same; that is, one patient might experience adverse side effects on Vytorin but not on a different statin Rx;, for example, Pravachol (pravastatin).
http://www.johnshopkinshealthalerts.com/health_after_50/HA50-mag7.html

Also, by chance are you of Asian descent?  Some research has shown that those of Asian descent are more suceptible to myalgia related complications from statins.

Regardless, I would make an appointment with my doctor immediately and print out and show my doctor the article below at my appointment:
http://journals.lww.com/theendocrinologist/Abstract/2006/09000/Role_of_Thyroid_D...
"Hypercholesterolemia, which can arise from different etiologies, is frequently treated with a class of HMG-CoA reductase inhibitors called statins. One of the most significant risks associated with the use of statins is the development of myopathy, a risk that may be compounded by the coexistence of hypothyroidism. The underlying metabolic mechanisms that account for muscle disease in these 2 settings show some common etiologies. The overlap of symptoms associated with hypothyroidism and statin-induced myopathy should prompt the physician to screen all patients presenting with myopathic symptoms with or without elevated creatine kinase levels and all hyperlipidemic patients before initiating statin therapy for hypothyroidism using a measurement of thyroid-stimulating hormone."

Also be aware that all of your medical records legally belong to you.  Many patients are not aware of this, and you can request that any and all of your medical records be provided to you, including your lab results.

Also, is your physician a cardiologist or an internal medicine doctor?  

You are right to persevere and ask questions of your physician if you are experiencing pain that is severe enough to keep you up at night.  Be advised that a competent, conscientious physician loves patients who are good "historians" and will happy to answer questions such as these.  A patient is their own best advocate in their own medical treatment, and can often aid in their own diagnosis by researching on their own and asking questions such as these, and you should not feel the least bit hesitant about asking these or any other questions you may have regarding your own medical diagnosis or treatment.  

Good luck, and feel free to contact me again with any follow-up information resulting from your conversation with your doctor, and/or provide additional lab testing results and let me know the outcome and I will try to assist further if necessary.