Thyroid therapy - tips and traps.

Thea, aged 63 years, presents for review after a small inferior myocardial infarction (MI) 3 months previously. You note that her total cholesterol before starting a statin in hospital was high (7.1 mmol/L [normal range <5.5]) with an LDL of 5.5 mmol/L (normal range <3.4), an HDL of 0.9 mmol/L (normal range 1.0-2.2) and a triglyceride of 1.4 mmol/L (normal range <1.7). Two years previously her total cholesterol was marginally high at 5.6 mmol/L with an LDL of 4.0 mmol/L, an HDL of 1.0 mmol/L and triglyceride of 1.2 mmol/L. No specific treatment was instituted at the time apart from general lifestyle advice. Thea says she is feeling fine and has had no chest pain since the MI. However, she thinks the MI has 'slowed her down' a little. She has gained 'a lot of weight' over the past year or two (5 kg in the past year and 8 kg compared to 2 years ago). Her medications include aspirin 100 mg daily, carvedilol 6.25 mg twice per day, atorvastatin 20 mg daily, ramipril 10 mg daily, vitamin D 50 000 IU 3 monthly, ibuprofen 400 mg intermittently and a range of complementary medicines, vitamins and mineral supplements.