Q: I am 37 years old weighing 77 Kgs and have been diagnosed with hypothyroidism. I have been using Eltroxin 50 mg and TSH has come down to 0.96 from 150 in one year. I have IBS and hyperacidity too. I have also been diagnosed with a fatty liver. My serum cholesterol is 229 and triglycerides are 288 and rest is in normal range. I was asked by one of the doctors to take Atrovastatin 10 + Ezetimbe along with Fenofibrate for 30 days and then he said he would like to shift me to Atrovastatin + Fenofibrate combination drug. I do not have hypertension or diabetes. Do I need to take lipid-lowering agents at this age? If so for how many months should I take the same? Is it right to take the combination of Atrovastatin with Ezetamibe and then fenofibrate at night all at a time before bed?

A:Cholesterol and triglycerides levels of most patients of hypothyroidism are higher than normal and are result of the inadequate functioning of thyroid gland. In your case serum cholesterol is marginally high while triglycerides are a bit more elevated. These get resolved in due course when the primary disease is brought under firm control and no drug treatment is usually required. In my opinion, giving three drugs is not clinically warranted particularly when side effects of all the three medicines are cumulatively are taken into account. Side effects of atorvastatin are: Headache, myalgia, arthralgia, asthenia, insomnia, rash. Flu-like syndrome, sinusitus. Elevated ALT & CPK levels. Sensory & mixed sensorimotor peripheral nerve disorders. Tendon rupture (serious). Amnesia. Myopathy, rhabdomyolysis ( so called dissolution of muscles, which has caused fatalities). Side effects of fenofibrate are : Rash, photosensitivity, alopecia (loss of scalp hair), liver inflammation (hepatitis), elevated liver enzymes, fatigue, vertigo. Inflammation of lungs, other lung disorders. Pancreatitis (can be serious). Rarely sexual asthenia, gall bladder stones, photosenstivity, muscle toxicity. Blood disorders. Side effects of ezetimibe are as follows: increase in serum tranaminases & creatinine phosphokinase. Myalgia. Myopathy/rhabdomyolysis. Hepatitis. Thrombocytopenia. Headache, nausea, abdominal pain, diarrhoea. Arthralgia, fatigue, cough. Angioedema, rash, pancreatitis. In my view, instead of a very aggressive three-drug therapy, it would be more worthwhile to (a) reduce weight (for a height of 169 cm, 77 kg is at least 7 kg over), (b) do regular brisk walk for 45 minutes to cover no less than 4.5 km at least 5 days a week, (c) diet regulation by reducing saturated fats and (d) at the most take relatively safer agent Omega 3 FA (sold as Maxepa - 1 cap daily with food) which would bring down the lipids.