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Suggest treatment for high BP with high cholesterol and hypothyroidism

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Posted on Mon, 28 Jul 2014
Question: Hi!
Age:28
Sex: Female
Creatinine: 142 umol/L
eGFR: 51 ml/min/1.73 m*2
Cholestrol: 7.34mmol/L
Blood pressure : High Leveleing from 140/96 upto 170/__ (recorded 170/__ lst week today: 138/97)
Triglycerides: 2.31 mmol/L
Ferritin: 14ug/L
T.S.H. : 7.81
R B C count: 4.19 (x10**9/L)
Hematocrit: 123 g/L

else every test is normal. I'm worried because my dr told me today that ITs chronic and she refereed me to kidney specialist dr. I have very high blood pressure plus cholesterol problem plus creatinine and eGFR levels are not favorable. How seriousmy condition is and how fast I should act. I don't see any symptoms as far. But I feel so cold, my hands and feet remain very cold throughout. and I feel restless alot. i feel like eating alot of salt, may be because of my TSH level. Please guide me what to do in this all sitution. I'm in canada dr appointments and medical process is very slow here. But I can homeopathy medicine from medical store easily. Please guide and act soon on my case. If have any questions please feel free to ask. my email: YYYY@YYYY . Thanks
doctor
Answered by Dr. Binu Parameswaran Pillai (1 hour later)
Brief Answer:
Hello

Detailed Answer:
Hello,

Good day.
According to the available information, you have high blood pressure along with high cholesterol and hypothyroidism. TSH is still 7.81 which is suboptimal and hence levothyroxine can be increased.

At your age, we need to find out why the blood pressure is so high. We need to run tests to find out if you have secondary hypertension. You have high creatinine and little low GFR. But this may reverse once the blood pressure is sufficienctly controlled.

HAve you had s serum sodium and potassium test ?? What is your height and weight ? Any information on urine routine tests ? What about your periods ? What was the last periods?


If we control your bloood pressure and cholesterol level, your creatinine may come down. Please relax. You need to start on anti hypertensive medicines. We need to bring down your blood pressure to 140/80 or even lower than that. Please use Losartan if the serum potassium is normal.Please do not experiment with homeopathy medicines. You can reverse kidney issues or retard the progression by controlling the blood pressure, reducing the cholesterol and by reducing weight. Regular exercise is also very importat.

You need a urine test to look for albumin in urine. Also need an ECG of heart and ultrasound of kidneys and renal tract. You also need an eye check up to look at your retina. You need a blood sugar test as well

It is importat to reduce cholesterol as well with medicines like statin. Reduce the salt intake. ( it is not due to high TSH). REduce salty food and oily food. Increase vegetables and fruits in diet and avoid processed food.

I realise that there is a delay in seeking a specialist's help. But your GP can do all the above tests. Please do not delay further. Start medicines to reduce cholesterol and Blood pressure ASAP. As i mentioned earlier we need to rule out secondary hypertension.

Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (42 minutes later)
How can I attach reports?
doctor
Answered by Dr. Binu Parameswaran Pillai (8 minutes later)
Brief Answer:
attachment option present

Detailed Answer:
There is report attachment option in the query section
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (18 minutes later)
Reports Attached.

My blood pressure is in the range 110/77 to 130/82. Sometimes I notice that bottom BP is high sometimes 86,90,95,.
Should I keep using Losartran 50mg (Please check reports and guide -Please use Losartan if the serum potassium is normal)

I have history in my family for high blood pressure (my parents) and thyroid my real sister and sister from sibling.

I started Synthroid 25mg on 2 may,14 (Its reduced to 3.45 now, but on the same reports my eGFR reduced to 36 from 51, now its 32)

Height is 150cm (5.3) and Weight is 53-55.

Urine output = Water input (Only water)

Periods are normal and on time (Before was disturbed, it starts with spotting and kept delaying, but after PAP test and all its back to fine.)

How much salt per day I should consume or I should avoid completely (My sodium is 136 in the reports)

Please guide further
doctor
Answered by Dr. Binu Parameswaran Pillai (1 hour later)
Brief Answer:
Hi

Detailed Answer:
Hi,
Thank you for the reply. Got the reports
TSH has come down. Please continue same dose of Levothyroxine.
Your weight seems to be good for height. May be you can reduce by 2-3 kilos of weight.
Salt has to be reduced to less than 5 grams/day.

Dear, at your age, I certainly want to rule out secondary hypertension. You may need to see an endocrinologist there to do further tests.
I noted your abdomen scan reports. But you will need a renal artery Doppler study as well to look for renal artery stenosis.

Please proceed with the nephrology appointment as well. Your urine protein is high. They will need to look at the cause.

Potassium is normal, start on Losartan + Hydrochlorothiazide combination ( 50 + 12.5). We need a BP of 130/70 to retard the kidney disease progression.
You need a statin ( atorvastatin 10 mg) once daily to reduce the cholesterol level. Once you start on Losartan, you may repeat the creatinine and potassium after a week. If that is worsening, then you may have to switch to a different BP medicine like Amlodipine or something like that.

With so much of protein in urine and high cholesterol and high BP, NEPHROIC SYNDROME is one of the possibility. Your nephrologist will discuss further. DO YOU HAVE SWELLING AROUND ANKLES or EYES ??

Get an eye check up to look for blood pressure related changes in retina.

Hope this helps. You are welcome to ask more questions. But if you feel there is nothing more to ask, you may close the query

Wish you good health

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (3 days later)
Please advice me Diet. what should I eat in my diet?

Usually I'm eating

Cucumber
Lettuce
Cabbage
Beet Root
Cauliflower
Brocoli

Apple
Papaya
Watermelon

Ginger
Garlic
Onion
Cumin seeds
Turmeric
Red grounded chilli
Cardamon

Rice
Half cup of milk a day
Ghiya
Kaddu
Halwa
Yellow daal (Dalli daal)
Red Daal (Masoor daal)
khichdi
daliya

What should I avoid from these. And please advice what else I should add. I'm not getting good diet from these things.

Thanks

doctor
Answered by Dr. Binu Parameswaran Pillai (1 hour later)
Brief Answer:
Hello

Detailed Answer:
Yor diet seems to be okay. Since you have low GFR and proteinuria, i would like to suggest you to limit animal protein. Plant protein is good as long as it doesnt exceed 0.5 g /kg body weight. You may slighlty reduce the pulses ( dal ). If potassium is high, you may need to limit citrus fruits. Other items are good. Reduce salt as well
Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (24 hours later)
What are the side effects of Biopsy? Are there any long term side effects?
doctor
Answered by Dr. Binu Parameswaran Pillai (9 minutes later)
Brief Answer:
Hi

Detailed Answer:
Kidney biopsy is done percutaneously ( insert a small needle through skin to kidney). This is usually an ultrasound guided procedure. This may be required in your case to establish the cause and to decide correct treatment.

The side effects is bleeding and rarely infection. But it is very very rare. They will take all adequate precautions. There are no big long term side effects of this. The needle is very small and they take a very tiny sample

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (9 hours later)
Thanks for guiding. But what if there is something else like UTI etc which is effecting kidney and else everything s getting effected in my body. They shouldn't perform it before Biopsy? Would UTI be covered in Biopsy? Today again I started with abnormal bleeding. Pinkish thin liquid and thats too after 2-3 days after intercourse. I'm so stressed.
doctor
Answered by Dr. Binu Parameswaran Pillai (1 hour later)
Brief Answer:
Hi

Detailed Answer:
Hello,
UTI can cause kidney diseases. But in your case, significant protein in urine with high blood pressure most likely is due to Nephrotic Syndrome. We need to find the cause of this. Biospy is essential for that. Effective treatment can arrest the progression of kidney disease. You tend to have clotting problems when you have kidney disease and that might have contributed to the bleeding now. Please dont get stressed. Listen to your Nephrologist. You are young and we need to find an answer fast.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1435 Questions

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Suggest treatment for high BP with high cholesterol and hypothyroidism

Brief Answer: Hello Detailed Answer: Hello, Good day. According to the available information, you have high blood pressure along with high cholesterol and hypothyroidism. TSH is still 7.81 which is suboptimal and hence levothyroxine can be increased. At your age, we need to find out why the blood pressure is so high. We need to run tests to find out if you have secondary hypertension. You have high creatinine and little low GFR. But this may reverse once the blood pressure is sufficienctly controlled. HAve you had s serum sodium and potassium test ?? What is your height and weight ? Any information on urine routine tests ? What about your periods ? What was the last periods? If we control your bloood pressure and cholesterol level, your creatinine may come down. Please relax. You need to start on anti hypertensive medicines. We need to bring down your blood pressure to 140/80 or even lower than that. Please use Losartan if the serum potassium is normal.Please do not experiment with homeopathy medicines. You can reverse kidney issues or retard the progression by controlling the blood pressure, reducing the cholesterol and by reducing weight. Regular exercise is also very importat. You need a urine test to look for albumin in urine. Also need an ECG of heart and ultrasound of kidneys and renal tract. You also need an eye check up to look at your retina. You need a blood sugar test as well It is importat to reduce cholesterol as well with medicines like statin. Reduce the salt intake. ( it is not due to high TSH). REduce salty food and oily food. Increase vegetables and fruits in diet and avoid processed food. I realise that there is a delay in seeking a specialist's help. But your GP can do all the above tests. Please do not delay further. Start medicines to reduce cholesterol and Blood pressure ASAP. As i mentioned earlier we need to rule out secondary hypertension. Regards Binu