Underactive thyroid commonly elevates LDL cholesterol because thyroid hormones help clear lipids. While some cancer treatments (neck radiation, certain drugs) can cause thyroid damage, autoimmune disease is a frequent cause. Diagnosis relies on TSH and free T4 testing. Levothyroxine replacement usually improves both symptoms and cholesterol, but persistent high LDL often needs targeted lipid treatment to lower cardiovascular risk.

The link between low thyroid function and high cholesterol

Hypothyroidism (underactive thyroid) reduces the body's production of thyroid hormones. Those hormones help regulate metabolism, including how the liver clears LDL ("bad") cholesterol. When thyroid hormone is low, LDL and total cholesterol commonly rise, increasing cardiovascular risk.

Why cancer treatment matters - but it's not the only cause

Some cancer treatments can injure the thyroid. Neck radiation, radioactive iodine, and certain targeted cancer drugs or immune therapies may cause thyroiditis followed by hypothyroidism. Chemotherapy agents more broadly are less often direct causes, though treatment combinations and individual factors matter. Autoimmune thyroiditis (Hashimoto's), prior thyroid surgery, and iodine deficiency remain common non-cancer causes.

Symptoms and health consequences to watch for

Symptoms of hypothyroidism vary by severity. Common signs include fatigue, weight gain, dry skin, hair thinning, slowed heart rate, constipation, cold intolerance, and memory or concentration problems. Reproductive issues such as irregular periods or reduced fertility can occur. Long-standing untreated hypothyroidism can raise LDL cholesterol and contribute to hypertension and other cardiovascular risks.

Severe, untreated hypothyroidism (myxedema) is rare but can be life-threatening and requires urgent care.

Diagnosis and treatment

Diagnosis uses a simple blood test: TSH (thyroid-stimulating hormone) with free T4. When hypothyroidism is confirmed, the standard treatment is replacement with levothyroxine. Most people experience symptom improvement and many see LDL cholesterol fall toward normal once thyroid levels are normalized.

However, if LDL remains high after adequate thyroid replacement, clinicians often treat the cholesterol directly (lifestyle measures and/or statins) because persistent dyslipidemia independently raises cardiovascular risk.

Practical guidance and follow-up

  • If you have cancer treatment that exposed the neck or used drugs known to affect the thyroid, ask your oncologist about periodic TSH testing.
  • If you are diagnosed with hypothyroidism, check fasting lipids before and after thyroid replacement so your clinician can decide if additional cholesterol treatment is needed.
  • Lifestyle steps (healthy diet, regular exercise, quitting smoking) support both thyroid and cardiovascular health.
Regular monitoring and a combined approach - correcting thyroid hormone levels and managing lipids when needed - reduce long-term cardiac risks and improve quality of life.

FAQs about Hypothyroidism High Cholesterol

Can cancer treatment cause hypothyroidism and high cholesterol?
Yes. Neck radiation, radioactive iodine, and certain targeted cancer or immune therapies can damage the thyroid and lead to hypothyroidism, which in turn may raise LDL cholesterol. Not all chemotherapy causes this, so ask your care team about specific drugs and follow-up testing.
Will treating hypothyroidism fix high cholesterol?
Treating hypothyroidism with levothyroxine often lowers LDL cholesterol, but not always to target. If LDL remains high after thyroid levels are normalized, clinicians typically recommend lifestyle changes and may prescribe statin therapy.
What tests should I get if I’m concerned?
Start with blood tests for TSH and free T4 to diagnose hypothyroidism and fasting lipid panel (total cholesterol, LDL, HDL, triglycerides) to check cholesterol levels. Repeat lipid testing after thyroid replacement to guide further treatment.
Are the symptoms obvious?
Symptoms can be subtle and develop slowly: fatigue, weight gain, dry skin, hair thinning, cold intolerance, constipation, and slowed thinking. Because symptoms overlap with many conditions, blood tests are essential for diagnosis.
How often should thyroid function be monitored after cancer treatment?
Survivorship plans vary, but clinicians commonly check TSH within 6-12 months after neck radiation or when starting drugs known to affect the thyroid, and then periodically. Ask your oncologist or endocrinologist for a schedule tailored to your treatment and risk.