Best statin for hypothyroidism

In this article:

• How do statins affect people with hypothyroidism?
• Top recommended statins for people with hypothyroidism
• Statins comparison chart
• Side effects of statins in people with hypothyroidism
• Special considerations for people with hypothyroidism taking statins

In this article

• How do statins affect people with hypothyroidism?
• Top recommended statins for people with hypothyroidism
• Statins comparison chart
• Side effects of statins in people with hypothyroidism
• Special considerations for people with hypothyroidism taking statins

Statins like Lipitor (atorvastatin) and Crestor (rosuvastatin) are some of the most commonly prescribed medications in the United States—and that’s because they’re highly effective for lowering cholesterol levels. Hypothyroidism often causes high cholesterol, so it’s not surprising that people who have it often end up also taking a statin prescription. That said, while statins are great for controlling cholesterol levels, they also come with some special considerations for people with hypothyroidism. Here are all the important details. 

How do statins affect people with hypothyroidism?

Statins work the same way in the body whether or not you have hypothyroidism. They decrease low-density lipoprotein cholesterol (LDL) by blocking a certain liver enzyme that synthesizes it. These medications can also help the liver eliminate more of the body’s LDL cholesterol, reducing the amount that builds up in the blood vessels. 

In most cases, healthcare providers recommend stabilizing the thyroid hormones before beginning statin treatment. Research shows a connection between thyroid hormones and the production and clearance of cholesterol, so people who have hypothyroidism will also retain more LDL. Having hypothyroidism is like driving a car stuck in first gear, only going 15 miles per hour. Your whole system—like your engine—is running too slowly. Because your “metabolic engine” is sluggish, your body doesn’t clear out cholesterol as efficiently. Just like how a slow-moving car burns fuel poorly and gets clogged, your body starts to build up more cholesterol in the bloodstream.

“Before I even think about prescribing a statin, I usually want to get the thyroid issue treated and recheck their lipids,” says Michael Genovese, MD, chief medical adviser at Ascendant New York. “In some cases, once the thyroid is stable, the cholesterol levels improve, and we may not need a statin at all.” So, correcting that hormone imbalance might solve the problem without the need for statins. However, a study from 2021 also found that statins can improve thyroid function independently of their effects on cholesterol levels. 

That said, hypothyroidism might also be a risk factor for statin intolerance. A 2014 study reported that statin-intolerant people were more likely to have a history of hypothyroidism than statin-tolerant people. Statin intolerance could make someone more susceptible to symptoms like muscle pain or weakness, gastrointestinal side effects, headaches, and sexual dysfunction. 

This is why healthcare providers will typically monitor patients taking statins for hypothyroidism, and why it’s important to report any changes to your health right away. 

Top recommended statins for people with hypothyroidism

“There is no one ‘best’ statin for people with hypothyroidism, but in my experience, atorvastatin and rosuvastatin tend to be the go-to options,” Dr. Genovese says. 

Usually, certain statins will be best for certain people based on their medical condition, other medicines, and susceptibility to side effects. “I usually prefer hydrophilic statins, such as rosuvastatin and pravastatin, because they have a lower risk of penetration into muscle tissue, which reduces the risk of side effects like myalgia and myopathy,” says Mohammed Hamdi, MD, an endocrinologist at Houston Methodist Willowbrook Hospital. “This is particularly important in patients with hypothyroidism, as uncontrolled thyroid levels can independently increase the risk of myopathy.”

Here are the details on a few that are commonly prescribed for people with an underactive thyroid gland—typically after they’ve already treated their hypothyroidism.

Pravachol (pravastatin)

Hypothyroidism can increase the risk of statin-induced muscle pain (myalgia), but Pravachol has a lower risk of myalgia than other statins, making it a good option for people with thyroid issues. Plus, unlike other statins, Pravachol isn’t metabolized by the CYP3A4 enzyme, which means it causes fewer drug interactions. The only drawback is that Pravachol is a lower intensity statin, so it might not lower LDL levels to the goal range. 

Crestor (rosuvastatin)

Studies show that Crestor is associated with 50%–55% of LDL-C reduction, making it a highly effective option. So lower doses might do the trick, reducing the potential for side effects. But it’s also a high-intensity option, so certain side effects are still possible, especially at higher doses. Still, it’s a popular choice for its reliability and effectiveness. 

Lipitor (atorvastatin)

Lipitor is one of the more common statins in general, and like Crestor, it’s a moderate-to-high intensity statin, making it better for people who need significant LDL reductions to reach their goal LDL range. It has a greater risk of myalgia than Pravachol, but that risk can be less than Crestor’s for some people. One study from 2023 found that atorvastatin and rosuvastatin had similar efficacy. Rosuvastatin was associated with slightly lower LDL levels, but atorvastatin had a lower risk of new-onset diabetes mellitus.

Lescol (fluvastatin)

Lescol has some of the same advantages as Pravachol for people with hypothyroidism. It’s a moderate-intensity statin, so it has a lower risk of side effects. It also has fewer drug interactions. The downside is that it might not reduce LDL-C levels as much as Lipitor or Crestor. 

Statins comparison chart
Name	Pros	Cons	Cost*	Savings
Pravachol (pravastatin)	Lower risk of myalgia Fewer drug interactions	Low intensity	$17 for 90, 40 mg tablets of generic pravastatin	Get coupon
Crestor (rosuvastatin)	High intensity Lower risk of myalgia	Potential drug interactions Risk of new-onset diabetes	$8 for 30, 10 mg tablets of generic rosuvastatin	Get coupon
Lipitor (atorvastatin)	Moderate-to-high intensity Lower risk of elevated blood sugar	Greater risk of myalgia More drug interactions	$8 for 30, 40 mg tablets of generic atorvastatin	Get coupon
Lescol (fluvastatin)	Lower risk of side effects Fewer drug interactions	Low intensity	$45 for 30, 20 mg tablets of generic fluvastatin	Get coupon

*Average cost at time of publication. Drug prices fluctuate and vary by pharmacy and location. 

Side effects of statins in people with hypothyroidism

Side effects are a possibility for anyone taking statins, although not everyone will experience them, and some might be tolerable. Some of the most common include:

• Muscle aches (myalgia)
• High blood sugar (hyperglycemia)
• Increased liver enzymes (transaminitis)
• Digestive issues
• Headaches
• Memory loss
• Confusion 

Adverse effects vary from person to person and may only occur at higher dosages, so the ones you experience (if any) may differ from others. People with hypothyroidism can have all the same side effects. However, because the condition can cause statin intolerance, they might be more susceptible to muscle aches, cramps, and weakness. According to a 2025 case study, another possibility is rhabdomyolysis—a rare and potentially life-threatening condition where muscle breaks down and those components enter the bloodstream and can cause kidney failure.  

“If symptoms are severe and include unstable vital signs such as high fever, tachycardia, hypotension, or dark-colored urine, rhabdomyolysis should be suspected,” Dr. Hamdi says. “In such cases, the patient should seek immediate medical attention, including evaluation by their physician and possibly a visit to the emergency department for IV fluid therapy.”

Additionally, see a healthcare professional if you experience jaundice, fever, or significant changes in urinary output. And if any common side effect affects your daily life, talk to your healthcare provider. They might want to switch drugs or adjust the dosage. 

Special considerations for people with hypothyroidism taking statins

While statin therapy can work well for people with an underactive thyroid, there are still some considerations for both doctors and patients. First off, “it is always preferred to start with a low to intermediate dose of a statin. After about two months, the lipid profile should be repeated to assess response and adjust the dose as needed,” Dr. Hamdi says. “At the same time, thyroid function should be monitored by checking thyroid function tests (TFTs) every six to eight weeks until levels normalize. Once stable, monitoring can be done less frequently.”

The most common thyroid medication is levothyroxine, a synthetic version of the hormone thyroxine (T4). A study on simvastatin and levothyroxine suggests that statins don’t interact with the medication’s function. However, they might not be necessary either, since hypothyroidism might be the only cause of the elevated cholesterol.

Because hypothyroidism can increase the risk of statin intolerance, some healthcare providers opt to start with a lower dose of statins—particularly high-intensity ones. Then, if the patient tolerates it, the dose is titrated up from there (if necessary). Statin intolerance may include myalgia, so it’s important to report new or unexplained muscle pain to a healthcare professional. 

“If someone starts experiencing muscle pain or fatigue, I might switch them to a statin that’s known to be gentler, such as pravastatin,” Dr. Genovese says. “Sometimes, splitting the dose or taking it every other day can also be helpful. Moreover, if they are older or have other medical conditions, I tend to be more conservative with dosing from the start.”

Regular blood tests might also be required. Healthcare providers will likely want to keep an eye on your lipid levels, as well as your thyroid hormone levels. Some patients might also need to have their blood glucose tested regularly, since statin use can inhibit insulin function, raising blood sugar and potentially causing prediabetes or Type 2 diabetes. People with a history of myalgia or certain risk factors might also need to have their creatine kinase (CK) levels monitored.