### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I have been prescribed fenibrate 160mg qd after seeing my primary care MD this week.... I am already on Simvastatin 40 mg po qd and Zetia 10 mg po qd and I take 1200mg fish oil daily . I was recently diagnosed with hashimotos disease and my Synthroid dose is 125mcg daily . My lipid panel 6 mo ago had come down and my numbers were in normal range and this week they are elevated and more than they have ever been. (Triglyceride 540, HDL30, and total chol 209) My Tsh is also back to 4.27 while being on the dose of 125mcg of levothyroxine. My question is two-fold....could my lipid panel by off again because of the Hashimotos, and is it safe to take Tricor along with Simvastin and Zetia. Of course I am distressed that my numbers are way out of range (even though I follow a nutricious diet and get some exercise and take my medicine). I am a 55yo female with a strong family hx of high lipids ,,,,,One other thing the Endocrinologist put me on in Sept 2016 was metformin 1000mg for a HgA1C of 6.1 (?? don t know if that was necessary but complied and now wondering if that has something to do with the elevation of the numbers on my lipid panel? Thank you for your time . PS I am an RN and have spent my life working in cardiac care services area so this is a real big concern to me.

### output:

Hello, There are many reasons that may alter cholesterol test results. Your test result is likely inaccurate. I advise you to take the test again. The test should be taken at least 1 week after from the current test and the medical decision should be based on both results.  Hashimoto disease is a hyper-functioning of the thyroid gland. High thyroid hormones are known to decrease cholesterol level in Hashimoto disease. But cholesterol level may get increased in under-functioning thyroid gland. Regarding your medications: Simvastatin is a medicine that decreases cholesterol level by inhibiting cholesterol synthesis and has more effect on decreasing LDL levels. Vibrates (Tricorn) decreases TG levels, and Ezetimibe (Zeta) decreases cholesterol absorption from the gut. The combination is more effective than using a single cholesterol medicine but combination Tricorn with Simvastatin may increase muscle pain (myopathy). Metformin has no effect on test results, it was found to decrease cholesterol level.  Hope I have answered your query. Let me know if I can assist you further.