Thyroid Eye Disease and Dry Eye with Dr. Matt Dixon
In this interview, we’re discussing thyroid eye disease (TED) with Dr. Matt Dixon. Years ago, there wasn’t enough known about dry eye disease, and that was frustrating. However, Dr. Dixon became interested in dry eye disease because he started diving deep into it. He realized that dry eye patients need a ton of help and they need it early, before the condition worsens. Seeing success stories in his practice has been the catalyst to helping more people with this disease.
Years ago, he was also diagnosed with hypothyroidism, which deepened his interest in this disease and how it relates to the rest of the body.
What is Thyroid Eye Disease?
According to the American Thyroid Association, thyroid disorders affect more than 20 million Americans, and 60% of patients with the disorder don’t know they have it. In addition to this, more than 12% of Americans will eventually go on to develop a thyroid condition. The thyroid affects not just that gland itself, but the entire body. That’s why it’s so important to identify those suffering from this, so they can begin to lead normal lives sooner rather than later.
After being diagnosed with hypothyroidism, Dr. Dixon became more interested in this condition and how it relates to dry eye. Before his diagnosis, he experienced severe brain fog, fatigue, loss of focus, zero energy, poor sleep, and many other symptoms consistent with hypothyroidism. He was frustrated that his doctor didn’t do anything extra for him besides following the formula of diagnosis and medication, but the fact is that your entire body will be affected by a thyroid condition.
What are Symptoms of Hypothyroidism?
The following symptoms are incredibly common in those who suffer from thyroid issues. If you’re suffering from a few of these, yet your thyroid tests come back negative, it’s worth being retested or having other tests performed to dive deeper into the issue:
Loss of focus
Cold hands and feet
Aches and pains
Low sex drive
Gritty, dry eyes
Lump in the throat
Irregular cycles and infertility
What are Natural Treatments for Hypothyroidism?
We’re going to focus mostly on hypothyroidism in this discussion because it’s much more common than hyperthyroidism, yet the natural treatments and tests recommended can be important for both. Determining a cause is not always easy, and contributing factors may be different for everyone. For Dr. Dixon, he believes gut issues were a catalyst for his condition, but there are many other things that can come into play.
The thyroid gland works by receiving signaling from the pituitary gland, which secretes TSH. This promotes the thyroid to produce T4 hormone (which is inactive but available in the body to be converted into T3). To convert T4 to T3, we need the building blocks of iron, iodine, selenium, and zinc. Sometimes, a person will need hormones for everything to work correctly, but occasionally supplements, a better diet, and less stress can work well.
For example, if your body needs selenium (which we all do), you could take a supplement or you could eat a few raw, organic Brazil nuts each day, which are packed with selenium. Another thing you can do is make sure you’re taking a high quality multivitamin to supplement your already healthy diet. When Brazil nuts and healthy food aren’t options that day, you’ll have a multivitamin to fall back on. Sometimes, ashwagandha can be helpful for decreasing stress and making you feel better (but as with any supplement, pay attention to how your body reacts).
Speaking of this, it is so important to pay attention to how you feel. If something isn’t working for you, stop doing it. You know your body better than any doctor out there, and how you feel is the most important thing. No lab or test is going to replace this.
Dry Eye and Thyroid Eye Disease
Many times, the first sign of thyroid issues (hypo or hyper) is dry eyes, dry skin, and brittle hair. A sluggish thyroid means that your entire body can be sluggish, so this puts you at risk for eye issues. For example, if your body temperature never gets to normal, the oil in your meibomian glands may never become the consistency of healthy olive oil. This is where warm compresses come in and can make a huge difference when used regularly.
Since most Hashimoto’s patients are women, if their hormone function is less than optimal, the battle will be difficult. 95% of patients will be on a synthetic T4 medication, and most of them will have never had T3 testing done or been offered any other bioidentical hormone replacements for their condition. Regardless of symptoms and signs, we need to be tackling this early on and giving patients access to everything before severity increases. Before you’ll find relief for your dry eyes, the thyroid needs to be treated fully.
Artificial tears are going to do nothing for these patients, aside from symptom relief in the short term. Just like thyroid disease needs to be hit at the core, so does dry eye disease. The first important part is education, which we do a ton of on this site and through our videos. Similar to how dentists have ingrained it in our brains that we need to brush our teeth twice per day, eye doctors need to be discussing twice daily eyelid hygiene with their patients (and other ways to reduce inflammation) early on.
One amazing tool to use on dry eye patients is meibography. This imaging of the meibomian glands allows not only the doctor, but also the patient, to see the damage that has been done to the glands. There is no better wake up call than that!
What Labs are Important for Hypothyroidism and Hyperthyroidism?
Because medicine does not evolve quickly, the most common tests for thyroid issues are TSH and T4 lab tests. But who gets to tell us what normal is? Although the results tell you high or low, there is currently no optimal standard. Dr. Dixon believes that the TSH reference range should be 0.5-3.0 instead of the current, which is anywhere between 0.45-4.5. However, you may have a TSH that comes in at 2.9 or 3.0, but have all of the symptoms listed above. Most of the ranges we see in blood work compare you to millions of Americans who may be either very sick or normal.
Total T3 and total T4 may be tested, although a better test is free T3 (this is the one that matters). This will tell you the amount of free T3 in your blood serum, which can really confirm where you are. A good range to trust is 2.4-4.2, and if you can make sure it’s in the upper part of that range it’s even better for you. Many doctors do not typically order this, but it's important if you think you have thyroid issues.
Another important test that’s never ordered is reverse T3. This tests the amount of T3 that’s not really available for your body, and it’s just sitting there. TPO and thyroglobulin antibodies are also worth testing. If we’re concerned about inflammation and autoimmune disease, 90-95% of ladies will show antibodies at some point, putting them into the category of Hashimoto's.
If there are antibodies there, it’s likely tied to gut health, and gluten can be a huge issue. An elimination diet is crucial with this, although most people are not tested for thyroid antibodies. Unfortunately, most doctors will not even address the other tests and treatments you could be doing, aside from testing TSH and taking synthetic thyroid hormones. This is so similar to dry eye disease! How many doctors are just throwing artificial tears on everyone that comes in their door? In our opinion, too many.
If you’re frustrated by all of this, we hear you. The best thing you can do is find a functional medicine doctor who will work with you to get your body into the optimal (not just “normal”) ranges for the following blood tests:
51:26 - What about patients who have had thyroid removed or ablated?
52:39 - Melinda Pedd - Can Hashimoto's cause dry eye?
53:33 - Stephanie Ferl - Can thyroid medications cause dry eyes?
53:33 - Karen Boatright - Can medications used to treat thyroid disease help dry eye symptoms?
54:40 - Michele Lucas - Do you recommend Armour or Synthroid, and do either make a difference with regards to dry eye and MGD/posterior blepharitis?
56:01 - Mel Roy Grenier - I have a lot of thyroid symptoms but it comes back negative. Can à thyroid problem be missed?
57:33 - Ellen Robinson - I have Graves, TED, dry eyes, and allergies. What eye products are most successful for treating eyes with this combination of ailments?
59:45 - Kristie Pinkerton - Can Hashimoto’s or Sjogren’s cause pseudotumor and significant proptosis?
1:00:50 - Nannette Condie - How do they definitely rule out thyroid eye disease? I understand your labs can come back normal. Someone suggested an MRI or CT scan, is that true?
1:02:02 - Khadija Bens - Is TED irreversible?
1:03:05 - Candice Marie - I have medullary thyroid cancer, so no thyroid, and was recently diagnosed with EBMD. Any correlation with all of them?
1:04:49 - Pearl McElheran - Is there any relationship between a low thyroid and eyelashes falling out?
1:07:17 - Wal Verwest - If the thyroid has normal levels can I still be suffering dry eye?
About Dr. Dixon
Dr. Dixon is a graduate of Asbury College and the University of Alabama School of Optometry. He has been an eye doctor for 30 years and specializes in contact lenses of all types. He uses state-of-the-art technology to offer the latest in contact lens design. Dr. Dixon prescribes bifocals, torics (for astigmatism), and offers Ortho-K, which reduces nearsightedness while you sleep. He has written for various optometric publications and has been a guest blogger forStop the Thyroid Madness. He is married to Jenna (Pope) Dixon. He is a songwriter and musician and the father of three children.