Hashimoto’s Thyroiditis and Dry Eye Disease

[helvella]

The association of Hashimoto's thyroiditis and dry eye disease (DED) is discussed in detail. Including specific clinical testing details.

The report explains its own significance:

Unlike GD, where numerous studies have analyzed the presence of dry eye and the cytokine profile of tears, only a few studies have examined the occurrence of dry eye in HT. However, no study has analyzed the cytokine profile of tears in patients with HT.

And it comes up with this good but unsurprising conclusion (taken from the discussion):

However, patients often experience significant delays in diagnosis, with some studies indicating that it can take up to seven years from symptom onset to diagnosis. Early diagnosis of HT-related DED is important so that patients can be effectively treated and further complications can be prevented.

Yet another situation where early diagnosis potentially makes a big difference but is often (usually?) not achieved.

Which to a large extent leaves patients to identify they have issues and choose and use and pay for their own treatments.

Hashimoto’s Thyroiditis and Dry Eye Disease

Abstract

Hashimoto’s thyroiditis (HT) is an autoimmune thyroid disease with characteristic lymphocytic infiltration and fibrosis. Chronic autoimmune changes that occur in the thyroid gland in HT may also affect the lacrimal gland. Objectives: This study aimed to analyze tear biomarkers and explore correlations between these biomarkers and clinical ocular parameters in patients with HT. Methods: A total of 150 participants were divided into three groups: HT (N = 50), non-HT DED (N = 50), and healthy controls (N = 50). The participants underwent a series of diagnostic tests for DED, including the Ocular Surface Disease Index, Tear Break-Up Time, Lid-Parallel Conjunctival Folds, Schirmer test without anesthetic, lissamine green and fluorescein staining. Tear samples were analyzed for cytokine and enzyme levels (interleukin 1β, tumor necrosis factor α, interleukin 6 (IL-6), interleukin 8, interleukin 10 (IL-10), interleukin 17A, matrix metalloproteinase 9 (MMP-9)) using ELISA and multiplex immunoassay. Statistical analyses were conducted to compare groups and assess biomarker correlations. Results: Dry eye disease was observed in more than half of the study group (27/50), with severe symptoms observed in 48.15% of the DED HT subgroup. IL-6 levels were significantly elevated in the DED HT subgroup compared to the non-HT DED group (p = 0.010), suggesting specificity for HT-associated DED. MMP-9 was elevated in both the HT and non-HT DED groups (p < 0.001) but lacked specificity for HT (p = 0.059). The DED HT subgroup exhibited significantly lower IL-10 levels (p = 0.008). Lissamine green staining and LIPCOF were significantly higher in the DED HT subgroup (p < 0.001). Conclusions: Dry eye disease is common in euthyroid HT patients without signs of TAO. This study highlights the potential role of IL-6. Lissamine green staining and LIPCOF are valuable diagnostic tools for assessing the ocular surface in DED HT patients.

Keywords:

Hashimoto’s thyroiditis; dry eye disease; biomarkers

Open access here:

mdpi.com/2077-0383/14/5/1710

[Buddy195 Administrator]

Thanks for sharing Helvella. I’ve found having both Hashimotos and Thyroid Eye Disease (TED) often raises a few medical eyebrows, as it is more commonly associated with Graves. Regarding dry eye symptoms I’ve found preservative free drops essential (eg Hyloforte or HycoSan). Even though the eye swelling and pain has subsided, dry eye and light sensitivity are ongoing issues for me.

[helvella]

Personal experience:

I have not had a positive antibody test (neither TPOab nor TGab) - though I have rarely had either tested. TGab only recently in a bundle.

However, before diagnosis of hypothyroidism, I had dry eyes, and for years after. I used to use ViscoTears single dose during the day and LacriLube at night. Treatments have, I believe, moved on. In time, I simply found I didn't need to treat them.

However, I had made the original mistake of using ordinary dry eye drops which contained preservative before I understood. Ended up using them more and more frequently. And getting worse. They'd give a few minutes of apparent relief but the need to re-apply became ever more frequent.

The posted paper is very welcome but I think we need even more research across all thyroid disorders.

Buddy195

[FAB-jellybean]

Thanks for this helvella . Something else I didn't associate with my hypothyroidism. I've never had high antibodies when tested for any autoimmune disorder, despite having them. 13 years ago, before I was prescribed T3, I was tested for and told I have suspected Sjogren's Syndrome as I needed artificial saliva as well as eye drops. They wouldn't do the necessary biopsy as they can only treat the symptoms anyway. Not unsurprisingly sadly, no-one ever even thought about my symptoms being my low T3. Thankfully, I don't need the saliva any longer but my dry eyes persist. Even the optician hasn't linked that with my thyroid. And like Buddy195, I've found preservative free eye drops a must. Would be interesting if someone took this research further to find the effects of people being on optimal doses of thyroid hormones. Not only for DED, but for the other known issues too.

[SlowDragon Administrator]

I have Hashimoto’s and dry eyes ……especially at night

No endocrinologist ever remotely interested in this

Optician about 7 years ago…..said “yes of course you have dry eyes at night …..your eyes are swollen and eyelids don’t shut completely when you sleep”

Since T3 added ….and especially since Levo dose reduced a little eyes feel less swollen and are definitely less dry

I have been able to reduce dose Levo a little more since changing to Vencamil levothyroxine last year as I find it so much more effective.

I use Xailin Night Lubricating Eye Ointment - preservative free

[jgelliss in reply to SlowDragon]

This is so interesting. Can it be that the T4 drys our eyes and T3 acts more as a bit of a lubricant? Thank you so much for sharing SD.

[SlowDragon Administrator in reply to jgelliss]

We see regularly on here, when on Levo only we often have to push dose up to get Ft4 high in range in order to try to push Ft3 up

High Ft4 can give hyper type issues…..anxiety, insomnia, palpitations etc etc

When adding small doses of T3 alongside ……frequently dose of levothyroxine can be reduced a little

[Alanna012]

Thanks Helvella! I follow your advice and use Hycosan drops occasionally - mostly deep winter when radiators make things worse and high summer. When I was on Levothyroxine mono-therapy I had chronic blepharitis. My eyelids were puffy and my eyelids felt like tweed rubbing against my eyeballs when I closed them.

An optician told me it was 'a known and expected' side effect of Levothyroxine medication itself before dismissing me.

A private ophthalmologist said it was the result of inadequate resolution of hypothyroidism. He was surprised I was on 100mcg Levothyroxine and wrote to my doctor querying my dosage...whose response was to look up my previous blood test, tell me my TSH was 'well' in the range (4) casually glanced at my eyes and said they look 'clear'...well, yes they do doctor, I'm on month two of a three month course of steroid eye drops!

Adding T3 has helped a lot, no more blepharitis, but I still get thick upper eyelids that make me look what I call cow-eyed like Bessie the cow😅 But that's also probably due in part to allergies.

I still get the penetrating staring eye or drowsy look, which is the hypothyroid antibodies I think.

[suebob59]

I have very high antibodies and have just been diagnosed with anterior uveitis so on steriod drops for 6wks. The hospital dr asked if I had any autoimmune illnesses. Also 20yrs ago diagnosed with scleritis, same treatment. Both very painful if not treated rapidly. Yet GP says high antibodies are of no consequence!!