T.E.D. ( thyroid eye disease) includes two major disorders: Graves disease( HYPERthyroidism) and Hashimoto's thyroiditis ( hypothyroidism). I am not going to discuss Graves disease here- which can lead to bulging eyes, as well as extremely dry eyes. And by dry eyes, I am talking about eyes that feel itchy, burning, gritty and may be red and sore. Also included in this line up of dry eye symptoms are photophobia, blurred vision, eye irritation, as well as excess tearing ( sounds counterintuitive, but it happens).
Although I do not know of anyone personally that had her/his thyroid disorder diagnosed by the symptom of dry eyes, I read that sometimes persistent dry eyes can lead to the diagnosis of a thyroid disorder. In a nutshell, the thyroid gland and the eye share certain proteins. In Hashimoto's, a person's immune system may attack the eye proteins as well as the thyroid tissue, thus leading to T.E.D.
There are two types of classification of dry eye disorders: tear-deficient dry eye ( impaired or decreased lacrimal gland function) and evaporative dry eye( one cause of this may be wearing contact lenses). A physician can determine the type of dry eye one has, and suggest the appropriate treatment(s).
Even if one is getting treatment for a thyroid disorder, this will not take care of the dry eye problem. Thyroid disorders and T.E.D., although they share a common cause, are separate issues and need to be addressed as such. There are several ways that can help people cope with the dry eye issue. These include:
*use artificial tears frequently ( I have found that the single use, preservative free ones are very handy. I can keep some at home, some in my purse,etc. ) These do not contain preservatives which can cause sensitivity in some people. DO NOT USE drops that " get the red out". These will only make the dryness worse as well as causing irritation in some people. Eye lubricating ointments can be used at bedtime- they cause a slight vision blur, but are generally very soothing.
*do not smoke
*use a humidifier in your home- especially now, since we are using heaters, which will also dry out the eyes.
*purchase Blue Light blocking glasses- they are available in no correction or in several strengths of reading glasses. I have purchased some of these and am wearing them when I use the computer, my phone, or sometimes for reading. I have found that these work pretty well for me. Added bonus: it is supposed to be beneficial for sleep.
* increasing the amount of omega-3 fatty acids in one's diet( salmon, tuna, sardines(!) and other fatty fish. One can also take fish oil in the form of caplets/capsules. Omega-3 fatty acids will help with blocking inflammation, so this may be helpful.
*there are prescription drops available that help with tear production. I would suggest that a patient speak with their physician to see if this is a good option for them.
* some people find wearing glasses, and not contact lenses, are more comfortable. Again, this is a subject to discuss with your physician.
I found a study involving a clinical trial to determine if there was long term impairment of the lacrimal glands after the administration of large doses of the I-131(RAI). This study was published in The European Journal of Nuclear Medicine Imaging, 2002 November;29(11) 1428-32. It was a relatively small study of only 88 patients, all with a history of receiving a large dose of the I-131 for thyroid cancer. 92% of these patients had at least one test that indicated impaired lacrimal gland function. The study's findings are as stated: " Our findings suggest that in the majority of patients, lacrimal gland function may be permanently impaired after high dose radioiodine therapy. All three layers of the tear film are involved and there is a pronounced long term effect on the tear film stability."
I had suspected that not only could my extreme dry eyes be attributed to my previous Hashimoto's disease, but that it must also have something to do with the large RAI dose that I received after my thyroid was removed due to papillary with follicular variant thyroid cancer. I have salivary gland issues due to the large dose of RAI that I received. I see an ENT who is a cancer head and neck surgeon and is keeping an eye on one of my salivary glands that is enlarged. My doctor told me that while the RAI primarily affects the thyroid tissue( or thyroid cancer cells in my case), it can also be taken up by cells in the stomach, salivary gland, thymus, nasal mucosa, lacrimal glands, and breast. So, in talking with my physician, and finding this research article, although a small one, stated above, I think that my extremely dry eyes are ,at least partly, due to a large dose of RAI.
Do I wish that I had not had the RAI? No, I know that I needed it due to the severity of my thyroid cancer, staging etc. However, I wish that I had not received such a large dose. It has been ten, almost eleven years ago since I received my dose of RAI. I am hopeful that now, with more information about how RAI can also affect other tissues in the body, Radiologists or Oncologists can make a more informed decision about the dosage of RAI . Perhaps a lower dose can be used- one that will effectively destroy any remaining rogue thyroid cancer cells with less damage to other tissues that might take up the RAI. No pun intended, but hind sight is always 20/20.
