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ODs should test for hypothryroidism

Issue: April 2018

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To the Editor:

Thanks for your excellent article urging ODs to become more involved in managing these difficult diseases (“Comanagement a priority in patients with autoimmune diseases,” February 2018). I agree we should be more proactive in ordering lab testing.

Still, we don’t often recognize perhaps the most common autoimmune disease affecting our patients, hypothyroidism. Hypothyroidism is very common, with a majority (women) having Hashimoto’s disease, and a large portion suffering from dry eye disease (DED).

Prevalence numbers are hard to determine because a “normal” TSH is a contentious subject. If we look at normal TSH levels close to 2.5 to 3.0, many more patients would be diagnosed and treated earlier in the course of the disease. Often, levothyroxine alone is insufficient in reducing the signs and symptoms of hypothyroidism and, if left unchecked, DED becomes more difficult to manage.

Optometrists should start by observing hypothyroid patients closely for DED and take an inventory of other symptoms that might indicate poor control. For suspected or confirmed hypothyroid patients, we can request the most recent labs. If not available, ordering labs such as thyroid auto-antibody (TPOAb), TSH, free T4 and free T3 can be especially beneficial in identifying marginal or undertreated cases. And, with as many as 10% of patients over the age of 65 suffering from hypothyroidism, TPOAb testing is certainly well justified.

Thanks for your very informative article.

Matt Dixon, OD
Perry and Warner Robins, Ga.

Disclosure: Dixon reports no relevant financial disclosures.

Dear Dr. Dixon:

Thanks for your letter and sage advice. Arguably, hypothyroid is the quintessential autoimmune disease. Somewhat vague symptoms, a lack of definitive findings and equivocal labs often cloud the diagnosis. For this reason, as you aptly note, it’s all the more critical we be vigilant and participatory in our patients’ care.

Thanks again for contributing to Primary Care Optometry News.

Michael D. DePaolis, OD, FAAO
Editor, Primary Care Optometry News