Recently I interviewed Dr. Rani Banik, as she is a board-certified ophthalmologist and fellowship-trained neuro-ophthalmologist with additional training in functional medicine, and we chatted about thyroid eye disease. If you would prefer to listen the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:With me, I have Dr. Rani Banik, who is a board-certified ophthalmologist and fellowship-trained neuro-ophthalmologist with additional training in functional medicine. Dr. Rani focuses on the root cause of eye diseases and uses integrative strategies for conditions such as thyroid eye disease, macular degeneration, cataracts, dry eyes,glaucoma, as well as other diseases of the visual system. Her treatments are based on nutrition, botanicals, lifestyle modifications, essential oils, and supplements. Dr. Rani runs a private practice based in New York City, in Manhattan. Thanks for joining us, Dr. Rani.
Dr. Rani Banik: Thanks so much, Dr. Osansky. So happy to be here.
Dr. Eric: Same here. It’s great to chat with you again. We’re of course going to cover thyroid eye disease. Why don’t you start out by briefly discussing what thyroid eye disease is?
Dr. Rani: Sure. Thyroid eye disease is an autoimmune disease. What happens is the body creates antibodies against tissues within the eye socket. We know that an autoimmune disease is the body attacking any tissues. Here specifically it’s attacking receptors found in the soft tissues of the eye socket, in the fat and the muscles of the eye socket. What ends up happening is there is an inflammatory response. There are certain signs and symptoms we can talk about that develop because the body is attacking itself.
The majority of people who have thyroid eye disease have Graves’ Disease. About 90% of people with thyroid eye disease have it. It can also occur with hypothyroidism. For example, Hashimoto’s. Sometimes people are even euthyroid, meaning their thyroid is functioning just fine, but they have autoimmune markers that are attacking the eye sockets. It can occur in the entire spectrum of thyroid disease in some form of autoimmune activation.
Dr. Eric: You said it can occur in Hashimoto’s. Percentage-wise, 80-90% of cases of thyroid eye disease is in those with Graves’.
Dr. Rani: The vast majority have hyperthyroidism from Graves’. The minority have Hashimoto’s or are euthyroid.
Dr. Eric: Why don’t we talk about the stages that one can expect to experience? There are different stages of thyroid eye disease.
Dr. Rani: It’s very easy. There are two main stages. One is the active stage of the disease, and then there is the inactive stage of the disease. The active stage is the acute inflammatory stage. It usually lasts anywhere from six months up to two years when there is a lot of congestion. The inflammatory cells, both B-cells and T cells, get activated. They cause swelling and redness and sometimes pain or discomfort. That is all the active stage of the disease.
In the inactive stage of the disease, which happens usually after two years of onset, people don’t have as much of the congestion, the redness, but they can certainly have puffiness, swelling, and continue to have some of the other symptoms of the active stage. For example, I didn’t mention this earlier, but double vision can persist into the inactive stage. Other things like dry eye can persist. That is the main way to categorize it. There is not a clear cut-off to the inactive stage. It’s not a sudden change; it’s a gradual change that happens.
Dr. Eric: I know it varies, but on average, how long does that active phase last?
Dr. Rani: In my patients, I would say the average is about a year, sometimes a little bit longer, that it persists. After two years, usually it does transition into the inactive stage. The first six months are usually the most dynamic. That is usually where the majority of the inflammation is apparent. That is when the patients are the most symptomatic, in the first six months.
Dr. Eric: Once someone is in the inactive stage, are they permanently in the inactive stage? Or can they revert back to the active stage?
Dr. Rani: Great question. A very small percentage of patients can get reactivated. Usually there is some kind of trigger. The trigger I have seen most often is stress. Or exposure to certain types of toxins. Perhaps they have been ill with something else, and that can trigger it. Many thyroid patients, because it is an autoimmune disease, other autoimmune diseases may coexist. Let’s say they have thyroid, but they also have something else like lupus. If their lupus flares up, it is much more likely that their thyroid eye disease is going to flare up as well. That is something to watch out for. These flares can sometimes happen together. But the vast majority of patients, and fortunately, once they go into that inactive stage, they remain inactive.
What I tell my patients is this is a long journey. It can be very frustrating. Having these symptoms can affect your function and your appearance. People are disturbed by all of these changes that are happening that they seem to have no control over. I tell them, “You have to hang in there. There is no quick fix for this. Eventually, things will get better, but it can take a couple of years before things start to get better.”
Dr. Eric: If someone does need surgery, they do need to wait until that inactive stage. Is that correct?
Dr. Rani:I base it off of their lab work. First, their thyroid has to be stable. If their thyroid values are still fluctuating, going up and down and up and down, that is not the opportune time for surgery. That means their eye changes could be fluctuating. Even if you think your eyes are stable, but your thyroid is still all over the place, you cannot have surgery. It is not a good idea.
Once the labs have stabilized, then I wait another six months to make sure that the eye findings are stable before recommending any type of intervention like surgery. In the meantime, there are so many things people can do, which we’ll talk about hopefully, to try to ameliorate some of those symptoms rather than going the surgical route.
Dr. Eric: Yes, we will discuss some of those things that they could do. You mentioned stress. Stress could be a factor in potentially reverting back to the active stage from the inactive stage. As far as triggers in general, you mentioned thyroid eye disease is autoimmune, so I imagine the same triggers that you see with Graves’ and Hashimoto’s and lupus and rheumatoid arthritis. Food, infections, chemicals, is that correct?
Dr. Rani: Absolutely. Infections, viruses in particular, I have seen people flare up after viruses. Not common, but it can happen. Stress, meaning lifestyle habits. When people don’t sleep well, when they are not rested, when they are not eating on a regular schedule, when they are eating inflammatory foods, all of those can be triggers.
Toxins. We know the biggest toxin exposure risk for thyroid eye disease is smoke. Smoking in particular. Any kind of air toxin, even cooking fumes. I have seen some patients who are professional chefs. They do know that if they are not wearing their eye protection when cooking, their eye symptoms tend to flare up. These are all things that are under your control. It’s important to be aware of all of these modifiable lifestyle factors.
Dr. Eric: Is it safe to say that if someone has Graves’ Disease with thyroid eye disease, since that is a common combination, that the triggers will be the same? Whatever is triggering Graves’ is triggering thyroid eye disease. Or do you find that it might be separate? I know it’s difficult to tell sometimes; you can’t always tell. In my opinion, I would say there is overlap. The same factors that trigger Graves’ can trigger thyroid eye disease. In your opinion, would you agree?
Dr. Rani:Absolutely. Even though they may have the same triggers, I want to point out one really interesting clinical pearl, I guess. A thyroid condition, whether it’s Graves’ or Hashimoto’s, and thyroid eye disease, even though they are caused by the same autoimmune process in the body, they don’t always go in parallel. For example, what I mean by that is someone could have a history of Graves’. It may have been a long time ago, like 20-30 years ago that it was treated. All of a sudden, they develop thyroid eye disease. I have seen that in a handful of patients. They are completely quiet from the thyroid side, and decades later, all of a sudden, they develop thyroid eye disease. In that situation, we have to think about these lifestyle triggers, exposures, etc. Why did they flare up?
Or the opposite can happen. Sometimes they can have no history of thyroid conditions and then all of a sudden start developing these unusual eye symptoms. They don’t know what’s going on. Ultimately, they get diagnosed with thyroid eye disease. Their thyroid seems to be fine. It’s functioning fine. They are euthyroid. Then years or even a decade later, they develop the clinical symptoms and signs of autoimmune thyroid disease. They don’t always go hand in hand in terms of the time frame.
The reason I say it’s a clinical pearl is because we are going to be talking about some of the symptoms and signs of thyroid eye disease. If you do experience any of these, be sure to talk to your eye doctor and primary doctor, and maybe get a referral to an endocrinologist. Or vice versa. If you are seeing an endocrinologist or are being managed by your primary care doctor, and you start to have some of these eye symptoms, be sure to ask for a referral to go see an eye doctor. It could be the onset of thyroid eye disease.
Dr. Eric: Why don’t we talk about some of the symptoms and signs? I also wanted to discuss what happens when someone sees you for the first time, like the procedure. Maybe start out by explaining why someone would see you. I imagine it’s more moderate to severe cases when they are seeing you because I know endocrinologists don’t refer every thyroid eye patient to an ophthalmologist. When would a patient usually see you or be referred to you? What is the routine when they initially see you for the first time?
Dr. Rani: The majority of patients who actually get referred to me as a neuro-ophthalmologist or an oculoplastic specialist who also deals with thyroid eye disease is when the condition is interfering with their function. Not just swelling of the lids or redness or dryness, but if there are other issues that come into play. For example, vision loss. That is a big one. If someone starts to have blurry vision, and they actually feel like their peripheral vision is somehow affected. Maybe they have some patchy vision, or their central vision is affected, or if they start to have double vision, that is usually when they get referred to a neuro-ophthalmologist.
Those are the more moderate to severe cases. I think that even the earlier cases should be referred. There are certain things that we can sometimes pick up on an exam that could help explain the patient’s symptoms that perhaps their endocrinologist won’t be able to pick up, or their regular ophthalmologist may not be able to pick up. These are very subtle things that either a neuro-ophthalmologist or an oculoplastic surgeon can pick up.
What happens during an eye exam? This is a great question. When patients come to see me, I tell them to block out half the day. They will be with me anywhere from two to four hours. This is not your regular eye visit. We are doing a lot of testing. We are getting a good feel for what is going on, what level are you at. What do we need to do to protect and preserve your vision?
First, I do a very thorough intake. I want to know not just their thyroid history but their entire medical history. I want to know what medications they’re on. I want to know their diet and lifestyle factors. It does get a bit of time to get all that information in the beginning. That can take me a half hour to 45 minutes to collect that preliminary information.
Then we start with the exam. Of course, we check vision, distance/near, color vision, depth perception (because that is important and can be affected in thyroid), and then we do a test called a visual field test. This is a challenging test to do. You sit in a machine, and the machine is like a white bowl. The machine is automated. It gives you little white dots. When you see the dot, you are pressing a button. The machine is testing your entire visual field, meaning your peripheral vision. This is very important for people with thyroid eye disease. If there is a lot of congestion in the eye socket, their optic nerve may be compressed, and they may have loss of peripheral vision. This will pick up even the earliest stages of optic nerve compression. That is important to do.
I check alignment. How do the eyes work together? Are they aligned? Are they misaligned? For example, is one eye higher than the other? Is one eye crossed in? Especially if someone has double vision, it’s important to do that alignment measurement.
I check their proptosis, meaning are their eyes bulging within their eye socket? There is a metal device that I use. I put it on their bones and can measure how prominent their eyes are. We do this at every visit.
Then we check their eye pressure, which is important because patients with thyroid eye disease can have elevated eye pressure. Some of them are at higher risk for glaucoma, which is associated with elevated eye pressure. It’s important to do that.
Then I check them under the microscope. I see their surface to see if their eyes are dry. I check their glands within their eyelids. I check the front of the eye, their iris, their lens. I am checking them for cataracts, etc. Then we dilate them.
Beyond the dilation, I check the nerve and the retina. We do photographs of the back of the eye. This is very important for monitoring patients. If there is any change, we can pick them up on serial photographs. We do regular photographs of the nerve and the retina. Then we do specialized, high resolution, ultrasound pictures. These ultrasound pictures tell us the health of the optic nerve, whether there has been any damage or not. We also do the retina.
All of that together takes a lengthy amount of time. It gives me the full profile of what is going on with a patient with thyroid eye disease. Of course, I look at their labs. I forgot to mention that. I ask my patients to bring in their labs. If they have had imaging, a CAT scan or an MRI, I ask them to bring me their CD-ROM so I can look at that. I can take a look at their eye socket. What is going on with their muscles? What is going on in the back of the eye socket? Is there any compression of the optic nerve? It’s pretty extensive.
Dr. Eric: I didn’t realize how detailed it was, that first visit. Do they have to come back for a second visit to get the findings explained to them? Or do they get the answers during the first visit?
Dr. Rani: I try to do everything at the first visit. I give them a road map of what to expect. Depending on where they are, if they have very mild symptoms, I may say, “Come back in six months or a year.” If they have more advanced disease, I may have to see them much sooner. In severe cases, I may be following up with them every week or two weeks. In moderate cases, I may be seeing them everythree to four months or so. It just depends on how they come in, where they are in the spectrum of the disease.
Dr. Eric: You also mentioned that you check things such as pressure to make sure that they don’t have glaucoma. Are people with thyroid eye disease more susceptible to developing other conditions such as cataracts, even macular degeneration, which is more age-related?
Dr. Rani: Glaucoma, definitely. If there is a lot of congestion in the eye socket, then the pressure in the eye can go up, just from the congestion. High eye pressure is a risk factor for glaucoma. Many people ask, “What’s a normal eye pressure?” This is in a Caucasian population of mainly men that the studies were done. Normal eye pressure is anywhere from 10-21. That being said, some people have pressures that are higher than 21, and it’s normal for them. Just having an eye pressure that is higher than 21 does not mean you automatically have glaucoma. We take the eye pressure in conjunction with the visual field test and the optic nerve appearance to determine if somebody has glaucoma.
That’s why all of those tests are important to determine is it just an elevated eye pressure, or is the elevated eye pressure putting someone at risk for damage to the optic nerve? It is really important that your eyedoctor should check it every visit. It’s kind of like a vital sign. When you go to the regular doctor, you get your blood pressure taken. When you go to the eye doctor, you get your eye pressure taken.
Dr. Eric: Makes sense. With cataracts and other eye conditions, are they more likely, too?
Dr. Rani: Fortunately, not that I have seen or heard about in the literature. As you mentioned, those are conditions that can happen to anyone as they get older. The one condition that is very common in thyroid eye disease patients is dry eye. It can occur independently of thyroid eye disease, but it can get exacerbated with thyroid eye disease. That is definitely something that your ophthalmologist will check. If you do have dry eye, it should be treated.
Dr. Eric: I was going to ask you about that. You mentioned how you feel that everyone with thyroid eye disease, even the mild cases, should see a specialist. Even if they are suspecting it might just be dry eye, you think it’s a good idea. Is it difficult to differentiate sometimes mild thyroid eye disease from a case of dry eyes?
Dr. Rani: Thyroid eye disease usually causes other congestion on the surface of the eye. We can see that under the microscope. Then there are also lid changes that can happen. Part of the exam as well is to look at the eyelids and see how the eyelids are resting on the eye. With thyroid eye disease, many of your listeners may know that the eyes start to open up. It becomes like a stare appearance. The eyes are wide open like a deer in the headlights. Because there are lid changes that happen where the muscles get pulled and tight and restricted, that alone can also contribute to dryness of thyroid eye disease.
It definitely needs to be treated much more aggressively. If the lids are wide open, let’s say when someone is sleeping, their cornea is not lubricated, they are at higher risk for not just dryness of the eyes but even a corneal ulcer. This is something that is so easy to prevent if it’s diagnosed early enough. Of course, we don’t want to let things go. That’s why I’m saying even patients with milder forms of disease should see an ophthalmologist at least for a baseline exam to see where they’re at, to see what they’re most at risk for, and to address it before it becomes a real problem, before it becomes an ulcer. The worst case scenario is an ulcer that is perforated. That is a medical emergency. We don’t want things like that to happen.
I don’t want to scare anyone. That is the other thing. We are talking about all of these potential things that can happen with thyroid eye disease. Some of these are really in the more advanced cases. We don’t see this commonly. Of course, you want to be aware of them so that you can be an advocate for your own health. If you do think that you have any of these things I’m talking about, definitely talk to your eye doctor about it. Get a referral to a neuro-ophthalmologist or oculoplastic specialist.
Dr. Eric: Thanks for sharing that, Dr. Rani. Before we talk about some of the natural options and things people can do in that active stage, can you talk about some of the conventional treatment options? I also want you to touch upon Tepezza as well.
Dr. Rani: Absolutely. We will talk about the traditional therapies that have been used for the past four to five decades. In terms of the order, the first thing we typically do is if someone is at risk for vision loss, we usually start with steroids. Steroids are not for the milder cases. They are reserved for the more advanced cases. We can give either IV steroids or oral steroids to help with the congestion in the eye socket. Steroids have lots of side effects. They are not ideal. It’s not something that we can use long-term.
In terms of long-term, there are other medications that can be used. Immunosuppressant medications to try to modulate the immune response. Even radiation therapy has been used.
The most exciting development in thyroid eye disease is Tepezza, which is teprotumumab-trbw. Tepezza is much easier to pronounce. This is the first FDA-approved treatment for thyroid eye disease. Steroids are used, but they are not officially FDA-approved. Tepezza is a biologic agent. What it does is targets a particular receptor that gets activated in thyroid eye disease. It targets the receptor for insulin-like growth factor. It prevents a lot of the release of some of the inflammatory modulators. It helps to improve congestion, puffiness, redness. It helps to reduce the size of the muscles in the back of the eye when they get inflamed. It can help reduce the proptosis/bulging of the eyes. It can also help with double vision.
Tepezza has changed the options for patients with thyroid eye disease. It is an infusion, just so you’re aware, that is given every three weeks for eight treatments, about six months of therapy. Usually within the first two to three months, patients notice a big improvement in their symptoms and signs in terms of the congestion and so forth. It may take a little bit longer to see some of the other benefits. For example, the double vision improvement, etc.
Tepezza is approved, but it is not easy for all people to get. The reason is because there are very specific criteria that patients need to meet for their insurances to pay for the drug. It is quite expensive. I don’t know the exact amount of the cost of therapy. I believe it’s well over $200,000 for six months of therapy. Sometimes patients need a second round six months or a year later. That’s why in order for patients to qualify, they have to meet certain clinical indicators for active thyroid eye disease.
Those are the typical standard treatment approaches. Surgery is an approach, which as I mentioned earlier, we usually reserve for the more advanced cases. There are a couple of different surgeries that can be used. Decompression surgery is one. Some of the bone is removed, either from the bottom of the eye socket or the medial wall of the eye socket. That lets the eye fall back into a more normal position. It helps with proptosis, congestion.
There can be a separate surgery for double vision if someone really has misaligned eyes. After some time, they are stable, and their thyroid is stable, but their double vision is not getting better. The surgery can realign the eyes so people can see single again.
There are cosmetic procedures that can be done to put the lids back into a more normal position. If the lids are wide open, there are surgeries to restore a normal lid positioning and improve cosmesis.
There are a lot of options out there. Not one combination of options is right for everyone. You should really talk to your doctor about what is the best option for you.
Dr. Eric: Getting back to the Tepezza. I know that it can have some dramatic effects when it comes to the eye bulging for example. I have had a few patients who had the Tepezza. With the double vision, you mentioned it takes longer. I have seen that, too, where if someone is going through the initial infusions, it doesn’t seem to be as effective. Very small sample size on my part. You probably have seen a lot more patients who have received it. As far as you have experienced, it can help with the double vision, but they might need another round?
Dr. Rani: Exactly. The patients I have seen who have had Tepezza, they had it mainly for their congestion issues. Let’s say they have double vision. If they have a big misalignment, let’s say one eye is up here and one eye is further down, it’s possible it could help to reduce it down. It may not exactly make it completely aligned. It definitely helps to reduce the congestion. We measure double vision in prism diopters. It improves that. Patients may still need to have a special type of glasses afterwards like prism glasses to help with any residual double. Ultimately, they may end up needing surgery. But the clinical studies have shown that it reduces the amount of double vision. It may not eliminate it inall patients, but it will reduce it. It is an indication for using Tepezza as well.
Dr. Eric: Okay. Any side effects people should be aware of with Tepezza?
Dr. Rani: Yes. There are side effects. They are considered mild, meaning not serious adverse effects, but they are adverse nonetheless. The most common ones I have seen are, after the infusion, nausea, fatigue, flu-like symptoms that can happen. Some of the more concerning side effects I have seen, I have had some patients who have had decreased hearing. That appears to be temporary fortunately. That is not something long-term, but it is something patients need to be aware of. Those are the main things.
I know that in the studies that were published on using Tepezza, the studies excluded patients with diabetes. I’m not sure exactly why they did that. I have seen some changes in blood sugar with Tepezza. It’s anecdotal experience. The patient should be under the care of an endocrinologist as well if they do have co-existing diabetes to monitor that.
Interestingly, there are also some reports of, and I don’t know whether this has been published yet, but I have talked to my colleagues about this. Patients who have thyroid eye disease sometimes have other changes in other parts of their body as well. For example, skin changes. I have heard that Tepezza has helped those changes as well. For example, people can get something called myxedema, which is a thickening of the skin in their lower extremities or a change in their skin texture. I have heard anecdotally that Tepezza may be able to help that as well. But that is not the real indication. The indication is eye disease.
Dr. Eric: There are alternatives if someone can’t get Tepezza, correct? As you mentioned, in other countries, it may not be available. There are other biologic agents?
Dr. Rani: Yes. The one that is most commonly used is called Rituxan or Rituximab. That particular biologic agent has been around for a long time. It’s a CD-20 inhibitor, so it’s a type of B cell inhibitor. It’s specific. It helps to modulate the immune system. Rituxan is used for many other conditions, such as other autoimmune conditions. It is more available in other countries. It is fairly safe. It is actually givennless frequently as an infusion. You have one dose, and you have a second dose within two weeks. After that, you have an infusion every six months. It is an indefinite treatment. Not like Tepezza where it’s six months and you’re done. It’s indefinite.
Dr. Eric: Let’s go ahead and discuss the natural, alternative options that people have with thyroid eye disease, especially in that active stage.
Dr. Rani: I am a strong believer that you can do a lot through your nutrition and lifestyle choices to help improve your autoimmune condition. This is very true for my patients with thyroid eye disease.
My first intervention is diet. First of all, I have them do a diet history and remove any pro-inflammatory foods that they have commonly. For example, initially, I do have them remove all gluten and dairy. You probably do the same, I’m guessing, because we are trained very similarly in functional medicine. Those are the two most common inflammatory foods that can trigger autoimmune disease. I usually tell them it’s difficult to do this, but I really want you to try to stick with this diet for three months. Some doctors will say three weeks, but I say three months because in three weeks it will hopefully decrease your IgG load. But the cells that create those IgGs, the T cells and the B cells, they live up to three months. If you really want to reset your immune system, do it consistently for three months.
Also, I use in my practice a specific diet that was designed by the Institute for Functional Medicine called the Renew Diet. It is an autoimmune diet that has certain other foods you are supposed to eliminate. The one class of foods I have found most important for these patients to eliminate are nightshades. I don’t know whether you have a similar experience as well in your practice. I do have quite a few patients that once they eliminate things like tomatoes, potatoes, eggplant, and peppers, they start to stabilize. If they accidentally have a little of it, they notice immediately that their disease is flaring up. They know their body is reacting to some compounds in those nightshades. I know it’s quite difficult to do because some of these vegetables and fruits are so pervasive in our foods that we eat. Most of us love these foods. But it is important to see if you are one of those people that reacts to nightshades. Do a trial. Eliminate it for, if you can, not just a couple of weeks but up to a couple of months and see how you respond to that. That is my first line of treatment.
I also use supplements and botanicals. In terms of supplements, the most important things are the anti-inflammatory supplements like Omega-3s, Vitamin D, and curcumin, which is turmeric. You can either have it as a spice with your food or take it as a supplement. Those are my top three for thyroid eye disease.
Of course, selenium. There is a European study that showed that selenium supplementation at 100mcg twice a day can be very useful. It can take some time to work. Don’t expect an immediate response. Some patients take it for a month or two and say, “it didn’t do anything, so I stopped taking it.” I tell them you have to take it for a good three to six months to see the benefits.
Dr. Eric: I do agree with the nightshades. I do have patients stop eating those as well. I also agree with Omega-3’s, Vitamin D, selenium, and turmeric/curcumin. They can all help with inflammation.
How about glutathione? Selenium is a co-factor for glutathione. Do you find taking NAC or liposomal glutathione to be beneficial at times?
Dr. Rani: It’s not my first line of therapy. But those agents, glutathione, NAC, and lipoic acid are all very potent antioxidants made by our bodies. We also can take them as supplements. In cases where patients are not responding, or if they continue to have worsening disease, I may add one or two of those into the regimen. They definitely are good for overall health. They are antioxidants, and they can help fight inflammation. It’s not my first line of therapy.
Dr. Eric: Being a functional medicine practitioner as well, I assume you also agree that it’s important to optimize the health of the gut because you need a healthy gut in order to have a healthy immune system.
Dr. Rani: Absolutely, yes. The gut is the cornerstone of functional medicine therapy. You want to promote gut health because in our gut resides a lot of our immune system. If you can decrease the activation of our immune system through the gut, promoting a good gut microbiome, you can decrease the immune system’s predisposition to getting ramped up and causing autoimmune disease.
I do recommend that patients have probiotics in their diet. Live probiotics, prebiotics, but also perhaps take a supplement as well. When I do recommend supplementation with a probiotic, I recommend cycling through it, not just to take the same probiotic all the time, but maybe every week or two weeks, cycle through two or three different brands, different strains of probiotics that you’re taking. Of course, make sure you are getting them in your diet as well. Lots of probiotic foods, fermented foods.
On the flipside, they can maybe trigger an autoimmune response in some patients. You have to see how your body is going to react to that in terms of live probiotic foods. I don’t know what your experience has been with patients with autoimmune thyroid condition and maybe even thyroid eye disease. You have to be a detective and find out if your body is going to react to something or not.
Dr. Eric: Definitely agree with that. How about the impact of stress, the role of stress management, as well as getting proper sleep?
Dr. Rani: So important. These are basic foundations of health. I have to keep emphasizing to my patients: How are you doing with your stress? What are you doing for stress relief? We all have stress in our lives. That is a normal part of our lives. We have to learn how to modulate that stress.
I will give you a perfect example of a patient of mine. This was a woman I started seeing over a year ago. She developed thyroid eye disease during the pandemic. She was completely fine, and all of a sudden, she had horrible swelling, double vision, dryness, etc. It turned out that during that time of lockdown, her daughter had come to live with her. They were living together. They had a lot of friction between the two of them. She was constantly fighting with her daughter. She believes this really triggered her stress. It’s unfortunate that this happened.
Then she made the decision to go visit her son, who lives out of state for six months. It was also a change in climate because she moved from New York to New Mexico for six months. In doing that, she was able to improve her stress level. She was exercising regularly in addition to that. She was eating the right foods. She was on the Renew Diet plan I mentioned earlier. She was taking the supplements. In doing that, she was able to put her body into a different state that was less inflammatory.
When she came back to New York, and she was back with her daughter, she was able to manage it better. She really attributes this sudden onset or development of thyroid eye disease to the stress in her life, both from COVID and from her home situation. She was able to modulate that. Just as an example of how stress can impact us. Little things that we can do to manage it are important.
Sleep is really important, too. I had another patient who I have been seeing for a very long time. She is actually a judge, so she has a very demanding schedule. A lot of stress in her life. She was barely sleeping, maybe four or five hours a night. That was impacting her health. Once she improved her sleep regimen, her habits, her sleep hygiene, she also started to meditate. That made all the difference for her in terms of being more at peace, more at ease in her stressful job. Her overall health improved as well. She had been on blood pressure medications. She was able to reduce her dosage. All of these lifestyle factors can improve not just your thyroid status, but perhaps many other aspects of your health as well.
Dr. Eric: Thank you so much for sharing those examples. I imagine anyone who has thyroid eye disease has found this to be really helpful. Before we wrap things up, a few things that I want to mention.
First of all, Dr. Rani and I had a masterclass earlier this year. If you want more information on how to improve your health when dealing with thyroid eye disease, that is something you might want to check out. Also, by listening, you could get 50% off. There is a code that you will need to enter.
Also, Dr. Rani is coming out with some books. We are recording this in December 2021, but in 2022, you’re coming out with not one but two books, correct?
Dr. Rani: Yes. I have been working on these books for the past three years. It’s taken a while to come to fruition, but I’m excited about them. One book is called Best Foods for Eye Health: A to Z. In this book, I go through all the nutrients we need for our eyes, for prevention of dry eye, cataracts, glaucoma, macular degeneration. I go through the nutrients we need and the foods that supply those nutrients. I have recipes in there as well.
The second book is a book on macular degeneration. It is very near and dear to my heart. I see a lot of patients with macular degeneration. I myself am at risk for macular degeneration because I have a gene for it. I am going to do everything I can to prevent vision loss. That is through nutrition and lifestyle. My book addresses functional, integrative approaches you can use, practical tips you can use, to decrease your risk for macular degeneration. Thank you for letting me share that.
Dr. Eric: You’re welcome. I assume they can visit Amazon to purchase them.
Dr. Rani: Yes, when they are out, they will be available on Amazon and Barnes & Noble, or you can visit my website, too. If any of you have taken on a project like writing a book, you know it is a long journey. This is something I poured my heart into, so I’m really excited about both of these projects.
Dr. Eric: As an author myself, I am excited for you as well and can’t wait to read them. Your website, what is it?
Dr. Rani: It’s my full name, www.RudraniBanikMD.com [2]. I have a lot of blogs on my website. I talk about all kinds of eye health topics. As a neuro-ophthalmologist, I treat a lot of migraines, so you can find a lot of hopefully helpful information on migraines through my website.
Dr. Eric: Wonderful. Thanks again, Dr. Rani. As usual, it was great chatting with you. As I mentioned, I’m sure those with thyroid eye disease and even people without thyroid eye disease, because a lot of what we mention can also help people with other autoimmune conditions, too. Talking about some of the supplements and gut health. I’m sure everyone with thyroid eye disease found this to be valuable. Thank you again for joining me here.
Dr. Rani: It was my pleasure. Thank you so much.