Read what this Eye Doctor Observed in His T4-only Treated Patients!

Matt Dixon ODThe following Guest Blog Post has been written Matt Dixon, OD who currently practices optometry in Perry, Georgia.

And not only did Dr. Dixon find himself with hypothyroidism, he made quite an interesting observation: 90% of his patients currently taking levothyroxine still have symptoms!


So how did an optometrist (eye doctor) become passionate and obsessive about spreading the news about what Janie calls the “Madness”?

My personal journey

I don’t quite fit the typical patient profile for a hypothyroid patient.  I’m not female, no weight issues. I’ve always been very active. Yet when the symptoms started, I was clueless about where they came from or that they all could even be related. 

All eye docs are trained to recognize thyroid eye disease, but truthfully, we focus on end-stage symptoms of Grave’s disease and the ophthalmopathy that often comes with it.  And the typical optometrist does not encounter this very often.  I had no clue that in my own practice, hypothyroidism was one of the most common conditions I see. 

I suppose my first symptoms were body aches and pains.  I had always experienced annoying back issues and I presumed that deterioration was setting in as I became older (40’s).  I’ve also always been cold-natured. And by 2010, I noticed that I was struggling to make it through the work day. So by the end of the day, I was exhausted.  In fact, I was no longer exercising, but found myself buried on the couch as soon as I came home, not getting up until I forced myself to climb into bed.  Once I made it to bed, I couldn’t fall asleep and became addicted to Ambien.  When the alarm clock woke me up the next morning, my wife had to literally pull me out of bed.  If I ever forced myself to jog, I felt as if I was carrying a 25 lb. backpack.  I also began to struggle with unexplainable stress and anxiety.  

But what finally prompted me to seek answers was in fact eye-related.  I was driving my kids home one night and the road in front of me actually moved suddenly from left to right.  I hit the brakes and feared for our safety!  My 17 year old son took the wheel and we made it home.

The madness for me began

My physician at the time is a well-liked internist in my community.  I made an appointment for a checkup complete with blood work.  I had some issues that I was concerned about, but neither the assistant nor doctor reviewed my symptoms. 

I went back in a week and promptly received a prescription for Synthroid for hypothyroidism.  With little discussion about the disease, I headed to the pharmacy. After a couple of weeks I began to improve.  But I wanted to know more.  I found the vast list of hypothyroid symptoms online and could not believe how many I was experiencing.  I read enough to know that elimination of symptoms was the best way to dose the medication and focusing on TSH only would lead to under-treatment. 

More importantly, if my doctor did not know any of my symptoms, how could he know when I was adequately treated?  It was time for a new doctor.

Why do MD’s undertreat hypothyroidism?

My new doctor, unlike the previous one mentioned above, did review my symptoms and pledged to increase Synthroid until my TSH was reduced to around 1.  I made sure they were paying attention to how I was feeling.  Yes, I improved tremendously and found my happy place on brand name Synthroid.  But I did move over to natural desiccated thyroid (NDT) and was even happier. As I adjusted to the new medication and found the correct dosage, I was able to get through the day with full energy and better mental focus.  Most days I am symptom free.

In my area, I have yet to find more than a handful of docs who use NDT with any frequency.  In my patient population, I rarely encounter a patient on NDT unless I have coached them to find a way to get the prescription.  (Optometrists are licensed to prescribe oral medications but only for eye conditions) 

Synthroid is the number one prescribed drug in America!

This is no accident and it will not be easy to battle the industry that achieved this coveted ranking.  Doctors clearly have been trained to use synthetic T4-only meds as the treatment of choice, having been convinced that it is highly effective.  Trying to change this at the medical school level will likely never happen.  Attempts to enlighten physicians who are convinced that levothyroxine treatment and normalizing TSH levels is the best care will rarely lead to change.  In fact, general practitioners and internal medicine docs will continue to get it wrong as long as endocrinologists and the American Thyroid Association (ATA) promote Synthroid religiously.  Those who have seen the light, thanks to educators like Janie Bowthrope, will laugh (then cry) when they read the preview from the ATA’s published pocket guidelines How could these smart folks be so misinformed and allow patients to suffer?

What can one eye doctor do?

I’ve decided to review residual symptoms with every patient who comes into my office taking any form of hypothyroid medication.  The majority of them have never reviewed such a list!  Occasionally, a patient will not circle a “single symptom”, but more often patients will have “several” symptoms.  I offer a 3-page summary of how hypothyroidism can be properly treated and, of course, I have them google STTM.  After counseling over 100 of these patients (with only one complaint), many have returned to say thank you.  Sadly, most patients get the push back from their MD and will remain on T4-only meds.  I’ve also learned that if a physician has not studied the use of natural desiccated thyroid and is only committed to normalizing TSH, even the patients who convert to NDT may still suffer due to ineffective dosing.

I treat many patients with dry eye syndrome, which is very common and sometimes costly to treat.  I am convinced that treating dry eye syndrome in a patient who is undertreated for hypothyroidism is like trying to change a flat tire on a car that is still moving.  Every eye doctor should take an interest in this disease even if for this reason alone!

What can a patient do?

Refuse to tolerate inadequate treatments.  Be passionate about your own health.  Recognize that very good doctors with good intentions have been misinformed and may be facing tremendous pressure in our rapidly changing healthcare system.  They do not quickly change deeply held beliefs when it comes to recommended treatments.

Study Janie’s recommendations.  Make an effort to help your physician understand.  When seeking a new doctor, nurse practitioner, physician’s assistant or osteopath, ask questions before you make an appointment.  And do not assume that a board-certified endocrinologist is any more enlightened about this disease.

Final thoughts

My best analogy in attempting to drive home the importance of optimal treatment of hypothyroidism in my patients is to show them their vision as it would appear through a half-strength pair of glasses.  I ask them if they would be happy to see like this.  I ask them how quickly they would find a new eye doctor who prescribes full-strength glasses.  They get it.  I’m passionate about this disease and the patients who are literally suffering and feel uninvited to shout “I feel like crap!” to a doctor who won’t listen.  Together, we will make a difference.

Matt Dixon, OD


Dr. Dixon has practiced in Perry and Warner Robins, GA for over 25 years.  He provides comprehensive eye care and frequently counsels patients regarding wellness.  He has written numerous articles on eye disease and the business of optometry.

He is married to Jenna and has 3 children and 2 dogs.  He is an aspiring songwriter and has recorded 2 albums.  Thanks to NDT, he is quickly becoming a CrossFit addict.

151 Responses to “Read what this Eye Doctor Observed in His T4-only Treated Patients!”

  1. nicholas losco

    hi looking for any help i can get, i have been on Naturethroid for about 5 yrs all of a sudden out of no where i started having adverse effects, hot flashes down my left arm numbness and tingling in my left ring finger and left pinky pain deep in my left bicep and forearm, numbness in my tung lethargic feeling tingling in the center of my head about 1 inch up from my forehead pains under both under arms all within 10 to 15 mins after taking it. At first i thought i was allergic to it then i thought that maybe the pills some how got tainted i order through express scripts so i told my doctor she wrote me out an emergency script being as i was to scared to take the naturethroid that was giving me those effects so i was off the meds for about 3 weeks got a script for WP thyroid and about 3 days into taking it started to get the exact same effects as the naturethroid so i went back to my doc she did a blood test and my blood work came back as if i was not taking thyroid meds TSH 118.800 (ref range 0.270-4.200) THYROXINE FREE 0.329 (ref range 0.930-1.700) Triiodothyronine 0.365 (ref range 0.800-2.000) Hemoglobin 17.8 (ref range 13.5-17.5) mean platelet volume 11.3(ref range 8.0-11.0) Absolute Eosinophil Count 0.11 (0.20-0.90) NO FREE T3 NO FREE T4 then she decided to put me on T4 meds Levothyroxine 175mcg and about 6 days into taking that I started having the same exact effects minus the lethargic feeling iv been waking up the last two days feeling like i have a hang over i have tremors feet are ice cold and i feel as if I have been off my thyroid meds for over a month like when you come off of them to do the full body scan I REALLY AM LOST AND NEED A HAND AND ALL I FEEL LIKE I KEEP GETTING IS KICKED IN THE FACE……. Please anybody with some info can you help please.

    • James

      Hi Nic
      I have all the same symptoms as you – with me it happen after doc kept increasing Synth T4 to try (Nov 2015) and get me to close to TSH 0. I was about 10 at the time. I changed over to NDT60 (Jan 2016) and felt 90% better for a month, but all the symptoms began coming back. I started halving my NDT dosage and they were significantly reduced. My blood tests borderline but I feel okish. (TSH 6.5, T3 and T4 within range but low). I take between quarter and half the prescribed dose depending on how I’m feeling each day.
      Feel cold or depressed take a little extra.
      Feel itchy, hot, skin crawling – take a little less.
      I’m also investigating Testosterone (mine low) and Cortisole (waiting saliva test results).

      Final note These symptoms for me are also induced by Gluten, I am 100% gluten and preservative free (not a crumb) and I avoid eating anything not made by me from scratch with fresh produce. Simply described – meat rice potato and veg. I cook extra at night and take it to work for lunch. Breakfast at work – I buy a Fruit salad, glass of milk – no coffee. I quit coffee recently because I read a few blogs where NDT people were getting nerve issues from coffee. And I was drinking a heap of real coffee every day and had a few nerve shakes and pains. Also checkout Low FODMAP Diets – Ive been trying for a few weeks and feel improvements.
      Ive lost 10kg since going gluten free and on NDT. My weight hovering in top percentile of correct weight for height. But concerned about losing any more. Also swimming and jogging 4 days a week (always have) – I find exercise really helps when the symptoms are bad. Occasionally you’ll find me jogging round the block a 2 in the morning.
      Anyway that’s my two cents worth – hope something helps you.


      • Janie Bowthorpe

        James, one grain is just a starting dose from which we have to raise. Check out this page: But if we have low cortisol or low iron, we won’t be able to raise without issues until those are treated.

        • James

          Hi Janie, understand. I was on Thyroxin150 for 3 years and then something happening in my body and I cant tolerate it.
          I get hot crawling skin/scalp when I go above NDT30 or Thryoxin25 perday. Is it possible that my Thyroid is making a recovery since going gluten free Nov 2015. My T3 and T4 numbers are within range – TSH poor at 6.5. My Iron is good waiting on cortisol test to come back. Taking a Calcium D supplement. MS testing later this week. Reading about pooling and RT3.


  2. Stephanie

    This is a great blog entry. I would love to see something similar from a dentist. I have had tons of dental problems and dentists are always asking me if I chew ice, suck on lemons, etc. in an effort to figure out what is going on with my teeth. I suspect the problems result from years of untreated hashimoto’s and then years of poorly treated hashimoto’s (thankfully followed by years of well-treated hashimoto’s). The enamel is basically gone, pieces of my teeth fall off all of the time, and a tooth cracked entirely and had to be removed. I have good dental hygiene and do not chew ice, suck on lemons, etc. I once saw a brief writing about links between thyroid and dental problems, but I never really found anything in depth. Each time I ask a dentist about this, they say that there is no link. If hair and bones are weakened by thyroid disease, I am sure that teeth are too. We really need some professional writing on this subject so that we can raise awareness.

    • Patricia

      Stephanie – I’m not sure about dental problems per se, but from what I’ve read there is a link between hypothyroidism and osteoporosis, which seems to point to low calcium and Vitamin D or the inability for the hypothyroid patient to properly utilize these nutrients. I recently found some information that said that if you aren’t getting Vitamin K2, then the calcium isn’t going to be absorbed by your bones or teeth, but is more likely going to attach to soft tissue (like your arteries) and cause you heart disease problems. Will you hear this from most doctors? Probably not. Instead they’ll put you on some expensive medication (with a host of side effects) and tell you to take more calcium.

      • Stephanie

        Thanks! I just heard this from the clerk at my local health food store as well. It is interesting that they have become my first resource for medical questions.

  3. Ginny

    I thought I was moving around to quickly making my vision alter – nope, Dr. Dixon just confirmed, it’s my thyroid doing crazy things again. What a great article and an issue that should be discussed at medical meetings. Keep up with your research Dr. Dixon.

    Agree with blogger Patricia, teeth (and eyes) seem to be adversely affected by the malfunctioning of thyroids. My teeth have hairline fractures and enamel is disappearing. Dentist says no way to repair enamel and now I’m just waiting for the cracking to result in crowns and caps that will probably be needed for my teeth.

    One other adverse reaction to Levothyroxin – GERD. Stop taking the medication and the GERD goes away.

    • Jean L

      I am so glad you posted this problem with your eyes and teeth. My teeth felt like they were going downhill. It is hard to describe the feeling. Also, I had very bad night vision and slight problems with day vision. A lot of professionals out there do not really realize the effects of hypothyroidism. It effects just about everything. So, anybody out there who is not sure what is wrong with you- get your thyroid levels checked. It certainly cannot hurt and you may solve your health issues by having this test done.

      Good luck to the people having symptoms. I hope you resolve your problems.

  4. Ginny

    New doctor and new prescription. Here I go again. This is a never ending fight to stay on natural thyroid. New endo doc says, this new prescription for sodium levothyroxine is the “purest” synthetic you can get, you’ll see a difference right away. You bet I did!!! Three weeks on Tirosint 137 mcg and I was ready for the hosptial. Experienced myxedema and almost went into a coma. Thankfully endo doc saw the danger of ALL sodium levothyroxine’s for me and immediately put me back on Armour thyroid. Thyroid patients must constantly fight this battle so I’ve discovered a good way is to post on ALL my medical records “ALLERGIC TO SYNTHORID”. I keep all my thyroid medication presciption labels AND 1 tablet taped to the prescription so I can show the doctor how many prescriptions/dosages I’ve taken over the years (this one was really impressed with all the “colors of sythroid” I had taken.

  5. Karen Waters

    Interesting to read about the teeth issues. I have had teeth issues for several years. I thought it was just that I malabsorb calcium as I do all vitamins due to the duodenal switch weight loss surgery I had in ’09. Now a double whammy it is my Hashimoto’s that is causing issues with my teeth and yes with my eyes. So hard to read sometimes. My eyes seem to flutter. Things are not clear especially this light print in this post. My ophthalmologist will be doing a procedure on my eyes in a few weeks to help the blurriness. It is a laser procedure called the YAG capsulotomy if anyone is interested. I need to get this done so badly.. Yes so my eyeballs hurt a lot like I want to pull them out. Anyone else have this eyeball issue? Awful, awful. I think maybe it is time to increase my Armour. Currently on 60 mg. of Armour morning and afternoon. Maybe add another 30 grams?


Leave a Reply