Prevalence of Sjögren's with Autoimmune Thyroid Disease

I was diagnosed as hypothyroid in 2014 and with Hashimoto's in late 2016.  Since that time, I have strongly identified as someone with thyroid disease, considering that my only problem.

I have always been dry with no appreciable change in my dryness until around 2016.  It was around the time of my Hashimoto's diagnosis that my dryness began to increase rather noticeably.  

My scalp became flaky in 2016, and the skin on my arms took on a desiccated appearance.  I gradually began to suspect Sjögren's disease.  Initially, I decided that I didn't have it since my condition was quite mild compared to the horrific pictures of dry lips and skin that I found online.  I was in nowhere near as bad shape as what I saw in those pictures.

In early 2020 during the lockdown phase of the pandemic, my lips became excessively dry.  I was so worried about Covid-19 during that time that the stress undoubtedly worsened my condition.  By the way, I was correct to be worried.  I have now had Covid twice, and each infection permanently worsened my autoimmunity.

In late 2020, I told my doctor about my dryness and that I thought I had Sjögren's.  I tested negative.  I still thought I might have it.

By 2024, I was thoroughly convinced that I had Sjögren's, due to the ever-increasing dryness.  I asked to be tested again, and I tested positive.  

For much of the time since then, I've identified more with Sjögren's than with Hashimoto's simply because the dryness has impacted me far more than any thyroid symptoms.  My dry eyes are the biggest problem, and my lips still burn.  My skin is desiccated.  My scalp flakes; my heels are cracked; and my fingers split open rather often.  Sometimes I have Band-Aids on half of my fingers due to painful splits.  

I have recently realized that both diseases are interacting within my body and that neither is necessarily more important than the other.

The article, The Association of Sjögren Syndrome and Autoimmune Thyroid Disorders, states that autoimmune thyroid disease (both Hashimoto's and Grave's diseases) and Sjögren's disease are the most common coexisting autoimmune diseases that occur in a single patient and that up to 32% of autoimmune thyroid patients also have Sjögren's disease.  It would explain why so many thyroid patients are dry.  I wonder if we are dry more because we have Sjögren's disease as a comorbidity to thyroid disease than that our thyroid disease is the cause of the dryness.  We think that thyroid disease alone causes dryness, but most of us might have a mild case of Sjögren's and not know it.

The above linked article draws this conclusion:

The coexistence of SS [Sjögren's Syndrome] and AITD [autoimmune thyroid disease] occurs frequently in clinical practice probably due to common pathogenetic mechanisms shared by these two conditions. From a practical point of view, it is important to screen patients with SS for AITD and vice versa because the presence of the two disorders may influence patients’ clinical presentation and long-term outcome. It is widely accepted that AITD–SS patients may have a milder phenotype of SS with a lower risk for lymphoma development... Intriguingly, AITD–SS patients over the follow up frequently present additional autoimmune diseases and should be closely monitored especially for liver autoimmunity.

It is concerning that patients with both diseases are likely to develop additional autoimmune diseases.  I do have some scattered symptoms that could indicate that I am slowly developing other diseases.  I wish that I could reduce my stress, but I have no control over that.

The Sjögren's Foundation states:

Up to 40% of patients are not positive for anti-SSA and are seen as "seronegative," making diagnosis harder.  Some don't have obvious symptoms of dryness, a key indicator of Sjögren's, but present with symptoms that doctors don't realize are associated with the disease.  Some doctors mistakenly believe a patient has to meet the very strict criteria designed for use in clinical trials to be diagnosed with Sjögren's.

Patients can have mild forms of diseases.  A patient can have a disease even if it doesn't fit the textbook definition of the disease.

I tested negative for anti-SSA in 2020 but still felt it was likely that I had Sjögren's disease.  I finally tested positive in late 2024, but even then, my anti-SSA level was not far out of range.  Fortunately, I was diagnosed by a rheumatologist without having to go through a lip biopsy, which I've heard doesn't always detect the disease and can be a torturous experience.

Despite my worsening dryness, my condition is a complex overlap of Hashimoto's and Sjögren's diseases.  There is no way to separate them to know which one is causing certain symptoms.  The one silver lining is that I can supplement my thyroid levels with medication, which does mitigate some of the dryness.  

Sudden Significant Swallowing Problems (Dysphagia)

Since the summer of 2024, I have had occasional trouble with swallowing.  Originally, the problem occurred sometimes when I swallowed supplements.  Typically, I have always been able to swallow any kind of pill or capsule with no trouble at all and could typically swallow three to five at once without difficulty.  

I remember at least one instance in June or July 2024 where a maca root capsule became stuck in my throat.  I finally coughed it up after around half an hour.  Beginning in the fall of 2025, I began to have more frequent problems with swallowing, including with food getting stuck in my throat.  This happened with dry foods like bread and crackers.  

The problems became even more frequent in December and January.  I had a bad virus in December that inflamed my thyroid (see post).  I didn't know if my goiter was a contributing factor to the swallowing problem or if worsening Sjögren's was more to blame.

I was concerned that the problem had reached the point to where I would need medical intervention.  As the problem continued to worsen, I began swallowing lots of air, which caused additional problems.  As the problem progressed, I tried to find answers.  

I used my browser's search history to obtain dates and see what my concerns were.  

Jan 13 trouble swallowing
Jan 15 trouble swallowing
Jan 16 swallow therapy
Jan 18 stress swallowing problems
Jan 18 swallowing techniques
Jan 18 how not to swallow
Jan 18 swallowing air while drinking

In January, I thought that stress was the main problem.

Feb 27 swallowing problems after covid
Feb 27 stress swallowing

In February, I thought that stress and the virus from December were the cause.

Mar 18 swallowing too much air
Mar 18 swallowing too much air when taking vitamins
Mar 20 what does difficulty swallowing feel like with Sjogren's
Mar 20 how to swallow properly
Mar 20 how to correct swallowing problems
Mar 20 swallowing exercises for Sjogren's
Mar 21 why do some people have trouble swallowing after a virus
Mar 26 how to avoid swallowing air
Mar 26 how to avoid swallowing air when taking vitamins
Mar 27 taking vitamins indigestion trouble swallowing
Mar 27 esophageal swelling immediately after swallowing vitamin
Mar 30 can heartburn narrow the esophagus to where swallowing is difficult

In March, I briefly tried swallowing exercises, which I quickly abandoned.  I've been able to swallow fine my entire life, and this problem spiraled out of control in the last six months.  I decided that the strength of my esophageal muscles or my technique wasn't likely the cause of the issue.

I also felt that something was off in my throat.  It was like my esophagus had a pocket somewhere in the vicinity of my thyroid where stuff was getting stuck.  Something was structurally wrong, and no amount of exercise would solve that problem.

I began to suspect that heartburn had something to do with it.  If so, then it was caused by my vitamins, which were getting stuck in my throat at times.  I did learn that pill esophagitis is an actual condition caused by pills getting stuck in the throat.  The throat becomes irritated.

Two things happened at the beginning of April.  I had a filling repaired on April 2, and that was the day that I searched for information about esophageal swelling caused by dental problems.  I searched for that information before my appointment that day, since I recalled having an improvement in autoimmune symptoms after a filling repair in August 2024 (see post).  I learned that dental problems could possibly cause some swelling in the throat.  I don't think that was the problem, however.

In early April, I quit taking supplements that were harder to swallow or more likely to get stuck: probiotics, a multivitamin, B-complex, and maca root.  I continued taking omega-3 oils and sea buckthorn, since they help my dryness.

My swallowing problems have lessened.  I feel like the main culprit might have been the maca root, which was the supplement that gave me problems in the summer of 2024.  I will never take it again.  Eventually, I will resume some of the others, but I'm keeping off of them right now to give my throat a chance to settle down more.

I have been under intense stress this year, and people can develop swallowing problems due to stress.  Viruses can cause swallowing problems as well.  It could be that I had some irritation caused by maca root which worsened considerably after my virus and was also compounded by my high stress level.

I am still having some minor trouble swallowing.  It's definitely much less of a problem than it was during the last few months.  I am hopeful that I will continue to improve.

Intense Stress Worsens My Autoimmune Condition

As I wrote in "Teaching Heightens the Risk for Autoimmunity," the 2024-2025 school year broke me.  I had an unusually high workload which caused high stress.  Additionally, I got Covid for the second time in December 2024.  I have not been the same since that time.

I believe that I have long Covid and that the main manifestation is that it greatly worsened my dry eyes.  Another unpleasant impact is that I now frequently smell menthol.  The menthol odor is a phantom smell.  It's like I have Vicks or a similar product inside my nostrils.  When I smell the phantom methol odor, my eyes burn as if methol is in them.  It's quite annoying.

I have seen an ophthalmologist for my eyes since February 2025.  The measures taken so far have not helped.  I have now been referred to a dry eye specialist.

The current school year has been just as intensely stressful as the previous school year, except for a different reason.  What happened early in the year was honestly the most stressed I have ever been in all of the years I have been teaching.  I was not in good shape when the school year began, and the intense stress just continued to pile on.

People who are autoimmune are told to manage their stress levels.  I do what I can, but I can't control the demands that my job places on me.  I can't control how other people behave.  If I could retire right now, then I would.  I must work three more years before I will receive full benefits.  

Two consecutive school years of intense stress along with a Covid infection have worsened my autoimmune condition.  I feel like I've been on a steep decline.

I wish I could say what happened at the start of the year.  I will say that I finally got permission to do something in a certain way that resulted in some of the pressure being reduced.  It didn't save me from what was still a massive amount of work.  The workload has quite honestly been extreme this year.  During the fall, I frequently stayed at the school working until 6 to 7 PM each day and left with my work unfinished.  That took quite a toll on my body.  By December, I reached a point where I was able to leave before 6 PM most days, but the work load was still quite high.

In October, I tried Evoxac, which had a negative impact on my thyroid levels (see post).  My dry eye worsened again due to Evoxac.  I quit Evoxac at the end of October.  My eyes slowly began to improve.  My tiredness improved somewhat.

I then caught a bad virus, which I had from November 29 to about December 18. The virus was so bad that I tested myself for Covid three different times, and each time I tested negative.  I caught another virus which cleared by December 22. The left lobe of my thyroid became quite swollen. 

I decided to begin taking selenium to see if that would reduce the swelling in my thyroid.  I found a selenium supplement on Amazon that had 100mcg instead of 200mcg.  I wanted to be cautious and not risk overdoing it, even though 200mcg selenium is recommended for improvement in thyroid function.  I have taken 100mcg selenium daily since December 27.

I had a thyroid appointment scheduled for December 30.  I got my labs done.  

TSH = 4.99959 (range 0.35-4.94).  In June 2025, it was 2.1297. 
T3 Free = 2.18 (range 1.71-3.71).  In June 2025, it was 2.53.
T4 Free = 0.94 (range 0.7-1.48).  In June 2025, it was 0.97.

It was clear that the Evoxac followed by two viruses had unseated my thyroid levels.  My appointment for December 30 was cancelled by the clinic and rescheduled for April 15.  I was not pleased at the long delay, but I also knew that my dose would not be adjusted immediately after an illness.  I did not contact my provider with any details, since I knew that I had to wait it out.

I had hyperthyroid symptoms briefly around January 4 to 20.  This is typical after a viral infection.  The thyroid becomes swollen due to inflammation, causing it to release its store of thyroid hormone.  The secretion of extra hormone causes hyperthyroid symptoms.

During this time period, my swallowing problems worsened.  I'd had more trouble swallowing since the summer of 2024, and it greatly worsened during this time.  I will go into detail about the swallowing problem in a separate post.

By January 23, the swelling in my thyroid had decreased to what is typical for me.  I began to have hypothyroid symptoms.  Around February 3, I began to have more pronounced hypothyroid symptoms, which worsened into the middle of February.

I decided to get my labs done again on February 12.

TSH = 3.8043 (range 0.35 to 4.94)
T3 Free = 2.27 (range 1.71 to 3.71)
T4 Free = 0.95 (range 0.7 to 1.48)

The test results didn't match how I felt at that time.  I realized years ago that how I feel at any given time is tied to what my levels were approximately 14 days before.  This delay is caused by the pituitary-thyroid feedback loop.

My TSH and T3 Free had improved.  What struck me was that my T4 Free had only gone up slightly.  It was also not that great back in June 2025.  I had a suspicion that I might need a dose increase.  My provider told me that I needed to wait longer.  I wasn't thrilled about the idea, but I knew that April 15 wasn't that far in the future.

My condition began to improve.  I could tell that I stabilized at around March 20, but I didn't feel that great.  I tested again right before my April 15 appointment.

TSH 3.5777 (range 0.35 to 4.94),
T3 Free = 2.22 (range 1.71 to 3.71)
T4 Free = 0.96 (range 0.7 to 1.48)

Selenium supplementation is supposed to improve thyroid function, and there are multiple studies showing that it does.  I wondered what, if anything, the selenium had done.  

I pulled up my lab history and looked at the graphs.  I chose July 2023 to the present, for three reasons.  My thyroid medication was adjusted to 81.5mcg in July 2023, and I have been on that dosage ever since.  The graphs show the fluctuation of my thyroid levels while on a consistent dose.  My second Covid infection was in December 2024, and I have been in worse overall health since that time.  Finally, I felt really good when my labs were done in late December 2024, and I wanted to compare that data point to the entire time I've been on 81.5mcg of Tirosint. 

In late December 2024, I did not believe that my recent Covid infection had any impact on my thyroid levels.  I now realize that it must have.  I suspect that my thyroid was slightly more swollen at the time that my December 2024 labs were done.  My thyroid had probably released a small amount of extra hormone, which caused me to feel optimal.  As time passed, my levels have very slowly fallen off.  That's what I see in all three of these graphs. 

For TSH, lower is better so long as it's not near the bottom of the range.  I believe I'm optimal with a TSH of around 2.  My TSH was slightly less than 2 in late December 2024, which is the lowest value in the below graph.

Click or tap on the graphs in order to see them at a higher resolution.

Notice in this next graph that my highest T3 Free level of the last three years was in late December 2024.

The same is true in the T4 Free graph.  My best T4 Free level was in late December 2024.

This corroborates my belief that I was optimal in late December 2024.  I remember telling my provider that I felt like I was at my best at that time.  How I felt during that time caused me not to think that the Covid infection impacted my thyroid.

I am now convinced that my December 2024 Covid infection impacted both my thyroid and my eyes.  The worsening of my dry eyes may be in part due to thyroid hormone levels that have not been optimal.

At my April 15 appointment, I requested that my Tirosint be increased from 81.5mcg to 88mcg.  My request was granted.  I asked about my selenium supplementation of 100mcg daily.  It was suggested to continue with 100mcg daily for at least four to six weeks after beginning the higher dose of Tirosint.  After that time has passed, I can raise the selenium to 200mcg daily if I feel I need a further boost in thyroid levels.  That is my current plan.

I am hopeful that taking a higher dose of Tirosint will result in my dry eyes improving slightly in the next couple months.  Even if my eyes don't improve, I should feel better and have fewer symptoms.

Teaching Heightens the Risk for Autoimmunity

Those of us with high-stress jobs have a greater risk of developing autoimmunity.  A 2001 mortality study investigated whether an association exists between teaching and death caused by autoimmune diseases.

Excess autoimmune disease mortality among school teachers

The study concluded that evidence had been found of "excess mortality from autoimmune diseases among teachers" and that "teachers experience an occupational exposure that increases risk of autoimmune diseases."

I first began noticing what I now realize were autoimmune symptoms in the first few years that I taught.  The job immediately began wearing me down.  In some ways, it has gotten easier.  Once I quit looking like I was in my 20s, which unfortunately didn't happen until I was around 38, students began respecting me at a much higher level.  It's crazy how much more respect students have when their teachers look more like their parents.

In other ways, teaching has become infinitely harder.  If I still had the lack of respect that I once did and had to deal with the additional modern demands of the job, I wouldn't be able to do it at all.  As it is, I'm finding it terribly difficult to keep going.

I teach at the high school level, and my job has become so all-consuming that I don't have much left for anything else.  I have managed to continue selling books on eBay and Etsy, but I haven't been able to do anything else in addition to that.  I am not reading and am not keeping up with most other things.

I can't get into the specifics of my situation, but I can tell you about the overarching problems.

Young people have an extremely short attention span.  That is, we all have a shorter attention span than we once did, due to social media and smart phones.  Teenagers know no other world.  All of my students were born after the first iPhone was released.

Students have changed profoundly since the pandemic.  We are still trying to claw our way out of that.

Students are blatantly cheating on everything with AI.  We can't prevent it.  When I confront a student who clearly cheated on a test by using AI, they tell me that the work is how their tutor showed them.  They don't understand how obvious it is that the work is AI and that no tutor would ever work a math problem the way that AI does.  The students would be better off admitting it, but no, they think they can deceive me.  What they get is a teacher who makes sure they are never able to use AI on a test again.  

Test days used to be great days when I could get a lot of grading done.  Test days are now extremely stressful, and I get nothing done.  Anyone who has managed to use AI on a past test is watched carefully, and I must be constantly vigilant to make sure students don't trick me.  For instance, a student might write problems down on a slip of paper, sneak it into their pocket, and then ask to go to the restroom.  If I don't ask for their phone, then the student might access AI with their phone while in the restroom and then write down all the correct answers for the test.

We are supposed to do everything on Chromebooks, but students don't learn well without paper and pencil.  Besides that, they cheat with AI on all digital work.

I have continued to use paper and pencil all along, despite the intense pressure to quit consuming paper.  It appears that people are finally realizing that doing everything on a screen has set us back greatly.  Technology is great, but it should be supplementary to learning that is done primarily with paper and pencil.

Most young people now have poor reading comprehension.  Even many young people who love to read have poor reading comprehension.  I have seen it firsthand in online discussion groups where youth can only read books at a surface level.  They have no idea of any nuance that is obvious to those of us who learned how to read long before social media existed.

We have a very severe teacher shortage in Oklahoma that is continuing to worsen.  This has been caused by all of the above plus the way we are treated by Oklahoma politicians.  You'd have to live here to understand how bad it truly is.  

Our Oklahoma Superintendent of Public Education from early 2023 to late 2025 treated teachers as if they were political activists whose sole purpose was indoctrinating children.  He called teachers unions "terrorist organizations."  He suspended teaching certificates of teachers who made statements on their social media that he didn't like.  He tried to take away the accreditation of school districts if he didn't like something they were doing.  If he were still the superintendent, I would not have included this paragraph as it would have been too dangerous.

Our state legislature continues to push out laws that make it worse.  One of their recent ideas was to use $25 million from the Oklahoma public teachers' retirement account to fund tax credits for private schools.  It probably sounds like I'm making this up.  

And there's a bunch of other stuff that they've done or attempted to do.  We feel like we are constantly under attack.

The severe Oklahoma teacher shortage has caused people to be hired to teach subjects for which they aren't certified.  For instance, a social studies teacher would be hired to teach math.  Yes, I'm serious.

When students have a teacher who isn't qualified, then they might not learn as well.  When the students go to the next course, the next teacher must teach them everything they didn't learn the year before plus all the new content.  That's a tall order.  

We keep being told to change what we're doing to some other method.  We get yanked one way, and then we're yanked back the other way.

Back about 15 years ago, a veteran teacher remarked that she had noticed that education goes in a circle.  She said that we continue to try new things and end up right back where we started, doing the same things over and over again.  I didn't have quite enough experience at that time to see it, but now I do.  Educators are constantly being forced to change to some great new idea, which is just a rehashing of some previous great new idea that didn't work any better than anything else ever has.  After a cycle of around 15 to 20 years, we end up right back where we started.  And the cycle continues.

The 2024-2025 school year broke me.  I would have retired in May 2025 if I had qualified.  This year is the very first year that I do qualify to take early retirement with reduced benefits.  It does please me to know that my retirement window has now opened.  I will have to work for three more years to qualify for full retirement benefits.  I am counting down by months and weeks.  Currently, I am at three years and one month.  Soon, I will be able to say "fewer than three years."  

Bad Reaction to Evoxac—Worsened Dry Eye and Decreased Thyroid Levels

My overall dryness has been worse since I had Covid for the second time in December 2024.  Early last year, I was prescribed pilocarpine and had a terrible allergic reaction.  

When I had a rheumatology appointment in October, I requested to try something other than pilocarpine.  I was prescribed Evoxac.  I was excited, since I've heard that it's great.

Evoxac definitely helped the dryness in my mouth.  The problem was that it made my dry eyes worse and caused me to have blurry vision in the evening.  I have had problems with my eyes since early 2025.  I had seen some improvement in the early fall, and Evoxac pretty much wrecked my eyes again.

I have always struggled with my electrolyte levels.  Two different blood pressure medications failed last year because they either dangerously lowered my electrolytes or threw off my levels.  I simply cannot get my blood sodium level above the lower boundary of the normal range.  One blood pressure medication caused my blood sodium level to fall close to a level that would have required hospitalization.

I believe Evoxac impacted my electrolytes.  I've noticed that I get insomnia whenever my electrolytes are off, and I did get insomnia soon after starting Evoxac.

On top of all the other side effects, I am pretty sure that Evoxac impacted my thyroid levels.  I can't have that.

I searched thoroughly online for confirmation that I wasn't the only person who's ever had these reactions to Evoxac.  It seems to be a miracle drug for just about everyone.  I created this blog because my condition just doesn't follow the same pattern as everyone else.  It's baffling.

I scoured the internet for information to substantiate what I believed was happening to me, and I found just about nothing.  This has happened so many times...

I finally turned to AI to see if I could get any confirmation.  Here, I include excerpts from some of my chats with Chat GPT.  These chats occurred over around a two-week-long period, as I tried to figure out why I was having so much trouble with a drug that helps so many people.

I would like for you to search for any adverse thyroid impacts caused by Evoxac.  I would also like you to search online for any anecdotal reports of thyroid levels that could be tied to Evoxac.

I could not find credible clinical case reports, label warnings, or pharmacovigilance signals that link Evoxac (cevimeline) to causing thyroid dysfunction or to interfering with levothyroxine absorption.

Are there any reports of Evoxac making the eyes dry or making them burn?

Yes—there are reports and side-effect listings showing that Evoxac (generic Cevimeline) can cause dry or burning eyes, or other ocular symptoms, though the data suggest these are less common compared to the beneficial effect of increased tears.

ChatGPT also stated:

While the original intent of the drug is to increase secretions (including for eyes) in conditions like Sjögren's syndrome (which cause dry eyes and dry mouth), the side-effect listings show that in some people, the effect may be paradoxical (or perhaps related to other ocular irritation) resulting in "dry, burning, itching" eyes.

Naturally, I would be one of those people.

I'm wondering if—since Evoxac helps the body secrete more moisture—that going off it could impact electrolyte levels and then as a result cause symptoms like a temporary headache.

Evoxac (cevimeline) does alter fluid balance slightly by stimulating glands throughout the body.

ChatGPT also said:

There's no evidence in studies or adverse event databases that stopping Evoxac causes measurable electrolyte disturbances (like hyponatremia or hypokalemia).

Huh.  That's what it thinks.  It should be noted that I didn't think much of ChatGPT's responses.  AI is unreliable, and ChatGPT acts just like a gaslighting doctor who doesn't believe that a patient is having certain side effects.  It was a few days after this exchange that I decided to corner it.

Evoxac is a cholinergic agonist.  What about this?  See link.

https://www.sciencedirect.com/science/article/abs/pii/0196978185901573

The link I gave ChatGPT goes to "Cholinergic and VIPergic effects on thyroid hormone secretion in the mouse."  The study concludes "that basal thyroid hormone secretion is inhibited by both cholinergic activation and blockade."  Since Evoxac is cholinergic, I felt I had my smoking gun.

ChatGPT, behaving in an incredibly dense fashion, continued its spiel about electrolytes, completely ignoring that the link is to a page about thyroid function being impacted by cholinergic agonists.  I continued in my quest to pin down ChatGPT.

I am referring to this excerpt:

"It is concluded that basal thyroid hormone secretion is inhibited by both cholinergic activation and blockade.  Furthermore, TSH-induced thyroid hormone secretion is more sensitive to inhibition with cholinergic stimulation than is VIP-induced thyroid hormone secretion."

And it seems like Evoxac can impact thyroid levels in some fashion.   Isn't that what this means?

Come on, ChatGPT, you can do it...

• Both stimulating and blocking cholinergic receptors can reduce baseline thyroid hormone release (T3/T4).
• When thyroid cells are stimulated by TSH (the pituitary signal to make thyroid hormones), adding cholinergic activation further inhibits that secretion—meaning acetylcholine-like drugs (such as muscarinic agonists) could dampen thyroid output.
• The inhibition didn’t apply equally to all hormonal stimuli: thyroid stimulation via VIP (vasoactive intestinal peptide) was less affected than TSH.

So yes—mechanistically, cholinergic stimulation can suppress thyroid hormone release under some conditions.

ChatGPT added:

In theory, Evoxac could exert a mild inhibitory effect on thyroid hormone secretion, at least transiently or in sensitive individuals.

That’s not necessarily the same as causing hypothyroidism—but if you already have borderline thyroid function or are on levothyroxine, this kind of interference could slightly alter your TSH–T4 feedback balance.

Precisely.  I quit Evoxac five days ago because it messed up the fluid balance in my body.  My eyes became much more dry with Evoxac.  They are now getting better.  Additionally, my thyroid due to Hashimoto's is extremely sensitive to any medication changes of any kind.  Since there is evidence that Evoxac could impact thyroid levels, I believe that happened to me during the two weeks that I took Evoxac.  I have mild symptoms of thyroid imbalance.   It will take my body a couple weeks to return to baseline.

As I recall, it took around six weeks for my eyes to recover from the Evoxac.  As far as my thyroid levels, I then caught a horrible virus and have still not recovered my thyroid levels as of late April 2026.  But I digress.  That debacle will be addressed in another post.

Anyway, I figured that I had one-upped ChatGPT with my final prompts.  Evoxac was terrible for my body, and I never want to try it again.  It really did help with dry mouth, and I noticed how my mouth was more dry as the medication wore off.  The benefit was not worth the negative symptoms.  I will just continue dealing with my dryness, hoping that one of the new Sjögren's drugs is approved in the next year.  With my luck, I'll be allergic to it.  Still, I can hope.

How Often to Wash Hair and What Helps My Dry Hair

I used to have oily hair and oily skin.  I was excessively oily, and it was annoying.  I'd love to be that way again.  I'd rather have too much moisture than not enough.

My hair is now extremely dry, just like the rest of me.  Sjögren's disease attacks all of the moisture-producing glands in the body, and it has caused my hair and skin to go dry.

I take a megadose of fish oil each day.  It mitigates the dryness to some degree, but I'm still very dry.

Before I started taking thyroid medication in 2014, my hair was thin and brittle.  I saw improvement with thyroid medication, and gradually more improvement over the years as I added supplements.

I saw even more improvement in my hair beginning in late 2022 when I was switched to Tirosint, which is hypoallergenic.  Still, my hair had lots of breakage, even though it was much better than it once was.

Back when I had oily hair, I always washed it every day.  That habit was so ingrained that I have continued to wash my hair every day all these years, even once it became dry.  I just don't feel clean unless I wash my hair.

For a number of years, I've tried to figure out ways to get my hair to be less dry.  All the common online advice says not to wash hair every day.  When I've tried that, my hair becomes even more dry.

I created this blog because most of the common advice found online doesn't help me at all, and the hair situation is a perfect example.  I finally figured out that my hair is less dry when I wash it every day, just like I've always done.

Do you know why?  The moisture-producing glands in my scalp produce almost no moisture at all.  I think it's a combination of my aqueous deficiency and damage to the sebaceous glands.

The act of washing my hair puts moisture in it.  It's so obvious now.  Washing my hair gets it completely wet.  I let it air dry so that more moisture stays in it.  My hair is nice and soft in the evening after I've washed it.  

Around the time I figured this out, I saw an article that was in line with my thoughts.

Washing Your Hair Once a Week May Not Be a Good Idea—Even If It Looks Clean

While some experts say that washing your hair once a week is fine as long as you use a good shampoo and your hair responds well to that frequency, there's another side to the argument.  If your hair is extremely dry and not washed often enough, it can lose its natural moisture with age.

That has been my observation.  I need to wash my hair every day. 

When I skip washing my hair, my hair becomes more dry as the days pass.  As my hair dries, it becomes more brittle and more prone to breaking.

The thickness of my hair has improved over the years as I've added additional omega-3 supplements.  I've noticed an especially positive hair change tied to when I started taking sea buckthorn oil in early 2024.  

The top six inches or so of my hair is shinier than the rest of my hair.  It has a different consistency, and there's much less breakage.  I believe that sea buckthorn oil is the reason why my recent hair growth is of higher quality.

Sea buckthorn has also improved the health of my gums.  My gums used to be swollen, which caused my teeth to be so tight that I couldn't floss.  I can now floss easily.

The most popular brand of sea buckthorn oil is SeabuckWonders, but I prefer Sibu.  The Sibu sea buckthorn oil smells better and has a nicer color than other brands.

I started using Nexxus Repair and Nourish Ultra Lightweight Hair Oil back in February.  The directions say that it can be applied to wet or dry hair.  Whenever I apply it to dry hair, my hair ends up looking greasy and stringy.  It does not absorb properly when applied to dry hair. 

I apply it to my hair right after I wash it when my hair is still wet.  By applying it when my hair is wet, the oil distributes evenly through the hair so that my hair isn't oily.  

I find that I can also apply the oil when my hair is in the early stages of drying where it is still quite damp.  If I apply it when my hair is over halfway dry, then my hair becomes oily and stringy.  So long as my hair is quite damp or wet, the oil works great.

There was a bit of a learning curve when first using the Nexxus oil, since I didn't know how much to apply.  The directions say to apply 2-3 drops.  The container has a pump, so they might mean 2-3 pumps instead.  

My hair is long, down to halfway down my upper back.  I put around 5-6 pumps in my palm, rub my hands together, and then apply on the lower half of my hair, being sure to get the ends.  I then repeat the process on the top part of my hair.  

My hair will always be below average, but at least I've seen improvement over the years.

Back to Work Autoimmune Flare (Fall 2025 Edition)

April 21, 2026 note:  This post was written on September 9, 2025, and I backdated it to fit in the proper chronology.  I teach at the high school level.  This school year has been massively stressful, and I am just now beginning to write posts on what has transpired.  This post is the beginning of the story, so here it is.

....................................................

Each year when school starts, I have an autoimmune flare.  I used to call it a "thyroid flare," since the symptoms were what I would expect from thyroid disease.  Unbeknownst to me, I also had Sjögren's disease, and I now know that some of my symptoms were caused by it, not just my thyroid.

I was diagnosed with thyroid disease in 2014 and with Sjögren's disease earlier this year.  However, I know that I had symptoms of both beginning at least 30 years ago.

My back-to-school flare typically consists of deep fatigue, aches and pains, and brain fog.  It becomes quite noticeable in the two to three weeks after I go back to work each August, and it lessens around the middle of October.

In the last few years, my thyroid hasn't flared as much.  My symptoms are now primarily that of Sjögren's disease.

Indeed, I believe that my thyroid is now completely stable.  I have been on the same dose of Tirosint for over two years.  The last time my thyroid autoantibodies were checked, they were much lower.  The autoantibodies are still out of range, so I still have active Hashimoto's.  However, my thyroid seldom swells up so it appears to be stable.

It is now my Sjögren's disease that flares, and it flares constantly just like my thyroid used to do.

I went back to work on August 7.  I did pretty well at first, but two weeks later, like clockwork, I started having flares.  I had a bad one on August 23 that lasted for around a week.  I am in another bad flare that just started on Sunday.

My lips are burning, and my sense of taste is more distorted.  My eyes are more dry.  I wake up each morning massively dehydrated with dry eyes and burning lips.  It's miserable.

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April 21, 2026 additional note:  I will detail later events in another post.  Here, I will just say that I did end up having a thyroid flare beginning in October and that the flare worsened throughout the winter months, caused by several escalating events.  My thyroid medication dosage has now been increased for the first time in nearly three years.

Dry Eyes Part 7: Restasis

Insurance companies really don't like paying for prescription eye drops.  They insist that the over-the-counter garbage is sufficient.  Most of the over-the-counter eye drops irritate my eyes.  The few that don't irritate my eyes aren't effective at helping the situation.

On July 2, I was finally prescribed Restasis.  I had to endure torture from late February until the beginning of July simply because my insurance uses step-therapy.  Once I had two failed attempts (punctal plugs and serum tears) to help my dry eyes, I was approved for prescription eye drops.  That should have happened in February.

I was told that Restasis would burn my eyes for a short time each time I used it.  I was also told that it would take several months to see results.  That is why the prescription eye drops should have been approved in February.

The first thing I did when I got home was to check online reviews of Restasis.  They weren't good.  Many people complained about how much Restasis burned their eyes.  Restasis helped some people... eventually.  Other people said that it never helped.

Since I had had six bad reactions to medication and treatments since January (hydroxychloroquine, pilocarpine, chlorthalidone, lisinopril, punctal plugs, and losartan), I was afraid of the Restasis. 

I mean... I was genuinely scared.  My eyes had been so horrible that I didn't want to use something that would make them burn even more!

I have been using ChatGPT this year as I have sought answers to my eye problem.  I am wary of ChatGPT.  The silly thing complements me all the time because I have such great ideas!  Sometimes I tell it the real situation, and other times I query in a general sense to prevent it from pandering to me.

I had already told it about Sjӧgren's, Hashimoto's, Covid, and what treatments had already been tried. 

I first asked, "How does Restasis work?"  It told me a bunch of stuff, including that it doesn't start working immediately.

I wrote, "I'm just afraid to start taking it because of how irritated my eyes have been for the last five months."

Among other things, ChatGPT told me this:

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Restasis works best in people with inflammation-related dry eye—which includes:

• Autoimmune disease-related dry eye (like from Sjogren’s),

• Neuropathic inflammation post-viral (like post-COVID),

• And possibly ocular surface nerve hypersensitivity where inflammation is contributing.

It may actually help reduce the irritation long-term, but only after that initial difficult period.

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I verified through an online search that Restasis is prescribed for inflammation, so ChatGPT's response seems reasonable.

I then asked, "How long does the sensitive phase last?  How long do the drops sting the eye each time they are used?"

ChatGPT replied that the sensitive phase can last for 3 to 12 months and that the stinging is short-lived.  It also gave me some advice like to refrigerate Restasis and to use serum tears 15 minutes before Restasis.  

I picked up the Restasis on July 3.  My eyes were feeling overall pretty good that day, so I thought that I'd wait to try the eye drops.  I was quite fearful of trying Restasis. 

On July 4, I woke up and quickly determined that I wasn't going to have a very good day with my eyes.  I decided that I had nothing to lose.

The Restasis burned a little bit, but nothing like what people mention online.  Within an hour, I felt like my eyes were less irritated than they had been in... months.  I was perplexed, since Restasis is supposed to take months to work.  I considered that I might have been experiencing a placebo effect, but I quite frankly expected the Restasis to make my eyes worse.  I wasn't expecting sudden improvement, so I didn't think that I was manifesting a positive reaction.

Really, I was dumbfounded.

I searched online and found just a couple examples of people saying that Restasis helped immediately.  I decided to ask ChatGPT.  I didn't tell ChatGPT that I had already tried Restasis so that I wouldn't influence how it answered.  

I asked, "I understand that it takes at least two months for Restasis to help.  I saw a comment online where someone said that Restasis helped them immediately.  How often does that happen?"

This is what it told me:

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📊 How common is early relief from Restasis?

• In clinical studies and post-marketing reports, early relief (within days to 1 week) is uncommon, but not unheard of.

• Based on observational data and ophthalmology feedback:

  • Only about 5–10% of patients report early noticeable improvement in symptoms.

  • The majority notice changes between 1 and 3 months.

  • A subset (20–30%) see no benefit at all, especially if inflammation isn't the main driver.

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💡 Why do some people feel better so quickly?

A few possibilities:

1. Inflammation was the primary cause, and their ocular surface responded rapidly to even low-dose immunomodulation.

2. Placebo effect + supportive treatments (e.g., artificial tears, cold storage, serum tears) created a synergistic improvement.

3. The Restasis may have reduced nerve irritation quickly by calming immune cells that were triggering sensory nerve endings—especially in people with milder SFN-related inflammation.

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⚠️ But it's important to note:

• Most people with chronic or autoimmune-related dry eye need to wait at least 6–12 weeks to feel confident it’s working.

• Doctors usually recommend sticking with it for at least 90 days before deciding if it’s effective.

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I had already decided that my eye problem is inflammatory, at least the part since February.  There's also my aqueous deficiency from Sjӧgren's as well, but the rapid deterioration in my eyes was undoubtedly caused by the punctal plugs, other bad reactions, and likely Covid.  It seems logical that the Restasis could help me on a faster timeline because it would calm that inflammation.

By one week after starting Restasis, I felt that most of the damage caused by the punctal plugs had been reversed.  I still had periodic burning, which was a symptom that started with losartan, and my eyes were still quite dry.  After only one week of using Restasis, it was great that my eyes were mostly back to what they were before I got the punctal plugs.

I am now one month into Restasis.  My eyes are burning very little except for the burning I feel in the hour or so after I use Restasis each morning and evening.  I don't mind the burning as it feels like a therapeutic burning to me.  It's a mild burning that I rather like because it makes my eyes moist.  It makes me feel like the Restasis is doing good things to my eyes.

I look forward to using the Restasis each morning and evening.

My eyes are still quite dry and are still noticeably worse than before I had Covid in December.  The summer heat is really drying my eyes out.  I suspect that my electrolytes are still off from losartan.  It's going to take time, but I feel like the Restasis will gradually make my eyes better and better.

Also, I notice that I'm forgetting to use the hot compress on my eyes most days.  I'm not using eye drops quite as much, either.  My eyes are still dry, but they are slowly improving.

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Dry Eyes Part 6: Losartan, Flaxseed Oil, and Electrolytes

My eyes continued to be a problem, despite all of my futile efforts.  I also had a very annoying new symptom.  

In April, my eyes began burning, and I didn't know why.  Obviously, it was part of the problem, but why had they started burning after the punctal plugs were removed?

In May, the burning got worse.  I have been on thyroid medication since July 2014.  In May, my thyroid medication began making my eyes burn.  The burning would commence in the one to two hours after I took the thyroid medication and continued for at least a couple hours.  It was awful.

I knew that the problem wasn't the thyroid medication.  To clarify... the thyroid medication was undoubtedly causing the burning, but something else in my body had changed and was thereby causing the thyroid medication to do that.  I was pretty sure that the sodium in the thyroid medication was the problem.  It was like the sodium was hitting my eyes and making them burn.  My eyes had also started burning after I ate salty food.  That had never happened before.  

I had wondered about losartan because my eyes began burning within a couple weeks of starting losartan.  I finally realized that I needed to quit taking losartan to see if that was the problem.  I quit taking losartan on May 30.  I felt like my eyes improved some, but I wasn't sure if the losartan was the problem or not.

My appointment with my primary care physician was on June 5.  I told him that I had quit the losartan, that my eyes might or might not be better, and that I wanted to stay off of it for at least another couple weeks.  Additionally, my blood pressure wasn't spiking yet, and I would continue to monitor it.  He agreed.

My lab tests showed that my blood sodium had gone down some, and my blood potassium was on the high side.  Both were due to the losartan.

The eye burning caused by my thyroid medication gradually lessened.  Overall, my eyes began burning less.

By the middle of June, I thought I was improving, then I got worse again.  Why.....?

It was right at the end of June when I realized that I had run out of flaxseed oil around June 10.  I want to quit taking unnecessary supplements, so I chose not to continue.  I didn't think it was helping.

Since my eyes had worsened again, I concluded that it probably had helped.  I purchased more flaxseed oil and resumed taking it.  My eyes improved somewhat.  I concluded that I should continue flaxseed oil.

My eye appointment was on July 2.  I told my ophthalmologist that I was still worse than before I got punctal plugs, although I had improved somewhat since the plugs were removed.  

Back on February 26, my doctor said that my eyes had "some dryness."  This time, he said that they weren't that dry.  

I had been thinking for around a month that my eyes were inflamed from my December 16 Covid infection, and that the punctal plugs greatly aggravated the eye inflammation.  It didn't surprise me that my eyes weren't that dry overall.  But they sure have bothered me!

I was prescribed Restasis eye drops to use in addition to the serum tears.

Dry Eyes Part 5: Fish Oil Supplements

Once I quit using ointments with lanolin, my eyes seemed better, although I continued to struggle.

My Sjӧgren's has probably worsened, but I'm a bit perplexed.  My mouth dryness has been better, and I no longer get palpitations after I eat.

I continued to search online for remedies.  In my first post about my eyes, I wrote:

What I learned this weekend is that I need 2000mg to 4000mg combined of EPA and DHA.  The amount varies depending upon who is giving the advice, which is of course the problem with online advice.  It seems that people with dry eye need around 3000mg combined of EPA and DHA.  I've heard anywhere from 2000mg to 4000mg for Sjӧgren's.

In early June, I read more about omega-3 oils.  I read that people with rheumatoid arthritis (which I don't have) are recommended to take 4000mg to 5000mg combined of EPA and DHA.  I also saw some reports that people with Sjӧgren's could benefit from that same intake.

The quality of the fish oil matters, and the cheaper brands should be avoided.  Fish oil needs to be in triglyceride form, which is less likely to go rancid.  It should also be packaged in an opaque container so that it isn't exposed to light. An opaque container helps prevent the fish oil from going rancid.  Apparently, a lot of fish oil sold commercially is rancid.  

Even though I'd rather not have to pay for more expensive supplements, I also need for them to help me.  Taking rancid oil won't help.  I have read online that rancid fish oil can irritate the gut and promote inflammation.  My goal with fish oil is to reduce inflammation, not promote it.

I have taken Qunol fish oil for a number of years, and I feel like Qunol is a good brand.  However, I notice that the Qunol has an extremely strong lemon odor as compared to the two more expensive brands that I have tried.  This makes me suspicious about what they are covering with the lemon odor.  It's just too strong.  I am taking extra Qunol to use it up, and then I will take only the more expensive higher quality fish oil.

I switched to Sports Research Alaskan Omega-3 Fish Oil since it is slightly less expensive than Nordic Naturals.  Sports Research is said to be a high-quality brand.

I am also keeping my fish oil refrigerated to keep it from  going rancid.  If I'm going to take expensive fish oil, then I want to make sure that it is good quality.