DHEA and Sjogren’s Disease

Q. Dear Dr. Dean,

I’m 71 years old and am very healthy, except that I’ve had Grave’s disease (an autoimmune disease) since 1992, for which I underwent radiation treatment. Consequently, my thyroid is practically dead, and I’m on Armour Thyroid hormone replacement. I haven't taken any other replacement hormones in 3–4 years. I also have thyroid-related ophthalmopathy, which is currently in remission. Curiously, my eyes and nose get very irritated with dust or dry air, or for no apparent reason at all. I wonder if DHEA supplementation would be helpful to me, and if so, what dosage? I think I’ve read that DHEA and pregnenolone are contraindicated for one with my condition. I am using Eye D’Clare and it is pretty helpful for my eyes, but not completely—and my nose is still very dry and crusty at times. This makes my eyes uncomfortable, too. Maybe you could suggest a treatment for me.

Susan, Ingram, TX

A. Dear Susan,

You say that you’ve read that “DHEA and pregnenolone are contraindicated for one with my condition.” I’m not sure what condition you were thinking of?

With regard to your thyroid, DHEA appears to have a beneficial effect on thyroid function. Researchers in France stated, “It is well documented that DHEA behaves in many respects similar to the thyroid hormones, its thymomimetc properties including an aging related decrease and antiobesity effects. Administration of DHEA during aging has been suggested as a possible efficient rejuvenating treatment.”1 To test their hypothesis, they conducted studies with DHEA on aging and young rats, and concluded that DHEA markedly inhibits the senescent upregulation of rat thyroxin binding globulin (TBG) [which normally increases with age], a phenomenon in keeping with the hypothesis of rejuvenating action of the hormone.”

In other words, DHEA is probably good for an aging thyroid.

Based on what you have described, it sounds to me as if you have Sjogren’s Syndrome (or a variant thereof). Sjogren’s Syndrome is an autoimmune disease that occurs in women over 40, involving dryness in the mouth (xerostomia) and other mucous membranes (especially the nose and salivary glands), the conjunctiva of the eye (keratoconjunctivitis sicca), and possibly other autoimmune diseases such as rheumatoid arthritis.

It is suspicious that this came on after the onset of Grave’s disease, in that both Grave’s and Sjogren’s are autoimmune-related. Considering that Sjogren’s Syndrome is also commonly presents in postmenopausal women is consistent with its possibly being hormonally related. That’s another reason that it makes good sense to employ hormone replacement therapy—especially DHEA, as it is the most abundant steroid hormone in the body, and which drops predictably with age. Since women very efficiently convert DHEA to testosterone, I rarely prescribe more than 25 mg to women (taken in the morning). If signs of excess testosterone develop (acne, voice deepening, etc.), I recommend reducing the dose to whatever dose does not cause symptoms (usually, 15, 10, or even 5 mg). Paradoxically, women with autoimmune disorders such as Lupus can tolerate relatively large doses without problems, in the range of 100–200 mg per day.

I wonder if topical progesterone cream (available over the counter) might not also be of benefit? I recommend 20–40 mg per day, topically applied.

Your use of the hydrating agents in Eye D’ Clare II is a great idea, and sure to provide continuing relief to your dry eyes. Use it as often as necessary—and especially before going to sleep.

Unfortunately, there is no cure for Sjogren’s. If you are troubled by dry mouth, perhaps mints of Erythritol (as contained in many of Durk and Sandy’s low-glycemic products) would help. Also, Xylitol (another low-glycemic five-carbon sugar) in mints, or in a nasal spray (available over the counter) will help to maintain hydration of your oral and nasal mucous membranes,

Ward Dean, M.D.

Reference
  1. Vranckx R, Mechighel P, and Savu L. Effect of DHEA on rat thyroxine binding globulin, a protein upregulated during aging, in: Dehydroepiandrosterone (DHEA) and Aging, Annals of the New York Academy of Sciences, Vol 774, 1995, Bellino F, Daynes R, Hornsby P, Lavrin D, and Nestler J. (eds), pp. 335–336.

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