DEAR DR. ROACH: I have noticed that my 22-year-old granddaughter's eyes are bulging more than in the past. She has not had a recent thyroid test. Can you help me understand the cause of this? She is addicted to table salt, using an extreme amount with every meal. What problems will this overuse of salt cause her? Are the two conditions linked in any way? -- L.M.
ANSWER: Exophthalmos, the bulging appearance of the eye, is a classic sign of Grave's disease, an autoimmune stimulation of the thyroid gland, where antibodies binds to receptors in the thyroid, stimulating it to produce more hormone. The bulging is not a result of thyroid excess, but rather a cross-reaction of the antibody to fat cells behind the eye, causing the eye to bulge out. Treatment for excess thyroid hormone doesn't reverse this, because the antibodies are still present. Your granddaughter needs to be tested for Grave's disease.
I have seen people whose eyes just appear to bulge. They have sometimes had dozens of thyroid tests, as every doctor they see checks their levels. Other conditions that can simulate exophthalmos include obesity, Cushing's syndrome, inflammation of the eye muscles and other inflammatory diseases.
Excess salt may increase blood pressure, and may even increase stroke risk in people with normal blood pressure, but I can't think how it could be related to the appearance of her eyes.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com.
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