Endocrine Abstracts

Stress appears to activate the immunoneuroendocrine network and seems to be related to the development of autoimmune diseases. Graves’ disease is a multisystem disorder characterized by hyperthyroidism, eye disease and pretibial myxedema. Stress appears also to be related to the development of Graves’ disease.

The aim was to describe cases of Graves’ disease which developed immediately after a stressful life event.

Patients, ten female, aged 35–56 years old, presented with severe hyperthyroidism after a stressful life event. Within this cohort, three female patients had lost their father, immediately before the development of hyperthyroidism, two female patients had lost their mother immediately before the development of hyperthyroidism, three female patients had lost their husband immediately before the development of hyperthyroidism, one female patient had lost a child and one female patient had lost her husband 1 year earlier and one of her three children immediately before the development of hyperthyroidism.

Hyperthyroidism developed in these female patients in eight of them within a month after the loss of the beloved person and in two within 2 weeks after the loss of the beloved person. Hyperthyroidism was severe and was accompanied by involvement of the eyes only in two of the described cases. TSH receptor antibodies were detected in seven of the described cases. In all cases hyperthyroidism responded to the administration of antithyroid drugs.

In conclusion, stressful life events, in particular the loss of a beloved person, may be an initiating factor for the development of Graves’ disease. In these cases hyperthyroidism seems to be severe and to develop shortly after the loss of the beloved person. Thus, it appears that a strong emotional insult may be accompanied by activation of the immunoneuroendocrine axis and the development of a multisystem autoimmune disease, such as Graves’ disease.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.