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Age and stress as determinants of the severity of hyperthyroidism caused by Graves' disease in newly diagnosed patients

Department of Endocrinology and Metabolism, F5-161, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands¹ Laboratory of Endocrinology, Department of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands² Division of Clinical and Health Psychology, Department of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands³ Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

(Correspondence should be addressed to X G Vos; Email: x.g.vos{at}amc.nl)

Objective: The evidence that stress may provoke Graves' hyperthyroidism in genetically susceptible subjects is substantial. Whether exposure to stress is related to the severity of thyrotoxicosis has not been studied. Advancing age is associated with not only less severe Graves' hyperthyroidism but also self-reported stress. We tested the hypothesis whether advancing age is associated with less exposure to stress, resulting in a lower immunological response, and less severe Graves' hyperthyroidism.

Design: Cross-sectional multicenter study.

Patients: Two hundred and sixty-three consecutive untreated patients with a first episode of Graves' hyperthyroidism were included. The severity of Graves' hyperthyroidism was evaluated biochemically (freeT₄-index and freeT₃-index, thyrotropin-binding inhibitory immunoglobulin (TBII)) and clinically by the hyperthyroid symptom scale score (HSS score). Stress exposure was quantitated by three questionnaires.

Results: Advancing age was associated with less severe Graves' hyperthyroidism, both biochemically by lower serum freeT₃-index and freeT₄-index (P<0.01), lower serum TBII (P=0.05), and clinically by lower HSS scores (P=0.04) and smaller goiter size (P<0.01). FreeT₃-index and freeT₄-index were directly associated with HSS scores (P<0.01). Stress scores were associated with HSS scores (P<0.01) but not with biochemical severity of Graves' hyperthyroidism. Advancing age was associated with lower scores for stress exposure. Multivariate regression analysis showed that HSS score was independently related to the tendency to report negative feelings (P<0.01) but not to other stress scores and also not to age.

Conclusion: Advancing age is associated with less exposure to stress, lower serum TBII and less severe clinical and biochemical Graves' hyperthyroidism. Because no direct relationship exists between stress exposure and TBII or freeT₃-index and freeT₄-index, we reject our hypothesis that less stress is causally related to biochemically less severe Graves' hyperthyroidism in old age. HSS score is primarily determined by negative feelings and not by age.

This article has been cited by other articles:

				X. G Vos, N. Smit, E. Endert, J. G P Tijssen, and W. M Wiersinga Variation in phenotypic appearance of Graves' disease: effect of genetic anticipation and duration of complaints Eur. J. Endocrinol., July 1, 2009; 161(1): 113 - 118. [Abstract] [Full Text] [PDF]