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

Abstract：

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 (freeT(4)-index and freeT(3)-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 freeT(3)-index and freeT(4)-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). FreeT(3)-index and freeT(4)-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 freeT(3)-index and freeT(4)-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.

journal_name

Eur J Endocrinol

journal_title

European journal of endocrinology

authors

Vos XG,Smit N,Endert E,Brosschot JF,Tijssen JG,Wiersinga WM

doi

10.1530/EJE-08-0573

subject

Has Abstract

pub_date

2009-02-01 00:00:00

pages

193-9

issue

eissn

0804-4643

issn

1479-683X

pii

EJE-08-0573

journal_volume

160

pub_type

杂志文章,多中心研究

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