Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 13;8(1):bvad157.
doi: 10.1210/jendso/bvad157. eCollection 2023 Dec 1.

Stress-Induced Graves Disease: Spontaneous Recovery After Stress Relief

Jeresa I A Willems  1 , Daan J L van Twist  1 , Robin P Peeters  2 , Guy J M Mostard  1 , Roderick F A Tummers-de Lind van Wijngaarden  1
Affiliations

Stress-Induced Graves Disease: Spontaneous Recovery After Stress Relief

Jeresa I A Willems et al. J Endocr Soc. .

Abstract

Purpose: Emotional stress is a precipitating factor for Graves disease (GD). However, the influence of stress relief on the course of GD is unknown. Here, we present a series of patients diagnosed with stress-induced GD in whom stress relief alone led to remission of GD.

Cases: We report on 11 patients in whom hyperthyroid symptoms started just after severe emotional stress. All patients had suppressed thyroid-stimulating hormone (TSH) levels and elevated free thyroxine (FT4; 22.2-49.5 pmol/L) and TSH-receptor antibody (TRAb; 0.57-40 U/L) levels and were subsequently diagnosed with stress-induced GD. However, all patients declined antithyroid drug treatment. Surprisingly, clinical and biochemical remission was observed in 9 out of 11 patients after 1 to 3 and 2 to 7 months of self-reported stress relief, respectively. Five patients showed long-lasting remission (median follow-up 2.3 years). In 4 patients, remission was initially achieved, but GD relapsed 1 to 4 years afterwards. In 2 patients, treatment with antithyroid drugs was initiated because of rapidly increasing FT4 levels. Baseline FT4 and TRAb levels tended to be higher in patients who did not achieve remission. Furthermore, patients without long-lasting remission were more frequently known to have prior thyroid disease.

Conclusion: We report on a series of patients with stress-induced GD in whom stress relief alone led to remission of GD (thus without antithyroid drugs). This may indicate that clinicians could consider stopping antithyroid drug treatment or at least shortening the treatment period after stress relief in patients with stress-induced GD.

Keywords: Graves’ disease; remission; stress; stress relief.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Course of serum TSH (A), FT4 (B), and TRAb (C) levels in the patients with long-lasting remission of GD after stress-relief. *Indicates the moment of self-reported stress-reduction on the outpatient clinic. Each case is represented by a unique colored line. Only cases with multiple TRAb measurements are included in Fig. 2C. Single (1-2) TRAb values are included in Table 1. Abbreviations: FT4, free thyroxine; TRAb, TSH-receptor antibodies; TSH, thyroid stimulating hormone. Figures were designed using the Figlinq platform (https://figlinq.com/).
Figure 2.
Figure 2.
Course of serum TSH (A) and FT4 (B) levels in the patients with transient remission of GD after stress-relief. *Indicates the moment of self-reported stress-reduction on the outpatient clinic. !Indicates the moment antithyroid drug treatment was started. Each case is represented by a unique colored line. Abbreviations: FT4, free thyroxine; TSH, thyroid stimulating hormone. Figures were designed using the Figlinq platform (https://figlinq.com/).
Figure 3.
Figure 3.
Course of serum TSH (A) and FT4 (B) levels in the patients without remission of stress-induced GD after stress-relief. *Indicates the moment of self-reported stress-reduction on the outpatient clinic. !Indicates the moment antithyroid drug treatment was started. Each case is represented by a unique colored line. Abbreviations: FT4, free thyroxine; TSH, thyroid stimulating hormone. Figures were designed using the Figlinq platform (https://figlinq.com/).
See this image and copyright information in PMC

References

    1. Fukao A, Takamatsu J, Arishima T, et al. Graves’ disease and mental disorders. J Clin Transl Endocrinol. 2020;19:100207. - PMC - PubMed
    1. Benvenga S. Benzodiazepine and remission of Graves’ disease. Thyroid. 1996;6(6):659‐660. - PubMed
    1. Vita R, Lapa D, Vita G, Trimarchi F, Benvenga S. A patient with stress-related onset and exacerbations of Graves disease. Nat Rev Endocrinol. 2009;5(1):55‐61. - PubMed
    1. Falgarone G, Heshmati HM, Cohen R, Reach G. MECHANISMS IN ENDOCRINOLOGY: role of emotional stress in the pathophysiology of graves’ disease. Eur J Endocrinol. 2013;168(1):R13‐R18. - PubMed
    1. Codaccioni JL, Orgiazzi J, Blanc P, Pugeat M, Roulier R, Carayon P. Lasting remissions in patients treated for graves’ hyperthyroidism with propranolol alone: a pattern of spontaneous evolution of the disease. J Clin Endocrinol Metab. 1988;67(4):656‐662. - PubMed

LinkOut - more resources