Mental Health Status and Factors that Influence the Course of Graves’ Disease and Antithyroid Treatments

Abstract

Aims:

Biological, psychological and social factors may interact with the mental health status of Graves’ disease (GD) patients before and after antithyroid drug (ATD) treatment. Our aim was to quantify the impact of supportive and risk factors after recovery from GD which may enhance cure rates.

Patients and Methods:

300 patients were recruited for a 6-year prospective cohort study. Before and after treatment, we assessed the impact of biopsychosocial factors on the success of ATD treatment and mental health using the Symptom Checklist 90, the Eysenck Personality Questionnaire, the Life Event Scale, Simplified Coping Styles and the Perceived Social Support Scale. The patients routinely received ATD at least over 18 months. End-point was defined as cured (at least 2 years without a relapse after the withdrawal of ATD), otherwise as not cured.

Results:

Regression analysis explained 80.5% of the influences affecting mental health. The odds ratios (OR) revealed positive coping styles (OR: 2.90, 95% CI, 1.09–7.68), negative events (OR: 1.04, 95% CI, 1.01–1.07) and social support (OR: 5.10, 95% CI, 2.77–9.40) as protective factors, predicting a cure for GD patients. These variables explained 61.7% of the influences leading to a cure or no cure. Large thyroid volume was a risk factor, predicting failure (OR: 0.865, 95% CI, 0.83–0.90, P<0.000).

Conclusions:

Enhancing positive coping strategies and social support is important to improve mental health in GD patients, to avoid compromising work-related performance and endangering a patient’s social status.

Key words

thyroid autoimmunity - thyroiditis autoimmunity - thyrotropin hormones

• References

• 1 Chiovato L, Pinchera A. Stressful life events and Graves’ disease. Eur J Endocrinol 1996; 134: 680-682
• 2 Kun AWC. Life events, daily stresses and coping in patients with Graves’ disease. Clin Endocrinol 1995; 42: 303-308
• 3 Samuels MH, Schuff KG, Carlson NE et al. Health Status, Mood, and Cognition in Experimentally Induced Subclinical Thyrotoxicosis. J Clin Endocrinol Metab 2008; 93: 1730-1736
• 4 Gulseren S, Gulseren L, Hekimsoy Z et al. Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Arch Med Res 2006; 37: 133-139
• 5 Röckel M, Teuber J, Schmidt R et al. Correlation of “latent hyperthyroidism” with psychological and somatic changes. Klin Wochensch 1987; 65: 264-273
• 6 Bommer M, Eversmann T, Pickardt R et al. Psychopathological and neuropsychological symptoms in patients with subclinical and remitted hyperthyroidism. Klin Wochenschr 1990; 68: 552-558
• 7 Sait Gonen M, Kisakol G, Savas Cilli A et al. Assessment of anxiety in subclinical thyroid disorders. Endocr J 2004; 51: 311-315
• 8 Biondi B, Palmieri EA, Fazio S et al. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients. J Clin Endocrinol Metab 2000; 85: 4701-4705
• 9 Bianchi GP, Zaccheroni V, Solaroli E et al. Health-related quality of life in patients with thyroid disorders. Qual Life Res 2004; 13: 45-54
• 10 Abraham-Nordling M, Wallin G, Lundell G et al. Thyroid hormone state and quality of life at long-term follow-up after randomized treatment of Graves’ disease. Euro J Endocrinol 2007; 156: 173-179
• 11 Chen CH. Symptom Checklist 90 (SCL-90). In: Wang XD, Wang XL, Ma H. Rating Scales for Mental Health. Chinese Mental Health Journal. 1999. S31–S35 in Chinese
• 12 Gong YX. Eysenck Personality Quesationnaire-R Short Scale Chinese, EPQ-RSC. Changsha: Hunan Medical University; 1983
• 13 Xie YN. Simplified Coping Style. Chinese Mental Health Journal 1999; 122-124 in Chinese
• 14 Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav 1980; 21: 219-239
• 15 Yang DS, Zhang YL. Life Event Scale (LES). Chinese Mental Health Journal 1999; 101-106 in Chinese
• 16 Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res 1967; 11: 213-218
• 17 Jiang QJ. Perceived Social Support Scale (PSSS). Chinese Mental Health Journal 1999; 131-133 in Chinese
• 18 Chen DY, Jing J, Schneider PF et al. Comparison of the long-term efficacy of low dose ¹³¹I versus antithyroid drugs in the treatment of hypothyroidism. Nucl Med Commun 2009; 30: 160-168
• 19 Chen DY, Chen TH. Mental Health Status and Its Influencing Factors in Hyperthyroid Patients. Chinese Mental Health Journal 2006; 20: 820-823 in Chinese
• 20 Jin H, Wu WY, Zhang MY. Primary analysis of the assessment results for normal Chinese adults with SCL-90. Chinese Journal of Nervous and Mental Diseases 1986; 12: 260-263 in Chinese
• 21 Fahrenfort JJ, Wilterdink AM, van der Veen EA. Long-term residual complaints and psychosocial sequelae after remission of hyperthyroidism. Psychoneuroendocrinology 2000; 25: 201-211
• 22 Winsa B, Adami HO, Bergström R et al. Stressful life events and Graves’ disease. Lancet 1991; 338: 1475-1479
• 23 Yoshiuchi K, Kumano H, Nomura S et al. Psychosocial factors influencing the short-term outcome of antithyroid drug therapy in Graves’ disease. Psychosomatic Medicine 1998; 60: 592-596
• 24 Simon NM, Blacker D, Korbly NB et al. Hypothyroidism and hyperthyroidism in anxiety disorders revisited: new data and literature review. J Affect Disord 2002; 69: 209-217
• 25 Trzepacz PT, Klein I, Roberts M et al. Graves’ disease: an analysis of thyroid hormone levels and hyperthyroid signs and symptoms. Am J Med 1989; 87: 558-561
• 26 Paschke R, Harsch I, Schlote B et al. Initial psychological testing during the course of autoimmune hyperthyroidism. Klin Wochenschr 1990; 68: 942-950
• 27 Schlote B, Schaaf L, Schmidt R. Mental and physical state in subclinical hyperthyroidism: investigations in a normal working population. Biol Psychiatry 1992; 32: 48-56
• 28 Fukao A, Takamatsu J, Murakami Y et al. The relationship of psychological factors to the prognosis of hyperthyroidism in antithyroid drug-treated patients with Graves’ disease. Clin Endocrinol 2003; 58: 550-555
• 29 Stern RA, Robinson B, Thorner AR. A survey study of neuropsychiatric complaints in patients with Graves’ disease. J Neuropsychiatry Clin Neurosci 1996; 8: 181-185