A patient with stress-related onset and exacerbations of Graves disease
| Autor: | Salvatore Benvenga, Roberto Vita, Francesco Trimarchi, Giuseppe Vita, Daniela Lapa |
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| Rok vydání: | 2008 |
| Předmět: |
endocrine system
Pediatrics medicine.medical_specialty Goiter Adolescent endocrine system diseases Endocrinology Diabetes and Metabolism medicine.medical_treatment Graves' disease stress Endocrinology Thyroid peroxidase medicine Humans hyperthyroidism Heat intolerance environment Graves disease negative life events biology business.industry Thyroid medicine.disease Anti-thyroid autoantibodies medicine.anatomical_structure biology.protein Female Thyroglobulin medicine.symptom Thyroid function business Stress Psychological |
| Zdroj: | Nature Clinical Practice Endocrinology & Metabolism. 5:55-61 |
| ISSN: | 1745-8374 1745-8366 |
| Popis: | Emotional stress might affect thyroid function by causing immunological perturbations and also via neural pathways. This article demonstrates a case in which both the onset of Graves disease and later exacerbations of hyperthyroidism were triggered by stressful events, and discusses management strategies for patients with stress-related Graves disease. Background An 18-year-old, nonsmoking woman presented to her general practitioner with a 1-week history of weakness, fatigue, palpitations, nervousness, tremors, insomnia, heat intolerance, and sudden enlargement of a thyroid goiter that had been detected 2 years earlier. The patient's symptoms had started shortly after she experienced emotional stress. Diagnostic work-up disclosed an avid radioactive iodine uptake by the goiter. On ultrasound examination, the thyroid gland was enlarged with a diffusely hypoechogenic structure and intense vascularization. Investigations Thyroid scintigraphy with 131I; ultrasonography of the thyroid gland; and measurements of serum free T3, free T4, TSH levels and thyroid autoantibodies, including autoantibodies against thyroglobulin (TgAb), thyroperoxidase (TPOAb) and TSH receptor (TRAb). Diagnosis Graves disease, with stress-related onset and subsequent stress-related exacerbations. Management The patient was treated with methimazole to normalize levels of thyroid hormone and thyroid autoantibodies, and with bromazepam to help her cope with stress. The daily dose of methimazole was kept low during pregnancy. Over the 4 year period when the patient was taking methimazole, exacerbations of hyperthyroidism occurred twice: during her first pregnancy and 9 months after her first delivery. On all three occasions, symptoms were preceded by stressful life events. Further exacerbations were avoided by starting bromazepam treatment soon after the patient experienced stressful events. |
| Databáze: | OpenAIRE |
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