Psychiatric complications in Graves’ disease

Author:

Holmberg Mats123ORCID,Malmgren Helge4,Berglund Peter F5,Johansson Birgitta4,Nyström Helena Filipsson3467

Affiliation:

1. ANOVA, Karolinska University Hospital, Norra Stationsgatan 69, Stockholm, Sweden

2. Institute of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden

3. Wallenberg’s Centre of Molecular and Translational Medicine, Region Västra Götaland, Sweden

4. Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

5. Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

6. Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden

7. Gothenburg Centre for Person Centred-Care (GPCC), Göteborg, Sweden

Abstract

Background Mood disorders are common in Graves’ disease despite treatment. The pathogenic mechanisms involved are unknown and so is whether previous psychiatric disease influences these symptoms. Methods This is a longitudinal study conducted in Sweden on 65 women with newly diagnosed Graves’ disease and 65 matched controls. Participants were examined during hyperthyroidism and after 15 months of treatment. Examinations included blood sampling, and psychiatric testing with the Comprehensive Psychopathological Rating Scale for Affective Syndromes and the Structured Clinical Interview for DSM-IV – Axis I Disorders. We also performed two analyses of a national population-based registry to determine previous psychiatric diagnoses and previous prescriptions of psychoactive drugs in (i) all patients we asked to participate and (ii) all Swedish women given a diagnosis of hyperthyroidism during 2013–2018, comparing them to matched controls. Results There was no increased previous psychiatric comorbidity in Graves’ patients compared to controls. There was no higher prevalence of psychiatric diagnoses and prescriptions of psychoactive drugs between (i) included GD patients compared to those who declined participation and (ii) women with a hyperthyroidism diagnosis in 5 years prior to their diagnosis, compared to matched controls. Depression scores and anxiety scores were higher in patients compared to controls both during hyperthyroidism (depression (median (IQR): 7.5 (5.0–9.5) vs 1.0 (0.5–2.5) P < 0.001), anxiety: 7.7 (5.0–11) vs 2.5 (1.0–4.0) P < 0.001) and after treatment (depression: 2.5 (1.5–5.0) vs 1.5 (0.5-3.5) P < 0.05), anxiety: 4.0 (2.5–7.5) vs 3.0 (1.5-5.0) P < 0.05). Patients with a previous psychiatric condition, mild eye symptoms, and a younger age had more anxiety at 15 months compared to patients without these symptoms and a higher age (all p<0.05). Conclusion Graves’ disease affects patients’ mood despite treatment. A previous psychiatric condition, mild eye symptoms, and a younger age increase the vulnerability for long-lasting symptoms and require specific attention.

Publisher

Bioscientifica

Reference38 articles.

1. Quality of life in patients with benign thyroid disorders. A review;Watt,2006

2. Impaired health-related quality of life in Graves’ disease. A prospective study;Elberling,2004

3. Clinical outcome of radioiodine treatment of hyperthyroidism: a follow-up study;Berg,1996

4. Anxiety and depression are more prevalent in patients with Graves’ disease than in patients with nodular goitre;Bové,2014

5. Hyperthyroid dementia: clinicoradiological findings and response to treatment;Fukui,2001

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