Category: Thyroid

Monitor: 10

10 - Acute Stress Induced Graves' Disease in the Setting of Hypothyroidism

Thursday, Apr 25
12:00 PM – 12:30 PM

Objective :

Stress has been implicated as a major risk factor for many diseases including autoimmune thyroid disease. The pathophysiologic effect of stress is attributed to the overproduction of epinephrine, norepinephrine and cortisol. Elevated levels of cortisol can directly stimulate the thyroid to overproduce thyroid hormone. Chronic stress has been directly linked with the commencement of Hashimoto’s thyroiditis and thus thyroid autoimmunity while an extreme amount of emotional stress can precipitate a potentially life-threatening thyroid storm in the setting of Graves’ disease. We report three unique cases of females, with hypothyroidism, who upon exposure to severe acute stress developed hyperthyroidism.


 


Methods : n/a


Results : n/a


Discussion :

We present the cases of three females with a history of Hashimoto’s thyroiditis evidenced by clinical and biochemical hypothyroidism. When subjected to severe, acute psychological stress, the patients transitioned from established hypothyroidism to overt hyperthyroidism.  Hyperthyroidism was confirmed by increased I-131 uptake and elevated thyroid stimulating immunoglobulin (TSI) indicating a shift to Graves’ disease. All of these women were treated with radioactive iodine I-131 for definitive therapy of Graves’ disease. Currently these women are asymptomatic and require lifelong therapy with levothyroxine.


Conclusion :

Stress is known to be a major risk factor for many diseases. It is suggested that stressful life events can cause aggravation of autoimmune thyroid disorders although review of current literature describes no such cases. Our three cases represent a unique presentation of Graves’ disease, against a background of autoimmune hypothyroidism, following a severe acute stressful life event. All of these cases required definitive therapy for hyperthyroidism with subsequent evolution of hypothyroidism requiring lifelong therapy with levothyroxine.

Jana Havranova

Resident
St.Luke's University Hospital
Bethlehem, Pennsylvania

Resident

Hussam Tayel

Resident
St.Luke's University Hospital
Bethlehem, Pennsylvania

Resident

Thomas Gallagher

Endocrinologist
St. Luke's University Hospital
Bethlehem, Pennsylvania

Endocrinologist at St. Luke's University Health Network in Bethlehem, PA.

Mohammad Ishaq Arastu

Physician
St.Luke's University Hospital
Bethlehem, Pennsylvania

Physician