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.

中文翻译：

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格雷夫斯病的精神并发症

背景

尽管接受了治疗，情绪障碍在格雷夫斯病中仍很常见。所涉及的致病机制尚不清楚，先前的精神疾病是否影响这些症状也是未知的。

方法

这是一项在瑞典对 65 名新诊断格雷夫斯病女性和 65 名匹配对照者进行的纵向研究。参与者在甲状腺功能亢进期间和治疗 15 个月后接受了检查。检查包括抽血、使用情感综合症综合精神病理学评定量表和 DSM-IV – 轴 I 障碍的结构化临床访谈进行精神测试。我们还对基于全国人口的登记进行了两项分析，以确定 (i) 我们要求参与的所有患者和 (ii) 2013 年至 2018 年期间被诊断为甲状腺功能亢进症的所有瑞典女性的既往精神病诊断和精神活性药物处方，将它们与匹配的对照进行比较。

结果

与对照组相比，格雷夫斯患者既往精神科合并症并未增加。与那些拒绝参与的患者相比，（i）纳入的 GD 患者和（ii）与匹配的对照组相比，在诊断前 5 年内被诊断为甲状腺功能亢进症的女性之间，精神科诊断和精神活性药物处方的患病率并没有更高。与甲状腺功能亢进期间的对照组相比，患者的抑郁评分和焦虑评分均较高（抑郁（中位数 (IQR)：7.5 (5.0–9.5) vs 1.0 (0.5–2.5) P < 0.001），焦虑：7.7 (5.0–11) vs 2.5 (1.0–4.0) P < 0.001) 和治疗后（抑郁：2.5 (1.5–5.0) vs 1.5 (0.5-3.5) P < 0.05），焦虑：4.0 (2.5–7.5) vs 3.0 (1.5-5.0) P < 0.05）。与没有这些症状且年龄较大的患者相比，患有既往精神疾病、轻度眼部症状和年龄较小的患者在 15 个月时的焦虑程度更高（全部p <0.05）。

结论

尽管接受治疗，格雷夫斯病仍会影响患者的情绪。既往精神疾病、轻微眼部症状和年龄较小会增加出现长期症状的可能性，需要特别注意。