PSYCHOSOMATIC ASPECTS OF HYPERTHYROIDISM WITH A SPECIAL FOCUS ON GRAVES-DISEASE - A REVIEW

The following paper deals with the current research in hyperthyroidism , with special accent to Graves' disease. Besides severe psychological trauma a breakdown of neurotic defense mechanism on the ground of a s pecial personality structure was thought to be the trigger of the dise ase. The metabolic changes became the main point of interest. The infl uence of thyrostatic, surgical and radioactive therapies on psychologi cal symptoms, was investigated. Thereby, the previously anticipated em otional factors became less significant in the aetiology of the diseas e. A recent study (Paschke 1990) suggests that patient with hyperthyro idism have, even in an euthyrotic state, an increased vulnerability to anxiety provocing situations. At this point it is not clear, due to t he retrospective nature of the study, whether the vulnerability exists prior to the unset of the disease or is a result of the metabolic dis order. Both thyroxin and TRH are being successfully used in the treatm ent of major depression. TRH acts as a neurotransmitter in the autonom ic nervous system and can be demonstrated in the peripheral lymphocyte s. However, the exact mechanisms of action of thyroxin and TRH are sti ll unknown. Graves' disease is an autoimmune disease, that can be caus ed by specific HLA antigens. Thereby, a changed subpopulation of lymph ocytes can be demonstrated, as well as there disturbed functions. A co rrelation between high scores for anxiety and depression on one hand a nd the occurrence of an abnormal T4/T8 ratio on the other hand, have b een reported in a small number of cases (Paschke 1990). The psychologi cal symptoms in hyperthyroidism ism are similar to the symptomatology of neurotic anxiety and the anxious depressiv syndrom. However the att itudes of the patients to their disease differs. Therefore, it becomes a methodical question whether the neurometric scales used for psychia tric disorders can be employed as a researchtool in a disease like hyp erthyroidism. At the end of the article, based on the above discussion , an outlook on future psychosomatic research in the area of hyperthyr oidism, especially Graves' disease, is given.