Fukao Atsushi, Takamatsu Junta, Murakami Yasuhiro, Sakane Sadaki, Miyauchi Akira, Kuma Kanji, Hayashi Shunichiro, Hanafusa Toshiaki
First Department of Internal Medicine, Osaka Medical College, Takatsuki-city, Japan.
Clin Endocrinol (Oxf). 2003 May;58(5):550-5. doi: 10.1046/j.1365-2265.2003.01625.x.
The relationship between emotional stress and the onset of hyperthyroidism has been well investigated, but the relationship between psychological factors and prognosis of antithyroid drug-treated hyperthyroidism is not well known. This study has examined not only emotional stresses but also patients' personality traits using specific tests.
A prospective cohort study.
Sixty-nine patients with hyperthyroid Graves' disease in the euthyroid state after 2-5 years of antithyroid drug therapy and 32 healthy subjects as the control group.
Patients responded to three types of questionnaires, including the Minnesota Multiphasic Personality Inventory for personality traits, the Natsume's Stress Inventory for major life events, and the Hayashi's Daily Life Stress Inventory for daily life stresses.
In the Graves' disease patients, stress scores of life events correlated significantly with serum TSH receptor antibody activity (r = 0.424, P < 0.001) and thyroid volume (r = 0.480, P < 0.001). When the patients were divided according to prognosis (41 with relapse and 28 with remission), four personality traits including hypochondriasis, depression, paranoia and psychasthenia (mental fatigue) were significantly (P = 0.0146, 0.0052, 0.0125, and 0.0186, respectively) more common in the relapsed Graves' disease group than those of the remitted group. Six personality traits of conversion hysteria, psychopathic deviation, masculinity and feminity, schizophrenia, hypomania, and social introversion were not significantly different between the two groups. The scores of daily hassles (problems of daily life) were also significantly (P = 0.0124) greater in the relapsed Graves' disease group than in the remitted group. The scale scores of depression and psychasthenia showed a positive correlation with scores of daily hassles (r = 0.535, P < 0.0001; r = 0.580, P < 0.0001, respectively), while an inverse correlation with scores of daily uplifts (r = -0.373, P = 0.0332; r = -0.322, P = -0.0120, respectively).
The results suggest that major life events, personality traits of hypochondriasis and depression, paranoia, mental fatigue, and daily problems aggravate the prognosis of antithyroid drug-treated hyperthyroidism. Escape from life events is virtually impossible; thus coping strategies suggested by the physician may be useful in improving prognosis in Graves' disease.
情绪应激与甲状腺功能亢进症发病之间的关系已得到充分研究，但心理因素与抗甲状腺药物治疗的甲状腺功能亢进症预后之间的关系尚不清楚。本研究不仅使用特定测试检查了情绪应激，还研究了患者的人格特质。
前瞻性队列研究。
69例接受抗甲状腺药物治疗2 - 5年后处于甲状腺功能正常状态的格雷夫斯病甲状腺功能亢进症患者，以及32名健康受试者作为对照组。
患者对三种问卷进行了回答，包括用于人格特质的明尼苏达多相人格调查表、用于重大生活事件的夏目应激量表，以及用于日常生活应激的林氏日常生活应激量表。
在格雷夫斯病患者中，生活事件的应激评分与血清促甲状腺激素受体抗体活性显著相关（r = 0.424，P < 0.001）和甲状腺体积（r = 0.480，P < 0.001）。当根据预后将患者分组时（41例复发，28例缓解），包括疑病症、抑郁症、偏执狂和精神衰弱（精神疲劳）在内的四种人格特质在复发的格雷夫斯病组中比缓解组显著更常见（P分别为0.0146、0.0052、0.0125和0.0186）。转换性癔症、精神病态偏差、男性化与女性化、精神分裂症、轻躁狂和社交内向这六种人格特质在两组之间没有显著差异。复发的格雷夫斯病组的日常烦恼（日常生活问题）得分也显著高于缓解组（P = 0.0124）。抑郁和精神衰弱的量表得分与日常烦恼得分呈正相关（r分别为0.535，P < 0.0001；r = 0.580，P < 0.0001），而与日常愉悦得分呈负相关（r分别为 - 0.373，P = 0.0332；r = - 0.322，P = - 0.0120）。
结果表明，重大生活事件、疑病症和抑郁症的人格特质偏执狂、精神疲劳和日常问题会加重抗甲状腺药物治疗的甲状腺功能亢进症的预后。逃避生活事件几乎是不可能的；因此医生建议的应对策略可能有助于改善格雷夫斯病的预后。
