Departments of Endocrinology and Metabolism, Academical Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Psychoneuroendocrinology. 2012 Aug;37(8):1191-8. doi: 10.1016/j.psyneuen.2011.12.009. Epub 2012 Jan 5.
An association between stress and autoimmune thyroid disease (AITD) (especially Graves' hyperthyroidism) has been reported, but all studies so far on this topic have been retrospective.
To evaluate prospectively the relationship between stress and (i) de novo occurrence of thyroid antibodies and (ii) development of overt autoimmune hyper-/hypothyroidism.
Two nested case-control studies in a prospective cohort of 790 euthyroid women who were 1st or 2nd degree relatives of AITD patients. Follow-up was five year, with annual assessments including questionnaires on stressful life events, daily hassles, and mood. In study A, cases were subjects who developed TPO-Ab but remained euthyroid during follow-up (called event). In study B, cases were subjects who developed overt hypothyroidism (TSH>5.7 mU/l and FT4<9.3 pmol/l) or overt hyperthyroidism (TSH<0.4 mU/l and FT4>20.1 pmol/l) during follow-up (called event). For each case, two controls were selected, matched for age and duration of follow-up; controls in study A remained TPO-Ab negative, and in study B remained without overt hyper-/hypothyroidism.
Contrast in questionnaire responses between cases and controls at baseline, at one year prior to the event and at time of event.
Exposure to stress was not different between subjects who developed or did not develop TPO-Ab (study A). No differences were observed in stress questionnaires between hyper-/hypothyroid cases and controls at any time point, but hypothyroid cases had less negative feelings than controls at the time of diagnosis (study B).
The data suggest that stress is not involved in the pathogenesis of AITD.
压力与自身免疫性甲状腺疾病（AITD）（尤其是格雷夫斯甲亢）之间存在关联，但迄今为止，所有关于这一主题的研究都是回顾性的。
前瞻性评估压力与（i）甲状腺自身抗体的新发和（ii）显性自身免疫性甲亢/甲减的发展之间的关系。
在一个前瞻性队列中进行了两项嵌套病例对照研究，该队列包括 790 名甲状腺功能正常的女性，她们是 AITD 患者的一级或二级亲属。随访时间为 5 年，每年评估包括有关应激性生活事件、日常琐事和情绪的问卷。在研究 A 中，病例是在随访期间发展为 TPO-Ab 但仍保持甲状腺功能正常的受试者（称为事件）。在研究 B 中，病例是在随访期间发展为显性甲状腺功能减退症（TSH>5.7 mU/l 和 FT4<9.3 pmol/l）或显性甲状腺功能亢进症（TSH<0.4 mU/l 和 FT4>20.1 pmol/l）的受试者（称为事件）。对于每个病例，选择两名年龄和随访时间相匹配的对照；研究 A 中的对照仍为 TPO-Ab 阴性，研究 B 中的对照仍无显性甲亢/甲减。
在基线、事件前一年和事件时，病例与对照在问卷反应上的差异。
在是否发展为 TPO-Ab 的受试者中，应激暴露没有差异（研究 A）。在任何时间点，甲亢/甲减病例与对照在应激问卷上均无差异，但甲减病例在诊断时的负面情绪较对照少（研究 B）。
数据表明，压力与 AITD 的发病机制无关。
