The relationship of psychological factors to the prognosis of hyperthyroidism in antithyroid drug-treated patients with Graves' disease
The relationship of psychological factors to the prognosis of hyperthyroidism in antithyroid drug-treated patients with Graves' disease
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DOI：
10.1046/j.1365-2265.2003.01625.x
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发表时间：
2003-05-01
影响因子：
3.2
通讯作者：
Hanafusa, T
中科院分区：
文献类型：
--
作者：
Fukao, A;Takamatsu, J;Hanafusa, T
目的情绪应激与甲状腺功能亢进症发病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的关系尚不清楚。本研究采用特定的测试方法，不仅对患者的情绪压力进行了研究，而且还对患者的人格特征进行了研究。包括明尼苏达多相人格量表（Minnesota Multiphasic Personality Inventory）用于人格特征，Natalie's Stress Inventory用于主要生活事件，Hayashi's Daily Life Stress Inventory用于日常生活压力。生活事件应激评分与血清TSH受体抗体活性（r = 0.424，P < 0.001）和甲状腺体积（r = 0.480，P < 0.001）显著相关。按预后分组（复发组41例，缓解组28例），复发组中抑郁、抑郁、偏执和精神衰弱（精神疲劳）4种人格特征显著高于缓解组（P值分别为0.0146，0.0052，0.0125，0.0186）。转换性癔症、精神病性偏差、男性化与女性化、精神分裂症、轻躁狂、社会内向6项人格特质在两组间差异无统计学意义。Graves病复发组的日常烦恼（日常生活问题）评分也显著高于缓解组（P = 0.0124）。抑郁、精神衰弱量表分与日常困扰因子分呈正相关（r = 0.535，P < 0.0001; r = 0.580，P < 0.0001），而与每日向上的得分呈负相关结论主要生活事件、抑郁、偏执、精神疲劳、日常问题等人格特征加重甲亢患者的预后。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Graves病的预后。
OBJECTIVE 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.DESIGN A prospective cohort study.SUBJECTS 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.MEASUREMENTS 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.RESULTS 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).CONCLUSIONS 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.