title: [Grave's disease and stress].
abstract: BACKGROUND
  In recent years, there have been many reports about a possible association between Stressful Life Events (SLE) and the onset of Graves' Disease (GD). Nevertheless, most papers have been criticised and no such association has yet been proven.
  
  
  OBJECTIVE
  To assess the possible associations between SLE and the onset of GD.
  
  
  METHODS
  Retrospective study of 62 subjects, divided into 2 groups of 31 each, GD (Gp1) and controls (Gp2). The patients in Gp1 had thyroid disease diagnosed within the last 12 months, with clinical and biochemical confirmation. In Gp2, psychopathological and endocrine disturbances had been ruled out. Each 2 group consisted of 9 males (29%) and 22 females (71%). The mean age was 38.48 + 10.9 in Gp1 and 41.1 + 11.8 in Gp2. SLE evaluation (number and impact) was reported for the 12 months preceding the onset of symptoms of thyroid disease. To assess SLE, we used the Life Experiences Survey-LES from Saranson, Johnson and Siegel (1978; 1985). Statistical analysis was done using Mann-Whitney and Kruskal-Wallis tests.
  
  
  RESULTS
  Patients with GD had a significantly greater number of SLEs compared to Controls (p < .001). The number and impact of negative SLEs was significantly higher in Gp1 compared to Gp2 (p < .001). There were no significant differences between the groups in terms of the number and impact of both positive and neutral SLEs.
  
  
  CONCLUSIONS
  The findings of this study support that SLEs may contribute to the precipitation of GD. We observed that patients with GD had significantly more negative events and experienced a greater negative impact from them prior to the onset of GD. The association of SLEs with GD is probably related to the association of stress with changes in the immune system, which can play an important role in the aetiology of thyrotoxicosis.
authors.affiliation: Serviço de Endocrinologia, Diabetes e Metabolismo, Hospital Militar Principal, Núcleo de Endocrinologia Diabetes e Metabolismo, Hospital de Santa Maria, Lisboa.
authors.forename: A Matos
authors.initials: AM
authors.lastname: Santos
authors.forename: E Lacerda
authors.initials: EL
authors.lastname: Nobre
authors.forename: J
authors.initials: J
authors.lastname: Garcia e  Costa
authors.forename: P J
authors.initials: PJ
authors.lastname: Nogueira
authors.forename: Ana
authors.initials: A
authors.lastname: Macedo
authors.forename: J Jácome
authors.initials: JJ
authors.lastname: De Castro
authors.forename: A Galvão
authors.initials: AG
authors.lastname: Teles
mesh_terms: D000328:Adult; D000368:Aged; D003625:Data Collection; D005260:Female; D006111:Graves Disease / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000150:complications*; D013959:Thyroid Diseases / Q000209:etiology; D013971:Thyrotoxicosis / Q000209:etiology