BACKGROUND
Graves’ disease is the most common cause of hyperthyroidism in the United States. It has been noted that anxiety and other mood disorders are common in patients with hyperthyroidism and can be severe. Further, these symptoms may persist after the hyperthyroidism is controlled. One study found that even before patients had been diagnosed with hyperthyroidism, they were about 20% more likely to be taking psychiatric drugs or to have been hospitalized for psychiatric disorders, compared to individuals without thyroid disease. Once they were diagnosed with hyperthyroidism, their subsequent risk of receiving antipsychotic, antidepression, or anxiolytic drugs or of being hospitalized for psychiatric disorders was even higher (about 50%).

One aspect of Graves’ disease that may make underlying anxiety and mood disorders worse is the presence of Graves’ eye disease. When present, symptoms of Graves’ eye disease most often begin within 6 months of diagnosis of Graves’ disease. While the majority of patients with eye disease is mild, occasionally it can be severe with double vision or disfiguring with protrusion of the eyes.

This study was done to understand whether patients with Graves’ disease, especially those with eye disease are at a higher risk of death from suicide.

THE FULL ARTICLE TITLE:
Ferlov-Schwensen C et al Death by suicide in Graves’ disease and Graves’ orbitopathy: a nationwide Danish register study. Thyroid. October 30, 2017 [Epub ahead of print]. (http://online.liebertpub.com/doi/pdf/10.1089/ thy.2017.0365)

SUMMARY OF THE STUDY
Patients above the age of 18 years with a new diagnosis of Graves’disease were studied. Patients with Graves’ eye disease were included as were patients with psychiatric disorders. The data was compared to those who did not have Graves’ disease. From mid-1995 through 2012, Graves’ disease developed in 32,426 individuals in Denmark; 3965 of them also had Graves’ eye disease.

The data showed that patients with Graves’ disease were twice as common to die of unnatural causes, defined as accident, suicide, violence/homicide, and death of unknown manner, as compared to individuals without Graves’ disease. The risk of death by suicide was three times higher in patients with Graves’ eye disease.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This is a valuable study that alerts us to be watchful for changes in the mood of a patient with Graves’ disease— especially in a patient with disturbing eye signs or symptoms. A mental health assessment in patients with Graves’ disease especially with the associated eye disease may be necessary for the patient’s well-being and reduce risk of death from suicide /self harm.

—Vibhavasu Sharma, MD

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