Stress and graves disease


Stress and Your Thyroid: What’s the Connection?

Stress is a word that seems all too common in today’s society. Not only can chronic stress wreck havoc on your overall health and well-being, but it can affect your thyroid too.

Stress and hypothyroidism

Your thyroid works in tandem with your adrenal glands. The adrenal glands, which are above your kidneys, can handle small amounts of stress well. When you encounter stress they release cortisol, which enhances various bodily functions.

The most common thyroid disorders are autoimmune disorders where the body attacks its own tissue, in this case the thyroid gland. There are two types, Graves’ disease or Hashimoto’s thyroiditis.

Graves’ disease causes the thyroid to be overactive while Hashimoto’s causes it to be underactive. Stress alone will not cause a thyroid disorder, but it can make the condition worse.

The impact of stress on the thyroid occurs by slowing your body’s metabolism. This is another way that stress and weight gain are linked. When thyroid function slows during stress, triiodothyronine (T3) and thyroxine (T4) hormone levels fall. Also, the conversion of T4 hormone to T3 may not occur, leading to higher level of reverse T3.

Insulin resistance and issues balancing blood sugar often occur alongside hypothyroidism. Increased levels of glucocorticoids lower the levels of TSH in the blood. A delicate balance between stress hormones and cortisol must exist for proper thyroid function. If this delicate balance changes, your thyroid symptoms may increase.

Lab tests cannot always depict the right picture of how you’re feeling, and medications cannot always keep up with the changes that stress causes. Chronic stress can cause problems in your body for years before lab tests show a problem.

All the while, you may experience hypothyroid symptoms, such as fatigue or weight gain. This prolonged stress may crop up as depression or anxiety when both are actually hypothyroid symptoms.

Stress relief tips

You can help your overall stress levels and thyroid health by making some simple changes in your daily life.

Eat right

A healthy, balanced diet looks different for everyone. In general, plan to eat three well-balanced meals full of fruits, vegetables, and protein each day. Start your morning off with a good breakfast, one low in sugar but high in protein and fiber. Reducing alcohol, caffeine, and sugar in your diet will help with your overall energy levels.

Also, think about how you’re eating. Make sure to take the time to sit and enjoy a meal, which will help your body digest food better. While this may seem tough to do in your busy lifestyle, your body and thyroid will thank you for it.

Think about vitamins

You may want to consider adding thyroid-supporting vitamins and minerals to your daily routine. An iodine deficiency may be a cause of hypothyroidism. In addition to iodine, consider adding other essential vitamins and minerals, such as:

  • selenium
  • zinc
  • iron
  • copper
  • vitamins A, B, C, and E

Talk to your doctor before starting these supplements.

Sleep well

Getting enough quality sleep at night can be tough with hypothyroidism. Stress makes getting a good night’s sleep tough too. But aiming for a good night’s rest can have a huge impact on your thyroid health.

Try adopting a strict bedtime and avoid technology in the hours before bed. Slowing down before you sleep allows the adrenal glands to lower the stress response and rest.


Taking time to reflect or meditate can help the body relax. In turn, relaxation leads to reduced stress and less impact on your thyroid.

There are many ways to relax. For some people, making crafts helps to calm their bodies. For other people, deep breathing exercises, yoga, or simply being outside is enough.

You may not be able to remove all the stress from your life, but supporting your body with healthy foods, adding vitamins and minerals, sleeping properly, and trying some relaxation techniques can help you balance your overall health as well as your thyroid.

The Stress Thyroid Connection

Additional add-ons to consider:

RT3 90-250 PG/ML
Ferritin 70-150
Vitamin D 50-70
C-rp <0.8
Salivary DHEA
Salivary cortisol (4 point assessment)

A note on ferritin and hair loss!

Ferritin is the storage form of your iron and as a sensitive marker can be deficient even without experience of anemia or low red blood cells. Hair loss is often associated with hypothyroidism and ferritin plays an integral role as ferritin is required to transport active thyroid hormone to the center of the cells to be used. So if ferritin drops too low, T3 can’t be used in the body! Ferritin levels of at least 40 ng/ml are required to stop hair loss, while levels of at least 70 ng/ml are needed for hair regrowth.

Focus on having red meat 2-3x/wk from grassfed sources to support optimal ferritin values and if menstruating be sure to take a multivitamin with iron such as Multidefense with iron which is a whole food based bioavailable formula that includes methylated B-vitamins.

Thyroid dysfunction all comes down to STRESS!

The thyroid is impacted significantly by stress as the thyroid gland competes with the adrenal glands in times of significant stress. In survival prioritization, the body stimulates the adrenals for output of cortisol and adrenaline as it puts the brakes on the thyroid gland to prevent metabolic burn and preserve fuel reserves in a time of fight-or-flight! Unfortunately this shift of shutting down thyroid function slows down not only metabolism in the sense of weight gain and lack of fat burn, but it also interferes with the body’s ability to regulate hormones, cholesterol, and metabolic pathways in the liver including detoxification.

Stress can be both physical with impact on the body or mental with impact emotionally or cognitively both with the ability to drive the HPA-axis into overdrive which can drain or pump the brakes on the thyroid gland. As discussed stress can be self-induced and often may be overlooked as it can be something desired or intentional yet still driving the gland to be overworked!

Consider these stressors:

Physical: Running a marathon, crossfit or HIIT training, pregnancy, recovering from an injury, environmental toxicity, GI distress/dysbiosis, infection, food sensitivities, inflammation

Mental: job, spouse/partner, family dynamics, a death, fight, break up, test or deadline, new relationship, job promotion and new responsibilities

“Stress and anxiety can truly put the brakes on your primary metabolic gland!”

The sympathetic nervous system, fight-or-flight mechanism is also known as the HPA-axis after the glands that influence it, the hypothalamus-pituitary-adrenal glands. The thyroid is regulated by the hypothalamus and stimulated by the pituitary so directly this axis has impact on the thyroid by two of the three glands and the adrenals play a strong indirect role with feedback as cortisol reduces the conversion of inactive T4 into active T3.

Primary Mechanisms of the HPA-axis by gland:

H: body temperature, circadian rhythm, metabolism/satiety leptin, thyroid releasing hormone (TRH)

A: Cortex: Aldosterone (blood pressure regulator), Cortisol (HIGH→ Immunosuppressant, fluid retention, Low→ Inflammation, allergies), DHEA; Medulla: norepinephrine, epinephrine, dopamine (neurotransmitters that influence stress, anxiety, multitasking, professional drive, insomnia)

How stress directly impacts thyroid health:

Hypothalamus doesn’t make as much thyroid releasing hormone (low TRH)

Pituitary doesn’t stimulate thyroid (low TSH)

Adrenals make more cortisol which blocks T4→ T3 conversion and creates RT3 which blocks use of T3

How to defend against Stress to your Thyroid gland

  1. Go Gluten-free and reduce grain consumption

  2. Consider a Candida Cleanse!

  3. Get 7+ hours of sleep

  4. Focus on resistance training with cadence, gentle movement therapy, stretching as primary exercise, reduce HIIT and high stress activity!

  5. Work on mindfulness and meditation, reduce rumination and racing thoughts with action plans vs. pending

  6. Support your system with strategic supplementation (see below!)

  7. Eat an antioxidant-rich, anti-inflammatory diet!

Clean up your diet and remove gluten!

A first line defense is ensuring a diet free of chemicals, additives, and processed products, focus on whole real foods and eating in diversity to support your body’s nutritional needs. I work with clients to support their thyroid with tight gluten-free approach and most clients to even commit to grain-free as gliadin in gluten interferes with thyroid function. By removing inflammatory compounds from the diet we can manage and reduce physiological stress. Also, if a client has a history of yeast symptoms from vaginal yeast infection, thrush, antibiotic use, or dysbiosis, I will start them on my Candida Cleanse to reset their microbiome to reduce stress to the system. Antibodies released in leaky gut from gluten or other irritants and bacteria or yeast such as candidiasis can interfere with thyroid function causing autoimmune flare. Women especially that have had c-sections, or are on birth control, antibiotics, have high carb diet should start with a 10-week Candida Cleanse to plow the gut microbiome and reset for optimal bacterial balance.

Be realistic with your exercise and mental demands!

Beyond inflammatory foods and dysbiosis, we can reduce stress by allowing ample recovery in our exercise and focusing on resistance training and gentle movement therapy vs. HIIT training which can perpetuate stress response and thyroid burn out or shut down. And finally once we have managed physiological stressors, working on harnessing the “wild stallion” of the brain and managing racing thoughts through practice of mindfulness, meditation, and affirmations can play a huge role in rebounding and optimizing thyroid function. Working to reduce pending to-do tasks and implement timeline, strategy, and SMART goals can be a great way to reduce the stress we can put on ourselves for either not doing something we “should” or feeling overwhelmed to accomplish a necessary task. This action of stress reduction via task orientation, is accelerated by ample sleep of 8 or more hours per night which resets the circadian rhythm and stress response.

“Deep breathing and yoga practice are two additional recommendations I make to clients when looking to reset metabolic response. Finding release and the ability to unwind is essential in rebounding that burned out thermostat!”

Supplement the HPA-axis, provide building blocks, and reduce inflammation!

Strategic supplementation can also aid in optimizing thyroid performance and stress response. The following 3 formulas are my top recommendations to supporting your Thyroid on STRESS:

Adaptogen Boost→ This formula contains 3 well researched adaptogens or plant compounds that help the body in its resilience to stress demand while preventing oxidative damage, Cordceyps, Panax Ginseng, Rhodila. Specifically these 3 have been shown in studies to support fat burn, support brain function, reduce rT3 (thus enhancing expression of active thyroid hormone), and increase antioxidant status!

Cellular Antiox→ If you have been following my work for a while, you know how much I am obsessed with glutathione, the “powerhouse” antioxidant. As the most powerful antioxidant in the body, it can reduce free radicals that drive oxidative damage and reduce the inflammatory stress on the thyroid. Also studies show it has direct role in the deiodinase enzyme pathway that activates T4 in T3. Cellular Antiox pairs NAC a building block with easy to absorb s-acetyl glutathione form in synergy with B6 to aid in the activation and conversion.

Relax and Regulate→ Magnesium plays a dynamic role on over 300 enzyme pathways and magnesium levels are burned out from stress demand. Magnesium bis-glycinate is the most bioavailable absorbable form of magnesium that targets the neuromuscular system aiding in relaxation of tension in the body serving to promote optimal sleep, reduce inflammation, and maintain bowel regularity. On the thyroid magnesium aids in both production of thyroid hormone as well as conversion and activation. The Relax and Regulate formula provides magnesium in its highest quality form along with myo-inositol, which has been shown in a recent study to maintain optimal thyroid function for individuals with thyroiditis.

Click each formula name to purchase and learn more!

“Adapatogen boost can aid with stress induced fatigue providing resilience vs. gland burn out and targeting belly fat burn to enhance metabolic function!”

Food-as-Medicine for Thyroid support!

Minerals, antioxidants, and B-vitamins are a couple of areas of primary focus when using food-as-medicine to support this precious gland. Below are some recipes that will have anti-inflammatory effects and boost production while you support your body supplementally with above mentioned formulas to reduce the hit on the gland in the time of rebound and recovery!

Like every cell and organ in our bodies, the thyroid requires specific vitamins and minerals to carry out everyday functions. Though there are several nutrients the thyroid uses, I’ll highlight those that research shows to be most crucial.

Iodine, Selenium, Magnesium, Zinc

Thyroid hormones including both T4 and T3 are the only iodine-containing hormones in humans. The process of producing thyroid requires iodine. Selenium-containing enzymes function in a protective “detox” capacity, preserving the integrity as an antioxidant of the thyroid gland when we’re under all kinds of stress — oxidative, chemical, even social stress! Selenium and magnesium help the body to more efficiently recycle its iodine stores and preserving function of the organ. When zinc is low in the body, TSH (thyroid-stimulating hormone), T4, and T3 can in turn become low in the body.

Sea vegetables such as 1 tsp of dulse flakes twice per week or consumption of seafood and shellfish at 3 servings per week provides you with a nice dose of iodine, just 1-2 Brazil nuts each day provide you with ample selenium, magnesium is found abundantly in leafy greens, and zinc is found in beef, oysters, dark meat chicken, cashews, pumpkin seeds, and almonds!

Note: Magnesium due to demand often requires supplementation!

Antioxidants and B vitamins

Antioxidants and B-vitamins work to neutralize the oxidative damage of physiological, psychological and environmental stress on the gland In emotional, psychological or physiological stress, the body will convert excess T4 to reverse T3 (rT3) as a means of conserving energy for healing and repair.

Fresh herbs and spices are a great source of antioxidants focusing on turmeric, ginger, basil, rosemary, cilantro, cumin to name a few! Also packing in your produce from 2-3 cups of leafy greens, sulfur-containing veggies such as broccoli, cauliflower, brussels, and healthy fat forms of antioxidants in avocado, almonds, nuts and seeds. Liver and egg yolks may provide some of the most user-friendly forms of b-vitamins that work as a great boost to metabolism and thyroid function.


Check out these recipes to BOOST your Thyroid gland function! Click on each image for recipe.

Hyperthyroidism: When Your Thyroid Gland Goes Into Overdrive

By Tracy Tylee, MD

You feel tired. You’re having trouble sleeping. Your heart is racing, and you feel shaky day and night. You’re under a lot of stress, which might explain these symptoms. Or could it be something else…like a thyroid issue? Most of us who are knowledgeable about the topic of thyroid disease typically think of hypothyroidism, or low thyroid function, which can cause fatigue, difficulty concentrating and weight gain. However, fatigue and feelings of anxiety can also be symptoms of hyperthyroidism, or too much thyroid hormone. Recognizing these symptoms is important, as nearly all causes of hyperthyroidism require treatment to prevent long-term complications.

Just how much of a problem is hyperthyroidism?

Hyperthyroidism is less common than hypothyroidism, affecting about 1.2 percent of the United States population, compared to 5 percent affected with hypothyroidism. Like most thyroid disease, it is more common in women, and its incidence increases with age.

What symptoms does hyperthyroidism cause?

Thyroid hormone sets the pace for the body’s metabolism, the process by which cells turn nutrients into energy to enable your body tissues to function properly, so having too much thyroid hormone causes symptoms of an overactive metabolism. Persons with hyperthyroidism often experience weight loss despite an increased appetite, feel hot when others are not, have tremors, anxiety and fatigue. You might have difficulty sleeping. Or your bowels can be overactive, leading to frequent bowel movements. The eyes can also be affected with double vision or eye inflammation and pain when the patient has an autoimmune condition called Graves’ disease, which occurs when the immune system launches an attack on the thyroid.

Hyperthyroidism symptoms may be mild in their presentation or can be quite debilitating, particularly in older individuals where unexplained weight loss is often the only symptom. Many people may attribute their symptoms to stress, anxiety or even the normal aging process. However, it’s important to recognize the possibility of thyroid disease, as there are longterm complications arising from untreated hyperthyroidism. Older individuals with hyperthyroidism have a three-fold greater risk of atrial fibrillation, an irregular heart rate that increases the risk of stroke, compared to patients with normal thyroid function. Hyperthyroidism also increases the risk of osteoporosis and fracture. Treatment of hyperthyroidism can help prevent these serious complications.

How does hyperthyroidism develop?

Hyperthyroidism is due to too much thyroid hormone circulating in the blood. Normally, the amount of thyroid hormone in your system is controlled by the pituitary gland, a pea-sized structure located at the base of the brain. The pituitary gland produces a hormone called thyroid stimulating hormone (TSH), which travels through your bloodstream to the thyroid gland where it binds to receptors (a molecule that receives a thyroid hormone and permits it to dock on the nuclear membrane of a cell) and stimulates the thyroid to make thyroid hormone. Normally, when thyroid levels are high, the pituitary gland decreases production of TSH to reduce stimulation of the thyroid and return hormone levels to normal. Similarly, if thyroid hormone levels are low, the pituitary’s output of TSH will increase to stimulate the thyroid gland to produce more hormone (See Figure 1).

In hyperthyroidism, this system goes awry due to a number of causes. The most common cause of hyperthyroidism is Graves’ disease, in which your body produces antibodies that stimulate the TSH receptor on the thyroid gland. The thyroid can’t tell the difference between TSH and the TSH receptor antibodies, so it “thinks” the pituitary is directing the thyroid to make more hormone and the thyroid complies. Patients with Graves’ disease will often have an enlarged thyroid, also called a goiter, due to the increased stimulation of the thyroid gland.

Sometimes patients will have thyroid nodules that are producing thyroid hormone independent of TSH stimulation. This is more common for patients from iodine-deficient geographic areas, but it occurs worldwide.

Inflammation of the thyroid gland can also cause hyperthyroidism. This can occur following a viral infection, after pregnancy, or due to certain medications. In this situation, the inflammation damages the thyroid cells. Normally, the thyroid has large stores of pre-made thyroid hormone waiting to be released. When the cells are damaged, this hormone can leak out and lead to hyperthyroidism. This condition is usually only temporary – once the thyroid heals, the thyroid hormone stops leaking and levels return to normal within several months.

An important cause of hyperthyroidism is medication. Some weight-loss supplements may contain thyroid hormone components and can cause hyperthyroidism. If too little thyroid hormone causes weight gain and fatigue, it seems reasonable to assume too much thyroid hormone would cause weight loss and increased energy. Unfortunately, it doesn’t work that way. Too much thyroid hormone in the body can cause weakness due to loss of muscle mass, fatigue and other significant medical problems. Plus, excessive amounts of thyroid hormone can increase appetite, which is another reason it’s not a good weightloss tool. It is important to review any supplements you are taking with your physician to ensure you’re taking something that could be causing the problem or making your condition worse.

How is hyperthyroidism diagnosed?

When hyperthyroidism is suspected, a diagnosis is made through a simple blood test to measure both thyroid hormone levels and TSH. In most cases of hyperthyroidism, the TSH will be low as the pituitary is trying to decrease thyroid hormone production in response to the high levels of thyroid hormone in the body. The TSH is the most sensitive test available for measuring thyroid function, and in hyperthyroidism this may be low, even with thyroid hormone levels still in the normal range.

Once the blood test confirms the diagnosis of hyperthyroidism, additional tests may be needed to identify the underlying cause. In Graves’ disease, TSH receptor antibodies can be measured. Imaging studies are also helpful. One test, called a radioactive iodine scan, uses a small, harmless dose of radioactive iodine to help identify where excess thyroid hormone is being produced (thyroid cells are the main cells in the body that can absorb iodine). The thyroid uses iodine in the production of thyroid hormone, so if there is excess hormone production, such as in Graves’ disease, or the result of a hyperfunctioning nodule, a non-cancerous nodule growing in the thyroid that causes it to produce too many hormones, this area will “light up” on the scan. Conversely, if there is release of hormone stores rather than increased production, as occurs with inflammation of the thyroid, there will be low iodine uptake.

Thyroid ultrasound can also be helpful in identifying nodules. This procedure uses high-frequency sound waves that pass through the skin and are reflected back to the ultrasound machine, creating detailed images of the thyroid. An ultrasound is usually not necessary when the thyroid is overactive unless a nodule is apparent on physical examination and a nuclear medicine scan indicates that it is “cold,” which indicates the nodule is composed of cells that don’t make thyroid hormone. A nodule that is producing too much hormone will show up darker on the scan and is called “hot.”

Review of your medications with your provider is very important to make sure you are not taking excess thyroid hormone or other supplements that could cause hyperthyroidism.

What are my treatment options?

The treatment of hyperthyroidism depends on the underlying cause. If the thyroid is producing too much hormone, which occurs with Graves’ disease or hyperfunctioning nodules, thyroid hormone production can be blocked. There are several ways of doing this. The first is with a class of medications called thionamides. In the U.S., a thionamide called methimazole is commonly used, which blocks a step in the formation of thyroid hormone. The methimazole is typically taken once a day, initially at high doses, but the dose can be decreased as thyroid hormone levels return to normal. Methimazole can sometimes cause a rash, but is usually well tolerated. There are some rare but serious side effects, including liver injury or failure, which occurs in roughly one out of every 10,000 adults taking the medication, and suppression of the immune system, which can lead to potentially life-threatening infections, so your doctor will want to make sure you are aware of symptoms to look for.

Some individuals prefer a more definitive treatment, which can be accomplished with radioactive iodine or surgery. With radioactive iodine, commonly referred to as “thyroid ablation,” the patient is given a higher dose of radioactive iodine than what is used for a diagnostic scan. This will damage the thyroid cells and prevent them from being able to make thyroid hormone. This approach works well for hyperfunctioning nodules, as often only the nodule is damaged and the remaining thyroid gland retains normal function. In Graves’ disease however, since the entire gland is overactive, the patient will often become hypothyroid following treatment and require thyroid hormone replacement medication. Surgery, often reserved for those unable to take methimazole or radioiodine, is another option. If the thyroid gland is removed, there is no other internal source of thyroid hormone, so after surgery, the patient will be hypothyroid and require lifetime thyroid hormone replacement.

Hyperthyroidism due to thyroid inflammation is self-limited, meaning it will get better on its own. No specific treatment for this is needed.

What is the take-home message?

Stress and anxiety are common in modern day society. We often find ourselves having trouble sleeping, which can cause fatigue. However, when this is accompanied by other unexplained symptoms such as palpitations and tremor, or weight loss, the possibility of hyperthyroidism should be considered. While thyroid hormone is essential for normal metabolism, like anything, it is possible to have too much of a good thing.

How moods and emotions can be affected by your thyroid

Alongside these things you’ll respond better to medication if you manage your stress levels and eat a healthy diet. Try to establish a good sleep routine as well – winding down before bedtime and going to bed/waking up at the same time of day will help you break the cycle of lack of sleep at night making you irritable

Talk also to your friends and family so that they can understand what is happening and have the opportunity to be supportive.

If you would like to see other posts by Dr Vanderpump or follow him on Twitter via @DrMVanderpump

Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.

As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link

Graves’ Disease

What is Graves’ disease?

Graves’ disease is a disorder of the body’s immune system. The disease causes thyroid hormones to be over-produced, resulting in a condition called hyperthyroidism. This term means that the body has too much thyroid hormone. In fact, the most common cause of hyperthyroidism is Graves’ disease.

What is the thyroid gland?

Located in the lower front of the neck, this butterfly-shaped gland produces thyroid hormones. Such hormones help the body to stay warm, use energy, and keep organs such as the brain and heart working as they should. These processes are called your metabolism.

What causes Graves’ disease?

Graves’ disease can be set off by a process in the body’s immune system. In most cases, the immune system protects the body from foreign substances like viruses and bacteria. It destroys such substances with antibodies. These are produced by blood cells called lymphocytes. In certain people, however, lymphocytes make antibodies against their own tissues, causing damage.

Graves’ disease occurs when antibodies connect to the thyroid cells’ surfaces. The antibodies stimulate cells to overproduce thyroid hormones, resulting in an overactive thyroid.

Emotional stress can trigger Graves’ disease in some patients. Most people with Graves’ disease, however, report no specific stressful events.

What are the symptoms of Graves’ disease?

In hyperthyroidism, every function in your body can speed up. Some symptoms of hyperthyroidism include a racing heart, irritability, nervousness, hand tremors, and weakness of muscles. Other symptoms include:

  • Goiter: This is another name for an enlarged thyroid gland. It may appear as swelling in the front of the neck. Goiters caused by Graves’ disease (diffuse thyrotoxic goiters) can be small or large. Goiters may cause difficulty in swallowing, cause you to cough (if it is large enough), and cause sleeping difficulties.
  • Eye diseases: Such diseases include Graves’ ophthalmopathy, which is the bulging of the eyes and the swelling of tissue around the eyes. Symptoms in the eyes can start about 6 months before Graves’ disease is diagnosed. (However, these can occur without the thyroid ever becoming abnormal, as well as years before or after the hyperthyroidism.) Early signs of eye problems include inflamed eyes or double vision.
  • Skin disease: A lumpy, reddish thickening of the skin in front of the shins can form in rare cases. The condition is known as pretibial myxedema. Most often, the condition is painless and relatively mild. However, it can cause pain and usually is treated and diagnosed by a dermatologist.

Share Facebook Twitter LinkedIn Email Get useful, helpful and relevant health + wellness information enews

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

  1. 1

    Davies TF and Larsen PR (2003) Thyrotoxicosis. In Williams Textbook of Endocrinology, edn 10, 374–421 (Eds Larsen PR et al.) Philadelphia, PA: Saunders

    • Google Scholar
  2. 2

    Abalovich M et al. (2007) Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 92 (Suppl): S41–S47

    • Google Scholar
  3. 3

    Chan GW and Mandel SJ (2007) Therapy Insight: management of Graves’ disease during pregnancy. Nat Clin Pract Endocr Metab 3: 470–478

    • CAS
    • Article
    • Google Scholar
  4. 4

    Cooper DS (2005) Treatment of thyrotoxicosis. In Werner and Ingbars’ The Thyroid: A Fundamental and Clinical Text, edn 9, 665–694 (Eds Braverman LE and Utiger RD) Philadelphia, PA: Lippincott Williams & Wilkins

    • Google Scholar
  5. 5

    Williams RH (1946) Thiouracil treatment of thyrotoxicosis. J Clin Endocrinol Metab 6: 1–22

    • CAS
    • Article
    • PubMed
    • Google Scholar
  6. 6

    Brix TH et al. (1998) A population-based study of Graves’ disease in Danish twins. Clin Endocrinol 48: 397–400

    • CAS
    • Article
    • Google Scholar
  7. 7

    Guarneri F and Benvenga S (2007) Environmental factors and genetic background that interact to cause autoimmune thyroid disease. Curr Opin Endocrinol Diabetes Obes 14: 398–409

    • CAS
    • Article
    • PubMed
    • Google Scholar
  8. 8

    Mizokami T et al. (2004) Stress and thyroid autoimmunity. Thyroid 14: 1047–1055

    • CAS
    • Article
    • PubMed
    • Google Scholar
  9. 9

    Bagnasco M et al. (2006) Stress and autoimmune thyroid diseases. Neuroimmunomodulation 13: 309–317

    • CAS
    • Article
    • PubMed
    • Google Scholar
  10. 10

    Yoshiuchi K et al. (1998) Psychosocial factors influencing the short-term outcome of antithyroid drug therapy in Graves’ disease. Psychosom Med 60: 592–596

    • CAS
    • Article
    • PubMed
    • Google Scholar
  11. 11

    Fukao A et al. (2003) The relationship of psychological factors to the prognosis of hyperthyroidism in antithyroid drug-treated patients with Graves’ disease. Clin Endocrinol (Oxf) 58: 550–555

    • Article
    • Google Scholar
  12. 12

    Prummel M et al. (2004) The environment and autoimmune thyroid diseases. Eur J Endocrinol 150: 605–618

    • CAS
    • Article
    • PubMed
    • Google Scholar
  13. 13

    Leclere J and Werhya G (1989) Stress and auto-immune endocrine disease. Horm Res 31: 90–93

    • CAS
    • Article
    • PubMed
    • Google Scholar
  14. 14

    Ahren B (1986) Thyroid neuroendocrinology: neural regulation of thyroid hormone secretion. Endocr Rev 7: 149–155

    • CAS
    • Article
    • PubMed
    • Google Scholar
  15. 15

    Plaut M (1987) Lymphocyte hormone receptors. Annu Rev Immunol 5: 621–669

    • CAS
    • Article
    • PubMed
    • Google Scholar
  16. 16

    Larsen PR (1982) Graves’ disease and other causes of hyperthyroidism. In Cecil Textbook of Medicine, edn 17, 1206–1213 (Eds Wyngarden JB and Smith LH Jr) Philadelphia, PA: Saunders

    • Google Scholar
  17. 17

    Baschieri L et al. (1977) Sindromi ipertiroidee. In Trattato Italiano di Endocrinologia, 772–799 (Eds Cassano C and Andreani D) Rome, Italy: Società Editrice Univero

    • Google Scholar
  18. 18

    Benvenga S (1996) Benzodiazepine and remission of Graves’ disease. Thyroid 6: 659–660

    • CAS
    • Article
    • PubMed
    • Google Scholar
  19. 19

    Constaninou C et al. (2005) Diazepam affects the nuclear thyroid hormone receptor density and their expression levels in adult rat brain. Neurosci Res 52: 269–275

    • Article
    • Google Scholar
  20. 20

    Kragie L and Doyle D (1992) Benzodiazepines inhibit temperature-dependent L-triiodothyronine accumulation into human liver, human neuroblast, and rat pituitary cell lines. Endocrinology 130: 1211–1216

    • CAS
    • PubMed
    • Google Scholar
  21. 21

    Bribes E et al. (2004) Immunohistochemical assessment of the peripheral benzodiazepine receptor in human tissues. J Histochem Cytochem 52: 19–28

    • CAS
    • Article
    • PubMed
    • Google Scholar
  22. 22

    Bribes E et al. (2002) Involvement of the peripheral benzodiazepine receptor in the development of rheumatoid arthritis in Mrl/lpr mice. Eur J Pharmacol 452: 111–122

    • CAS
    • Article
    • PubMed
    • Google Scholar
  23. 23

    Iqbal MM et al. (2002) Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatr Serv 53: 39–43

    • Article
    • PubMed
    • Google Scholar
  24. 24

    Dolovich LR et al. (1998) Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ 317: 839–843

    • CAS
    • Article
    • PubMed
    • PubMed Central
    • Google Scholar
  25. 25

    Longo LP and Johnson B (2000) Addiction: Part I. Benzodiazepines—side effects, abuse risk and alternatives. Am Fam Physician 61: 2121–2128

    • CAS
    • PubMed
    • Google Scholar

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *