Bereavement as an Antecedent Factor in Thyrotoxicosis of Childhood: Four Case Studies with Survey of Possible Metabolic Pathways

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Abstract
Various organic and psychosomatic factors were postulated over the years as etiologic events antedating the onset of Graves'' disease. In some patients psychological events appeared to be important in the evocation of symptoms. Although examples of the latter were described in adults for many years, there is little published on this phenomenon in children. The present study delineates findings in 2 boys and 2 girls aged 8-14 yr. Separating experiences appeared to be related to the onset or relapse of Graves'' disease in these particular cases. In 3 of the patients the trigger event was represented by bereavement after death of a close death of a close relative; in the 4th case the boy''s loss was enforced by traumatic separation from his mother figure. In all these children depression was the common response to loss. The observed relationship between the affective disturbance and Graves'' disease is compatible with one or more hypothetical models. One such pathway, via depletion of brain monoamines associated with the state of depression, could cause an activation of the hypothalamic-pituitary-adrenal axis with resultant suppression of immune surveillance. This could permit the formation of thyroid-stimulating immunoglobulins (TSI) and hence Graves'' disease in genetically susceptible (HLA B-8) persons.