Topic: Graves' Disease and Stress

A Reader Writes:

"I was just wondering if you knew if Graves' could be triggered by black molds such as stachybotrys chartarum. I had been diagnosed with Graves Disease 6 years ago and went into remission. I have been working in a building (where Sick Building Syndrome is suspect) for just over a year and a half now. About a month and a half ago a water main broke and flooded 3 floors including the one in which I work. About a month ago I started to have familiar symptoms and was diagnosed with flare-up of Graves. I was wondering if there is a possible connection. I will also be contacting the Workplace Health and Safety Board about having the building tested."

David Derry Responds:

Dear Patient

Another important function for thyroid gland and thyroid hormone.

More than 75 years years ago physicians were examining(1) the connection between psychic (mental) stress and the onset or recurrence of Graves' disease. Not meaning that it was in the patient's head, but for that patient, events caused them severe psychological stress. We know from the studies on wild rabbits (see below) that one important function of thyroid hormone is to supply the brain with enough thyroid so it can function optimally under stress in order to cope with the crisis.(2) Thus thyroid hormone is even more important at times of psychological stress. If the thyroid itself is damaged from previous disease the gland cannot respond appropriately to the needs of the brain. If the gland does respond correctly and raises the blood thyroid hormone level then the person is able to cope with the stress without ill effects and carries on with their life. So if your events upset you sufficiently this would give a strong message to your thyroid to produce more thyroid hormone. Perhaps the bacteria contributed, but it would be insignificant when compared to your mental reaction to the situation. From your previous treatments and Graves' disease's natural burn-out tendencies your thyroid couldn't rise to the occasion correctly. (3) The attempt by your thyroid to help you could have caused your thyroid to overreact again.

Our understanding of stress was first described by Dr. Hans Selye in Montreal in the 1940s. He described a series of reactions of the adrenal glands to stress which became the basis of our present understanding of stress in the human body. What no one seems to have noticed is that all laboratory animals especially vertebrates and mammals are abnormal. All rats, guinea pigs, monkeys and these types of animals used for experiments to study body functions are in fact adapted to the laboratory environment. This means they have acquired the hard wiring in their brain which prevents them from reacting to captivity. If we were put in a cage, like they are, we would become extremely alarmed. This is the normal reaction of the body to capture and restraint.

Because of this adaptation of laboratory animals one of the most important functions of thyroid hormone and the thyroid gland has been missed for more than 50 years. In 1954 Dr. Joachim Kracht in Germany studied stress reactions in rabbits. (2) He found captured rabbits had a completely different stress reaction which did not involve the adrenal cortex. The full response was TSH (thyroid stimulating hormone) stimulation of the thyroid to thyrotoxic levels. The stress was all psychological and the thyroid was the only and most obvious response. Animals frequently died from the reaction to the psychological stress of capture. So he concluded from his experiments there were three types of stress reactions.

Stress reactions as defined by Kracht.

1. Selye's alarm reaction which is related to physical stress, fractures infections surgery etc. this is strictly an adrenal response.

2. The TSH stimulation Alarm reaction as seen in the captured wild rabbit. (psychological stress) This is strictly a TSH mediated thyroid gland response.

3. A reaction of both the adrenals and thyroid to stress of cold as shown in the rat. This response is both adrenals and thyroid.

It should be emphasized that there was no adrenal response to this huge psychological stress. The thyroid gland emptied rapidly and symptoms of thyrotoxicosis (too much thyroid hormone) appeared in the rabbit. He was also able to prove that this was completely mediated by the TSH pituitary system.

If the captured rabbits were treated very carefully they could slowly adapt to the surroundings. But the slightest bit of increased stress to the captured rabbits, such as humans or walking a dog through the lab once per day, made them die within 5 to 20 days. The death rate was not predictable because each animal was in a slightly different thyroid state at the time of capture. He also proved they did not die of starvation.

So this means one of the main functions of the TSH system is to maintain an adequate flow of thyroid hormone to the brain for its normal mental functions. However, under severe psychological stress, and I assume there are grades of stress and response, the thyroid gland responds rapidly by completely emptying all thyroid hormone into the blood stream. This high level of circulating thyroid hormone is for the brain to handle the mental stress that has occurred as a result of capture. The proper response of the brain would be to psychologically "cope" with the stress. However for many of the rabbits they still were not able to cope and therefore died. Hence the concept, which is so clinically obvious, that thyroid hormone is a coping hormone is backed up by a experiments showing clearly this most important function of thyroid.

This stress reaction also is likely responsible for the thyroid hormone resistance seen in adults who were abused or badly frightened during childhood below the age of 12. (4)It also points the way to treating them. My own experience is that adequate thyroid early after the trauma gives the patient the ability to cope with the incident. So there are no lasting effects on the patient.

One example was of a large boy of about 14 who had been beaten badly with lead pipes the year before at school. He was withdrawn depressed and unable to cope with school life. When placed on 250 mg of thyroid daily he rapidly (over a couple of months) returned to his old self. He took the thyroid for about two years and then weaned off without any ill effects. There appear to be no residual ill-effects from his beating.

In studying the tame rabbits Dr. Kraught was able to get the same but not as marked changes to the thyroid by having barking dogs outside thecages. Again this would be a psychological stress and not physical.

This is a specific thyroidal stress-reaction to psychological stress and has many implications.

I hope this helps to understand parts of the Grave's disease problem.

David

1. Bram I. Psychic trauma in pathogenesis of exophthalmic goiter. Endocrinology 1927; 11:106-116.

2. Kracht J. Fright-thyrotoxicosis in the wild rabbit, a model of thyrotrophic alarm-reaction. Acta Endocr 1954; 15:355-367.

3. Howard JE. Treatment of Thyrotoxicosis. JAMA 1967; 20:146-149.

4. Derry DM. Breast cancer and iodine Trafford Publishing Company Victoria Canada 2001 page 45.