Stress Affects Thyroid Stimulating Hormone and Thyroid Hormone in the Patients Who Underwent Thyroidectomy

Stress Affects Thyroid Stimulating Hormone and Thyroid Hormone in the Patients Who Underwent Thyroidectomy

Purpose: For recent decades, there have been many studies on the relationship with thyroid dysfunction and mood disorder, anxiety, or stress, but the results have been inconsistent. Also, few studies have examined the effects of psychological disorder on thyroid function in patients who underwent thyroidectomy. In this study, we investigated the relationship between stress and thyroid dysfunction in such patients. Methods: Twenty-eight patients were enrolled who underwent thyroidectomy from July 2007 to January 2016 and who experienced life events after thyroid surgery. Five patients underwent lobectomy. The mean follow-up period was 49 months. In this retrospective cohort study, thyroid stimulating hormone (TSH) and thyroid hormones (T4, T3) tested periodically were compared with PROC MIXED with SAS v9.4. The stressors were found by open questionnaire during outpatient’s visits. Results: The patients enrolled in this study took 3–8 thyroid function tests during the follow-up period (mean 49 months). Eight patients (28.5%) had mild to moderate hypothyroidism with TSH less than 10 μIU/mL and 14 patients (50.0%) had overt hypothyroidism with TSH >10 μIU/ mL. When the patients were under stress, free T4 decreased and TSH increased after adjusting the effect of decreased T4 (P<0.001), despite identical levothyroxine dose and good compliance. Conclusion: In the patients who underwent thyroidectomy, TSH increased under stress, because of the loss or lack of the compensatory response of thyroid. Therefore, for patients with thyroid cancer under stress, levothyroxine dose and frequency of outpatient visit will be needed to be adjusted during follow-up.