BEREAVEMENT AS AN ANTECEDENT FACTOR IN THYROTOXICOSIS OF CHILDHOOD - 4 CASE STUDIES WITH SURVEY OF POSSIBLE METABOLIC PATHWAYS

Various organic and psychosomatic factors have been postulated over the years as etiologic events antedating the onset of Graves' disease. In some patients psychological events have appeared to be important in the evocation of symptoms. Although examples of the latter have been described in adults for many years, there is little published on this phenomenon in children. The present study delineates findings in two boys and two girls with an age range of 8 to 14 years. Separating experiences appeared to be related to the onset or relapse of Graves' disease in these particular cases. In three of the patients the trigger event was represented by bereavement after death of a close relative; in the fourth 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.