Psychosomatic Medicine 17:420-427 (1955)
© 1955 American Psychosomatic Society

Emotional Factors in the Etiology of Hyperthyroidism Occurring in Relation to Pregnancy

Summary of Eleven Cases

¹ Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.

The study was carried out to investigate two hypotheses. It was considered that pregnancy might be a period of particular vulnerability to thyrotoxicosis because it is a time of marked physiologic alteration in thyroid activity. In a series of 67 hyperthyroid women who had been studied psychiatrically, 8 first suffered from the illness during pregnancy, 1 in the immediate postpartum period, and 2 suffered from recurrences of hyperthyroidism during a pregnancy. It is possible that the illness had started in earlier pregnancies in still other women in the series. The findings, which are very similar to those of Gardiner-Hill, suggest very forcibly that the widely held opinion that the illness infrequently starts during pregnancy is erroneous and that, to the contrary, it is a period of special vulnerability.

The second problem was to determine whether during this period of shift in thyroid activity the emotional problems commonly found to precipitate hyperthyroidism would be relatively absent or minimal. The survey of the case material indicates that 10 and probably all 11 of the women were in a highly precarious emotional state prior to the pregnancy and that the pregnancy in itself constituted a threat to the emotional equilibrium, adding to the turmoil already present. Although the material has not been presented to illustrate the point, the types of problems confronting the patients and the patterning of their personalities were strikingly similar to those of hyperthyroid women in general as reported by a number of investigators.

The patients studied constituted a group of hyperthyroid patients, specially selected, because it was a priori assumed that emotional factors might well be a minimal factor in precipitating the illness when it occurred in relationship to pregnancy. Although the study does not definitively prove anything, it is believed that the findings greatly increase the probability that emotional disturbances play an essential role in the etiology of hyperthyroidism.

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