pp 323-343

Hyperthyroidism: Cognitive and Emotional Factors

  • Jean E. Wallace
  • , Duncan J. MacCrimmon

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In describing the evolution of thought regarding hyperthyroidism, review usually begins with reference to Parry’s 1825 account of symptoms that appeared in a girl shortly after her frightening ride in a wheelchair (cf Bauer et al., 1987). When Robert Graves described the syndrome in his clinical lectures of 1834–1835, the title, “Newly Observed Affections of the Thyroid Gland in Females—Its Connexion with Palpitation—with Fits of Hysteria” (Graves, 1940), indicated that enlargement of the thyroid gland was viewed as a disorder of emotional origin, even though he suggested that the cardiac symptoms could reflect an organic disorder of the heart. As the symptoms of Graves’ disease became known and well documented, they continued to be associated with hysteria; Charcot considered hyperthyroidism a neurosis (cf, 1974). Even as diagnostic procedures identified the physiological abnormalities of thyrotoxicosis, interest in the role of emotional disorder or environmental stressors in the development of the disease persisted and was particularly active during the 1930s when psychoanalytic concepts were applied. There is a 150-year history of conceptualizing hyperthyroidism as a disorder in which adaptive-defensive style and personal or environmental stressors have been viewed as predisposing and precipitating factors.