The term ‘hyperthyroidism’ refers to disorders which result from overproduction of hormone by the thyroid gland. The term ‘thyrotoxicosis’ is broader and denotes the clinical, physiological and biochemical findings that occur when the tissues are exposed to, and respond to excess thyroid hormone, thyroxine (T4) and triiodothyroxine (T3), not necessarily originating from the thyroid gland. Common symptoms include nervousness, sleep disturbances, tremors, frequent bowel movements, excessive sweating and heat intolerance. Weight loss is usual despite a normal appetite and food intake. Graves' disease, also known as Basedow's disease, is the most common form of hyperthyroidism in patients younger than 40 years. It is a disorder which has a complex pathogenesis (with involvement of autoimmune factors) and is characterized by these major manifestations: thyrotoxicosis associated with diffuse goitre, ophthalmopathy and dermopathy. Other relatively common forms include toxic adenoma, toxic multinodular goitre and subacute thyroiditis.

A large body of literature on psychosocial aspects of hypherthyroidism is available

Life events

The notion that stressful life events may be followed by hyperthyroidism has been a common clinical observation. Bram (1927) reviewed 3343 cases of exophthalmic goitre. In 85% of cases he detected ‘a clear history of psychic traumas as the exciting cause of the disease’. Several retrospective controlled studies (Winsa et al., 1991; Sonino et al., 1993a; Kung, 1995; Radosavljevic et al., 1996; Yoshihuchi et al., 1998; Matos-Santos et al., 2001) have substantiated these clinical observations. All these studies used valid and reliable methods for life events collection.