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Objective: Mental fatigue, depression, anxiety and cognitive complaints are common in Graves’ disease (GD). Our aims were to assess the relationship between these variables in patients with GD during both hyperthyroidism and a long stable euthyroidism.

Methods: A prospective longitudinal case-control study where sixty-five premenopausal women diagnosed with GD and 65 matched controls were assessed twice with 15 months in-between. The first visit for patients was in overt hyperthyroidism and the second after treatment.

Results: During the hyperthyroid phase, mental fatigue, depression and anxiety were significantly increased for GD patients compared to controls (all p<0.001). Among GD patients 89% reported mental fatigue and among controls 14%. No difference in cognitive tests was found. After 15 months, significant improvements for GD patients after treatment were found for the items mental fatigue, depression and anxiety (all p<0.001), but these were unchanged in controls. GD patients reported residual mental fatigue (38%), 23% without depression and 15% mental fatigue combined with depression. Self-reported cognitive complaints were pronounced while cognitive tests did not reveal any deficiencies.

Conclusion: Mental fatigue and emotional distress are common in the hyperthyroid phase. These improve with treatment but are still more common in GD patients after 15 months of therapy than in controls. The residual mental fatigue is shown to be a phenomenon distinct from depression in this study. This indicates the importance of assessing mental fatigue in GD patients and underlines the need for rehabilitation and healthcare support as fatigue will have consequences for work ability.

Patients with Graves' disease (GD) not only need appropriate medical care, but they also need to be cared for. The aim of this review is to examine the literature on GD patient needs, expectations, perceptions, and quality of life. We will also present methods for patient care, define gaps in knowledge, and suggest factors that can be introduced into the regular care of GD patients. Patient information, teamwork with thyroid/contact nurses, education of personnel and patients, quality of life measurements, and the formation of a rehabilitation program have enough evidence to be implemented into regular care. However, visualizing patient needs through person-centered care requires further evaluation in GD patients before being implemented in routine care. We conclude that considerable improvement in nursing can be achieved in relation to GD.