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Stan R Ursem Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands

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Anita Boelen Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands

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Eveline Bruinstroop Department of Endocrinology and Metabolism, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands

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Petra J M Elders Department of General Practice, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
Amsterdam Public Health Research Institute, Amsterdam UMC, The Netherlands

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Jacobijn Gussekloo LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands

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Rosalinde K E Poortvliet LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands

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Annemieke C Heijboer Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan, Amsterdam, The Netherlands

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Wendy P J den Elzen Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
Laboratory Specialized Diagnostics & Research, Department of Laboratory Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
Amsterdam Public Health Research Institute, Meibergdreef, Amsterdam, The Netherlands

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conducted a systematic search in PubMed and Embase. In addition, we searched the following websites and guideline-specific databases: Guidelines International Network (G-I-N; http://g-i-n.net ), Trip database ( http://www.tripdatabase.com ), and Clinical

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Haiyang Zhang Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China

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Shuo Wu Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China

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Shuyu Hu Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China

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Xianqun Fan Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China

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Xuefei Song Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China

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Tienan Feng Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Huifang Zhou Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China

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fluid biomarkers such as thyroid-stimulating hormone receptor antibody, and imaging biomarkers like elevated signal intensity (SI) of orbital tissues ( 3 , 6 ). However, there is no consensus on the specific markers used in the models and there are no

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Caiyan Mo Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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Han Chen Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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Qi Zhang Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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Ying Guo Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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Liyong Zhong Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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hormones and can lead to hypothyroidism ( 7 ). Clinical manifestations of RTHβ depend on the severity of the mutation and individual and tissue-specific differences in resistance to thyroid hormones. Elevated thyroid hormone levels compensate for resistance

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Mats Holmberg ANOVA, Karolinska University Hospital, Norra Stationsgatan 69, Stockholm, Sweden
Institute of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
Wallenberg’s Centre of Molecular and Translational Medicine, Region Västra Götaland, Sweden

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Helge Malmgren Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

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Peter F Berglund Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

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Birgitta Johansson Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

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Helena Filipsson Nyström Wallenberg’s Centre of Molecular and Translational Medicine, Region Västra Götaland, Sweden
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
Gothenburg Centre for Person Centred-Care (GPCC), Göteborg, Sweden

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Background

Mood disorders are common in Graves’ disease despite treatment. The pathogenic mechanisms involved are unknown and so is whether previous psychiatric disease influences these symptoms.

Methods

This is a longitudinal study conducted in Sweden on 65 women with newly diagnosed Graves’ disease and 65 matched controls. Participants were examined during hyperthyroidism and after 15 months of treatment. Examinations included blood sampling, and psychiatric testing with the Comprehensive Psychopathological Rating Scale for Affective Syndromes and the Structured Clinical Interview for DSM-IV – Axis I Disorders. We also performed two analyses of a national population-based registry to determine previous psychiatric diagnoses and previous prescriptions of psychoactive drugs in (i) all patients we asked to participate and (ii) all Swedish women given a diagnosis of hyperthyroidism during 2013–2018, comparing them to matched controls.

Results

There was no increased previous psychiatric comorbidity in Graves’ patients compared to controls. There was no higher prevalence of psychiatric diagnoses and prescriptions of psychoactive drugs between (i) included GD patients compared to those who declined participation and (ii) women with a hyperthyroidism diagnosis in 5 years prior to their diagnosis, compared to matched controls. Depression scores and anxiety scores were higher in patients compared to controls both during hyperthyroidism (depression (median (IQR): 7.5 (5.0–9.5) vs 1.0 (0.5–2.5) P < 0.001), anxiety: 7.7 (5.0–11) vs 2.5 (1.0–4.0) P < 0.001) and after treatment (depression: 2.5 (1.5–5.0) vs 1.5 (0.5-3.5) P < 0.05), anxiety: 4.0 (2.5–7.5) vs 3.0 (1.5-5.0) P < 0.05). Patients with a previous psychiatric condition, mild eye symptoms, and a younger age had more anxiety at 15 months compared to patients without these symptoms and a higher age (all p<0.05).

Conclusion

Graves’ disease affects patients’ mood despite treatment. A previous psychiatric condition, mild eye symptoms, and a younger age increase the vulnerability for long-lasting symptoms and require specific attention.

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Agneta Lindo Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden

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Anne Breikert The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
Department of Endocrinology and Diabetes, Örebro University Hospital, Örebro, Sweden

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Peter Lakwijk The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
Thyroid Federation International, Kungsbacka, Sweden

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Christin Lundberg The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
Swedish Thyroid Association, Stockholm, Sweden

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Katarina Lunner The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
Swedish Thyroid Association, Stockholm, Sweden

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Birgitta Johansson Institute of Neuroscience and Physiology Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

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Helena Filipsson Nyström Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
Sweden and Wallenberg Center for Molecular and Translational Medicine, Västra Götaland Region, Göteborg, Sweden

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, 10 ). When the treatment goal is to improve patient function and well-being rather than prolong life, the patient's perception of their care is central and an important part of QoL measurement ( 11 ) and may need specific supportive actions. The

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Ringo Manta Department of Nuclear Medicine, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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Charlotte Martin Department of Infectious Diseases, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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Vinciane Muls Department of Gastroenterology and Endoscopy, CHU Saint-Pierre, University Libre de Bruxelles (ULB), Brussels, Belgium

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Kris G Poppe Department of Endocrinology, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

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significantly lower the risk for relapse of GD when added to the standard treatment. Although immunosuppressive drugs involved in the study included mycophenolic acid but not vedolizumab ( 14 ), specific data are lacking regarding the underlying vaccine immune

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Laure Felix Univ. Grenoble Alpes, Department of Radiology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France

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Peggy Jacon Univ. Grenoble Alpes, Department of Cardiology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France

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Maxime Lugosi Univ. Grenoble Alpes, Department of Internal Medicine, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France

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Justine Cristante Univ. Grenoble Alpes, Department of Endocrinology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France

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Julie Roux Univ. Grenoble Alpes, Department of Nuclear Medicine, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France

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Olivier Chabre Univ. Grenoble Alpes, Department of Endocrinology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France

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work did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. Consent Written consent has been obtained from the patient for publication of the results of procedures which had been used for

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Sofia Macedo Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal

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Ana Pestana Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal

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Liliana Santos Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal
North Lisbon University Hospital Center, Lisbon, Portugal

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Celestino Neves Faculty of Medicine, University of Porto, Porto, Portugal
University Hospital Center of São João, Porto, Portugal

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Susana Guimarães Faculty of Medicine, University of Porto, Porto, Portugal
University Hospital Center of São João, Porto, Portugal

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Amaro Duarte-Neto Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

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Marisa Dolhnikoff Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

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Paulo Saldiva Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

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Georgina Alves Institute for Research & Innovation in Health, University of Porto, Porto, Portugal

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Rute Oliveira Institute for Research & Innovation in Health, University of Porto, Porto, Portugal

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Didier Cabanes Institute for Research & Innovation in Health, University of Porto, Porto, Portugal

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Fátima Carneiro Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal
University Hospital Center of São João, Porto, Portugal

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Manuel Sobrinho-Simões Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal
University Hospital Center of São João, Porto, Portugal

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Paula Soares Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
Faculty of Medicine, University of Porto, Porto, Portugal

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the result of a second RNA extraction was negative for all genes after first extraction had been positive for two of the genes ( Table 2 ). In order to exclude some potential non-specificity of the viral genes amplified in the RT-PCR, we have also

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Jinson Paul Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India

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Aneez Joseph Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India

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Felix Jebasingh Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India

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Atul Ramachandra More Department of Critical Care, Christian Medical College, Vellore, India

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Julie Hephzibah Department of Nuclear Medicine, Christian Medical College Vellore, India

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Kripa Elizabeth Cherian Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India

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Nitin Kapoor Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India

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Hesarghatta Shyamsunder Asha Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India

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Nihal Thomas Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India

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studies from East Asia have emphasized the significance of genetic variants as a reason for the higher prevalence of TPP. Loss of function mutations in the skeletal muscle-specific inward rectifying K+ (Kir) channel, particularly Kir2.6, were found to be

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J Karmisholt Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
Department of Clinical Institute, Aalborg University, Aalborg, Denmark

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S L Andersen Department of Clinical Institute, Aalborg University, Aalborg, Denmark
Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark

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I Bulow-Pedersen Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
Department of Clinical Institute, Aalborg University, Aalborg, Denmark

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A Krejbjerg Department of Oncology, Aalborg University Hospital, Aalborg, Denmark

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B Nygaard Department of Endocrinology and Internal Medicine, Herlev University Hospital, Copenhagen, Denmark

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A Carlé Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
Department of Clinical Institute, Aalborg University, Aalborg, Denmark

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. Declaration of interest The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. Funding This work did not receive any specific grant from any funding agency in the

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