{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T02:21:03Z","timestamp":1789266063839,"version":"build-2803163510"},"reference-count":19,"publisher":"FapUNIFESP (SciELO)","issue":"6","license":[{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE Even though stress has been long known as a provocative factor for Graves\u2019 disease, its relationship with Hashimoto's thyroiditis is more controversial. Studies on this topic are scanty. This paper aims to report a case of stress-induced Hashitoxicosis.  RESULTS Here we report a case of Hashitoxicosis induced by a psychological stressful event in a 28-year-old woman with Hashimoto's thyroiditis. She had remained stably euthyroid for 12 years. She was first observed in April 2016, while euthyroid. She came back after 11 months because of fatigue and palpitations, in the absence of neck pain. Thyroid function tests revealed moderate thyrotoxicosis (undetectable TSH; FT4 36.94 pmol\/L, normal values 9.0-24.46; FT3 13.50 pmol\/L, normal values 3.07-6.14) with negative TSH-receptor antibodies. In the previous three months, she had experienced a psychological stressful event. Inflammatory markers were negative, and the white cell count was normal. Thyroid ultrasound revealed a modest increase in vascularization. Transient subclinical hypothyroidism ensued after seven weeks and spontaneously recovered. On the last visit, the patient was still on euthyroidism. (TSH 1.01 mU\/L; FT4 9.22 pmol\/L; FT3 3.98 pmol\/L). We also performed HLA serotyping and genotyping.  CONCLUSION This case demonstrates that, similarly to Graves\u2019 disease, Hashitoxicosis can also be triggered by stressful life events.<\/jats:p>","DOI":"10.1590\/1806-9282.65.6.830","type":"journal-article","created":{"date-parts":[[2019,7,20]],"date-time":"2019-07-20T15:07:27Z","timestamp":1563635247000},"page":"830-833","source":"Crossref","is-referenced-by-count":5,"title":["Stress-induced hashitoxicosis: case report and relative HLA serotype and genotype"],"prefix":"10.1590","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5977-3062","authenticated-orcid":false,"given":"Roberto","family":"Vita","sequence":"first","affiliation":[{"name":"University of Messina,  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4396-5032","authenticated-orcid":false,"given":"Valeria","family":"Cernaro","sequence":"additional","affiliation":[{"name":"AOU Policlinico G. Martino,  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-5342","authenticated-orcid":false,"given":"Salvatore","family":"Benvenga","sequence":"additional","affiliation":[{"name":"University of Messina,  Italy; University of Messina,  Italy; University hospital Policlinico G,  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2019,6]]},"reference":[{"issue":"5","key":"ref1","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1097\/MED.0b013e3282ef1c48","article-title":"Environmental factors and genetic background that interact to cause autoimmune thyroid disease","volume":"14","author":"Guarneri F","year":"2007","journal-title":"Curr Opin Endocrinol Diabetes Obes."},{"key":"ref2","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jaut.2015.07.009","article-title":"Immunogenetics of autoimmune thyroid diseases: a comprehensive review","volume":"64","author":"Lee HJ","year":"2015","journal-title":"J Autoimmun."},{"issue":"4","key":"ref3","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s11154-016-9363-2","article-title":"Molecular mimicry and autoimmune thyroid disease","volume":"17","author":"Benvenga S","year":"2016","journal-title":"Rev Endocr Metab Disord."},{"issue":"1","key":"ref4","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s12020-014-0289-8","article-title":"Stress triggers the onset and the recurrences of hyperthyroidism in patients with Graves\u2019 disease","volume":"48","author":"Vita R","year":"2015","journal-title":"Endocrine."},{"issue":"1","key":"ref5","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s12020-016-0909-6","article-title":"Certain HLA alleles are associated with stress-triggered Graves\u2019 disease and influence its course","volume":"55","author":"Vita R","year":"2017","journal-title":"Endocrine."},{"issue":"1","key":"ref6","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1038\/ncpendmet1006","article-title":"A patient with stress-related onset and exacerbations of Graves disease","volume":"5","author":"Vita R","year":"2009","journal-title":"Nat Clin Pract Endocrinol Metab."},{"issue":"6","key":"ref7","doi-asserted-by":"crossref","first-page":"R241","DOI":"10.1530\/EJE-14-0047","article-title":"Mechanisms in endocrinology: autoimmune thyroid disease: old and new players","volume":"170","author":"Effraimidis G","year":"2014","journal-title":"Eur J Endocrinol."},{"issue":"5-6","key":"ref8","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1159\/000104859","article-title":"Stress and autoimmune thyroid diseases","volume":"13","author":"Bagnasco M","year":"2006","journal-title":"Neuroimmunomodulation."},{"issue":"2","key":"ref9","first-page":"107","article-title":"Triggering role of emotional stress and childbirth. Unexpected occurrence of Graves\u2019 disease compared to 96 cases of Hashimoto thyroiditis and 97 cases of thyroid nodules","volume":"59","author":"Martin-du Pan RC","year":"1998","journal-title":"Ann Endocrinol (Paris)."},{"issue":"8","key":"ref10","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/j.psyneuen.2011.12.009","article-title":"Involvement of stress in the pathogenesis of autoimmune thyroid disease: a prospective study","volume":"37","author":"Effraimidis G","year":"2012","journal-title":"Psychoneuroendocrinology."},{"issue":"3","key":"ref11","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.bbi.2004.07.003","article-title":"Stress is not associated with thyroid peroxidase autoantibodies in euthyroid women","volume":"19","author":"Strieder TG","year":"2005","journal-title":"Brain Behav Immun."},{"issue":"1","key":"ref12","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1177\/0020764003049001151","article-title":"Is there an association between life events, postnatal depression and thyroid dysfunction in thyroid antibody positive women?","volume":"49","author":"Oretti RG","year":"2003","journal-title":"Int J Soc Psychiatry."},{"key":"ref13","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1196\/annals.1366.015","article-title":"The role of stress in the clinical expression of thyroid autoimmunity","volume":"1088","author":"Tsatsoulis A","year":"2006","journal-title":"Ann N Y Acad Sci."},{"issue":"4","key":"ref14","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1089\/thy.2007.0234","article-title":"Changed presentation of Hashimoto's thyroiditis in North-Eastern Sicily and Calabria (Southern Italy) based on a 31-year experience","volume":"18","author":"Benvenga S","year":"2008","journal-title":"Thyroid."},{"issue":"10","key":"ref15","first-page":"682","article-title":"Hyperthyroidism associated with histologic Hashimoto's thyroiditis","volume":"46","author":"Fatourechi V","year":"1971","journal-title":"Mayo Clin Proc."},{"issue":"4-5","key":"ref16","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.autrev.2014.01.007","article-title":"Hashimoto thyroiditis: clinical and diagnostic criteria","volume":"13","author":"Caturegli P","year":"2014","journal-title":"Autoimmun Rev."},{"issue":"4","key":"ref17","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1038\/gene.2008.26","article-title":"Analysis of HLA class II genes in Hashimoto's thyroiditis reveals differences compared to Graves\u2019 disease","volume":"9","author":"Zeitlin AA","year":"2008","journal-title":"Genes Immun."},{"issue":"2","key":"ref18","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/0198-8859(94)00089-9","article-title":"HLA-A and -DRB4 genes in controlling the susceptibility to Hashimoto's thyroiditis","volume":"42","author":"Wan XL","year":"1995","journal-title":"Hum Immunol."},{"issue":"2","key":"ref19","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1089\/105072501300042901","article-title":"Association of DRB1*04-DQB1*0301 haplotype and lack of association of two polymorphic sites at CTLA-4 gene with Hashimoto's thyroiditis in an Italian population","volume":"11","author":"Petrone A","year":"2001","journal-title":"Thyroid."}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/ramb\/v65n6\/1806-9282-ramb-65-06-0830.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T15:42:37Z","timestamp":1581090157000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302019000600830&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":19,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6]]}},"alternative-id":["S0104-42302019000600830"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.65.6.830","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}