Hyperthyroidism and suicide: a retrospective cohort study in Sweden

Abstract

Objectives: Mental symptoms and impaired quality of life commonly occur in patients treated for hyperthyroidism. Our aim was to determine whether a history of hyperthyroidism implies an increased risk of suicide. Results: The number of observed suicide deaths was 134 in the study cohort. A naive comparison with the age-, sex-and calendar period-matched general Swedish population yielded a moderately increased standardized mortality ratio (SMR), but stratifications revealed that the excess was mainly driven by women from Stockholm, whose baseline suicide risk was higher than for women in the rest of Sweden. Using the population rates from Stockholm, the SMR among Stockholm women with Graves' disease was 1.14 (95% confidence intervals (CI) 0.66-1.86) and toxic goitre 0.99 (95% CI 0.51-1.72). A direct comparison between the study cohort and the combined comparison cohorts, with multiple adjustments (including adjustment for residence in Stockholm), yielded a relative risk of suicide of 0.93 (0.68-1.26). Conclusions: This study did not confirm an increased risk of suicide among patients treated for hyperthyroidism.

A case report of suicidal behavior related to subclinical hyperthyroidism

“…Our findings are inconsistent with those of a relatively recent large cohort study in Sweden, which concluded that patients treated for hyperthyroidism did not have an increased risk of suicide 9. Overactivity of the adrenergic system may explain the similarity between the clinical presentations of hyperthyroidism and manic episodes or anxiety disorder 10…”

Death by Suicide in Graves' Disease and Graves' Orbitopathy: A Nationwide Danish Register Study

“…At variance with us, in the only other study on this topic, Abraham-Nordling et al (16), in a similar sized group of hyperthyroid patients who were selected on the basis of having had radioiodine or thyroid surgery, did not find an increased risk of death from suicide. Reasons for this discrepancy are not obvious.…”

“…However, little is known about unnatural deaths in GD and GO patients. To our knowledge, there is only one prior study on this subject, which found no significantly increased risk of suicide in hyperthyroid patients (16).…”

“…The Swedish study (16) included individuals diagnosed between 1950 and 2005 at a time when diagnostic tools were less sophisticated and therapy more ablative, that is surgery or radioactive iodine, than the current propensity of offering antithyroid drug therapy in our patients, diagnosed between 1995 and 2012 (6,30). We included all Graves' patients, on a national level, and employed validated Danish registries (18)(19)(20)23), while the Swedish study mainly included individuals from one region, Stockholm (16), and in contrast to our four matched controls, took advantage of one cohort hospitalized due to non-toxic goitre, and one undergoing cholecystectomy without control for pre-existing morbidity. Thus, we suggest that the disease burden of the control groups in the two studies may well have differed and that the studies are de facto incomparable.…”

All-cause and cardiovascular mortality risk after surgery versus radioiodine treatment for hyperthyroidism

“…Although the database is part of a nationwide equivalent that covers the years 1950–2000, it is considered to be essentially complete for the greater Stockholm area only during the years 1976–2000. The cohort has been described and used for research previously.…”