Clandestine thoughts and Graves' disease

We describe a 42-year-old man with Graves' disease who became thyrotoxic coincident with a major emotional trauma that was not disclosed until his third visit to the clinic. The possibility that distress denied might ignite Graves' disease via cross-talk in the psychoimmunoendocrine network is considered. We suggest that an empathic search for the stressor that activated the disease and the use of stress reduction techniques in the long- term management of Graves' disease may be useful. If nothing else, the physician may benefit from hearing the story of the individual's illness rather than the history of a patient's disease.