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Posttraumatic stress disorder and incidence of thyroid dysfunction in women

Published online by Cambridge University Press:  29 November 2018

Sun Jae Jung*
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
Jae H. Kang
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
Andrea L. Roberts
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Kristen Nishimi
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Qixuan Chen
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
Jennifer A. Sumner
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
Laura Kubzansky
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Karestan C. Koenen
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Author for correspondence: Sun Jae Jung, E-mail:



Abnormal thyroid function is prevalent among women and has been linked to increased risk of chronic disease. Posttraumatic stress disorder (PTSD) has been linked to thyroid dysfunction in some studies; however, the results have been inconsistent. Thus, we evaluated trauma exposure and PTSD symptoms in relation to incident thyroid dysfunction in a large longitudinal cohort of civilian women.


We used data from 45 992 women from the ongoing Nurses’ Health Study II, a longitudinal US cohort study that began in 1989. In 2008, history of trauma and PTSD were assessed with the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, PTSD, and incident thyroid dysfunction was determined by participants’ self-report in biennial questionnaires of physician-diagnosed hypothyroidism and Graves’ hyperthyroidism. The study period was from 1989 to 2013. Proportional hazard models were used to estimate multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for incident hypothyroidism and Graves’ hyperthyroidism.


In multivariable-adjusted models, we found significant associations for PTSD only with hypothyroidism [p-trend <0.001; trauma with no PTSD symptoms, 1.08 (95% CI 1.02–1.15); 1–3 PTSD symptoms, 1.12 (95% CI 1.04–1.21); 4–5 PTSD symptoms, 1.23 (95% CI 1.13–1.34); and 6–7 PTSD symptoms, 1.26 (95% CI 1.14–1.40)]. PTSD was not associated with risk of Graves’ hyperthyroidism (p-trend = 0.34). Associations were similar in sensitivity analyses restricted to outcomes with onset after 2008, when PTSD was assessed.


PTSD was associated with higher risk of hypothyroidism in a dose-dependent fashion. Highlighted awareness for thyroid dysfunction may be especially important in women with PTSD.

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