Objective: Although psychological stress and smoking have been proposed as contributing factors to Graves' disease, their independent roles in the pathogenesis of this disease have not been determined. We assessed the association between Graves' disease and psychological stress and smoking by using multivariate analysis. Methods: By a matched case-control method, we investigated the association between Graves' disease and stressful life events, dally hassles, smoking, drinking habits, coping skills, and social support in 228 patients (182 women and 46 men) with newly diagnosed Graves' disease; we used the conditional maximum likelihood method. Results: After data were adjusted for daily hassles, smoking, drinking habits, social support, and coping skills, we found that stressful life events were significantly associated with the risk of Graves' disease in women. The relative risk was 7.7 for women with the highest stress score compared with women with the lowest stress score (95% confidence interval, 2.2 to 27, p for trend < .001). Smoking was also independently associated with the risk of Graves' disease in women. The relative risk for women with the highest number group compared with women with the lowest number group for smoking cigarettes was 5.1 (95% confidence interval, 1.0 to 27; p for trend < .001). These factors were not significantly associated with Graves' disease in men. Conclusions: Psychological stress and smoking were associated with Graves' disease in women, but not in men.
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