Describe the aim of this project.

We’re studying the event of military deployment to find out if stressful life events precede Graves’ disease.

Why is this work important?

For military personnel (including Australians), if deployment is associated with future Graves’ disease it could mean that this condition might be added to the list of those related to military service. More broadly, it would give an explanation for why people might have developed their disease. It would also prompt mechanistic studies to find the immune pathway leading to Graves’ disease. And lastly, our data may be used to predict patients at highest risk of Graves’ disease, with the aim of trialing preventative strategies in in the future.

What have you discovered about Graves’ disease so far?

My team and I have discovered that there are likely racial differences in Graves’ disease incidence. Our first study, using U.S. military data, found that Graves’ disease is more common in black and Asian-American service personnel. Later, we went on to find that the same pattern in Americans aged less than 50 years, an age group where Graves’ disease is the overwhelming cause of hyperthyroidism. What’s fascinating about this racial pattern is that it is the opposite to Hashimoto’s thyroiditis, the major cause of hypothyroidism.

What aspect of this research excites you the most?

Firstly, this study could give the most definitive answer for whether stressful events precede Graves’ disease, a question that was first raised in the initial case reports of the condition published in the early 1800s. One key difference in our study compared with previous work is that all the exposures of interest were recorded at the time they occurred, which will prevent an important type of bias called recall bias, which could potentially have affected previous studies.

Secondly, providing strong proof that stressful life events precede Graves’ disease will prompt mechanistic studies and potentially trials of prevention strategies. Thirdly, we will not only be examining stress, we will also be assessing other potential exposures including infections.

Stressful life events have been associated with other autoimmune diseases e.g. lupus. What’s going on here?

It’s a great question, and one currently without an answer. There has also been a very small Swedish study of children with type 1 diabetes that also suggests exposure to stressful events are important. One could speculate that stress sets up a neuronal or hormonal environment that lessens self-tolerance or increases autoantibody production.

But not all autoimmune conditions have been associated with stress; for example there is no evidence that Hashimoto’s thyroiditis incidence is increased. So I think the first key step is to get high quality evidence of an association in one target condition (Graves’ disease), and that’s what my study is about.

How long before your work impacts patient care?

Our study will be ongoing for several years, but once completed, it could be used immediately in describing to patients why they may or may not have developed Graves’ disease. The translation of the study’s results will take some time after that.

What’s your Holy Grail – the one thing you’d like to achieve in your research career?

I want to continue to find the best ways of answering important questions in thyroid disease.

What is your biggest research hurdle?

The ongoing challenge is building a sustainable research program. This involves continuing to attract research funding in the current difficult environment, and balancing clinical, research, and family commitments.

Who has inspired you in work or life?

I’ve had many wonderful clinical and research mentors who have been inspiring and have been great models for me in my career. I also take inspiration from my patients – one great privilege of being a clinician is that you are let into people’s lives and experience their highs and lows up close.

Describe your perfect day.

Probably a simple day at home with the family: small sleep in, breakfast at the local café, some sort of sport with the kids, cooking dinner at home.