Childhood adversity and autoimmune thyroid diseases: A systematic review

Autoimmune thyroid diseases (AITDs) are among the most prevalent autoimmune conditions, particularly in women. While genetic and biological mechanisms have been studied, the potential role of psychosocial factors, such as childhood adversities, in the aetiology of AITDs remains poorly understood. Emerging evidence from psychoneuroimmunology suggests that childhood adversities may contribute to long-term immune dysregulation, potentially increasing susceptibility to autoimmune disease. This systematic review aimed to enhance understanding of AITDs, including Graves' disease and Hashimoto's thyroiditis, by synthesising evidence of associations between childhood adversity and thyroid autoimmune outcomes, with particular attention to how childhood adversity was measured across studies. A systematic search of databases was conducted from July to December 2025, and included: PubMed, PsychINFO, Scopus, MEDLINE, and Google Scholar. Eligible studies included peer-reviewed research examining childhood adversity in relation to autoimmune thyroid disease in adult populations. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and certainty of the evidence was evaluated using the GRADE approach. Four studies met the inclusion criteria, including two case-control studies and two longitudinal cohort studies, and findings were synthesised narratively. Two cohort studies examined broader autoimmune disease outcomes that included thyroid disease, with greater cumulative ACE exposure associated with increased autoimmune disease risk. Two case-control studies provided more direct evidence regarding AITDs, with emotional neglect showing associations with autoimmune thyroid diseases in both studies. However, the small number of studies and substantial methodological heterogeneity limited the strength and comparability of the available evidence. The available evidence suggests a possible association between childhood adversity and AITDs, yet the small number of included studies, substantial methodological heterogeneity, and very low certainty of the evidence preclude firm conclusions regarding the strength or consistency of this association. Further prospective longitudinal studies using standardised measures of childhood adversity and clearly defined thyroid autoimmune outcomes are needed.