Hygienic assessment of the effects of pesticides application on adult population morbidity with thyroid gland diseases.

OBJECTIVE: Introduction: It is proved that some groups of fungicides and herbicides are capable of affecting the thyroid gland, provoking its growth, leading to a compensatory change in the activity of the hormones synthesis. Therefore, the presence of their residual amounts in plant may affect the level of thyroid gland pathology. The aim of the work was to analyze the influence of pesticide application on the Ukrainian adult population morbidity with thyroid diseases in the period from 2001 to 2014. PATIENTS AND METHODS: Materials and methods: The methods of empirical and theoretical research of scientific information, namely analysis, synthesis, induction, deduction and systematization, epidemiological, cartographic and statistical methods were used. RESULTS: Results: The maximum level of thyroid pathology was found in the northern, western and northwestern regions, where the diffuse goiter dominates in the morbidity and prevalence of thyroid diseases; minimal - in the southern, eastern and south-eastern regions. It was established that the highest volumes of application of chemical plant protection products in the period 2001-2013 took place in the southern and central regions of Ukraine, namely in Poltava, Vinnitsa, Kharkiv, Dnipropetrovsk, Khmelnytsky, Odesa and Mykolaiv regions. Sufficiently high levels of pesticide application were in the Kyiv, Kherson regions, Crimea, Zaporizhia, Kirovograd and Cherkasy regions. CONCLUSION: Conclusions: The probability of the active chemical plant protection products usage effect on the level of prevalence and incidence of thyroid cancer, various types of goiter, hypothyroidism, thyrotoxicosis and thyroiditis in the central and southern regions was determined. Are regions with well-developed agricultural production.

The spectrum, incidence, kinetics and management of endocrinopathies with immune checkpoint inhibitors for metastatic melanoma.

OBJECTIVE: Endocrine immune-related adverse events (endocrinopathies) are increasingly prevalent with the use of immune checkpoint inhibitors for the treatment of metastatic melanoma and other malignancies. There are no evidence-based guidelines for the screening or management of such patients. To describe the spectrum, incidence, kinetics and management of endocrinopathies with immune checkpoint inhibitors. DESIGN: A prospective study conducted at Melanoma Institute Australia between April 2014 and October 2015. METHODS: A total of 177 patients were treated with (a) ipilimumab (n = 15), (b) anti-PD-1 (nivolumab, pembrolizumab) (n = 103) or (c) combination ipilimumab and anti-PD-1 (n = 59) and were screened and managed for the subsequent endocrinopathies. The main outcome measures were the incidence and kinetics of endocrinopathy by immunotherapy drug class. RESULTS: Thirty-one patients (18%) developed an endocrine immune-related adverse event (thyroid dysfunction: 14%, hypophysitis: 6% and autoimmune diabetes: 0.6%). Combination immunotherapy was more likely to result in a single or multiple endocrinopathy compared to anti-PD-1 monotherapy (27% vs 9% and 7% vs 0% respectively, P < 0.01). Endocrinopathies occurred after a median of 8 weeks from treatment commencement (range: 12-225 days), with combination immunotherapy resulting in significantly earlier onset compared to ipilimumab (median: 30 vs 76 days, P = 0.046). The majority of endocrinopathies were identified in asymptomatic patients with hormonal screening. There were no baseline predictors for endocrinopathy. CONCLUSIONS: Combination immunotherapy has a greater risk of development of endocrinopathy compared to anti-PD-1 monotherapy. Regular biochemical profiling of patients, particularly within the first twelve weeks, results in early detection of endocrinopathy to minimise morbidity.

Association of Surgeon Volume With Outcomes and Cost Savings Following Thyroidectomy: A National Forecast.

IMPORTANCE: Incidence of thyroidectomies is continuing to increase. Identifying factors associated with favorable outcomes can lead to cost savings. OBJECTIVE: To assess the association of surgeon volume with clinical outcomes and costs of thyroidectomy. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis performed in October of 2014 of adult (≥ 18 years) inpatients in US community hospitals using the Nationwide Inpatient Sample for the years 2003 through 2009. EXPOSURES: Thyroidectomy. MAIN OUTCOMES AND MEASURES: Complications, length of stay, and cost following thyroidectomy in relation to surgeon volume. Surgeon volumes were stratified into low (1-3 thyroidectomies per year), intermediate (4-29 thyroidectomies per year), and high (≥ 30 thyroidectomies per year). RESULTS: A total of 77,863 patients were included. Procedures performed by low-volume surgeons were associated with a higher risk of postoperative complications compared with high-volume surgeons (15.8% vs 7.7%; OR, 1.55 [95% CI, 1.19-2.03]; P = .001). Mean (SD) hospital cost was significantly associated with surgeon volume (high volume, $6662.69 [$409.31]; intermediate volume, $6912.41 [$137.20]; low volume, $10,396.21 [$345.17]; P < .001). During the study period, if all operations performed by low-volume surgeons had been selectively referred to intermediate- or high-volume surgeons, savings of 11.2% or 12.2%, respectively, would have been incurred. On the basis of the cost growth rate, greater savings are forecasted for high-volume surgeons. With a conservative assumption of 150,000 thyroidectomies per year in the United States, referral of all patients to intermediate- or high-volume surgeons would produce savings of $2.08 billion or $3.11 billion, respectively, over a span of 14 years. CONCLUSIONS AND RELEVANCE: A surgeon's expertise (measured by surgical volume of procedures per year) is associated with favorable clinical as well as financial outcomes. Our model estimates that considerable cost savings are attainable if higher-volume surgeons perform thyroid procedures in the United States.

[Assessment of the efficiency of prevention of iodine deficiency among the children's population of the city of Mezhdurechensk of the Kemerovo region].

In the article there are presented results of a study of indices of ioduria in preschool kids and school children of the city of Mezhdurechensk (south of the Kemerovo region). 411 children aged of 3-17 years participated in the study. The median of ioduria on preschooler kids was 97,0 pg/l, and the proportion of urine samples with iodine levels less than 50 pg/l - 1,0%. The median of ioduria in school children is 98,0 pg/l, the percentage of urine samples with iodine levels less than 50 pg/l accounts for 1,3%. On average, on the population of children there was established that the percentage of urine samples with iodine levels from 50-100 pg/l (mild deficiency) was detected in 53,5% of children. Comparative analysis of indices of the level of ioduria according to data obtained in 2008 and 2014 in a group of school children showed that the measures taken to prevent diseases caused by iodine deficiency (the use of iodized salt in the diet of children and adolescents from organized groups on a regular basis) have given positive results.

[Thyroid gland pathology in children population exposed to the combination of iodine deficiency and fluoride pollution of environment].

The article presents results of study of the impact of iodine deficiency and technogenic fluoride on the state of the thyroid gland in children. On the example of two districts of the city of Bratsk there were executed dynamic investigations (2002 and 2012), including the estimation of the pollution of ambient air and soil by fluorine compounds, levels of iodine intake by the body, the clinical examination of children aged from 5 to 7 years d and interviewing of their parents. In the course of the medical examination there were executed: physical examination by the pediatrician, endocrinologist, ultrasound examination of the thyroid gland, the determination both of serum hormone content by radioimmunoassay and urinary excretion offluorine and iodine. Concentrations of hydrogen fluoride and a solidfluorides in ambient air led to the accumulation offluoride ion in the soil. The iodine entering with drinking water and food, was established to provide only 37.5-50% of the daily requirement of iodine. Increased fluoride ion content in urine and milk teeth in children is associated with the concentrations of the fluorine-containing pollutants in the ambient air and soil. The fluoride pollution against the background of the natural iodine deficiency was established to increase the frequency of functional and morphological disorders of the thyroid gland in children.

The chernobyl accident 20 years on: an assessment of the health consequences and the international response.

BACKGROUND: The Chernobyl accident in 1986 caused widespread radioactive contamination and enormous concern. Twenty years later, the World Health Organization and the International Atomic Energy Authority issued a generally reassuring statement about the consequences. Accurate assessment of the consequences is important to the current debate on nuclear power. OBJECTIVES: Our objectives in this study were to evaluate the health impact of the Chernobyl accident, assess the international response to the accident, and consider how to improve responses to future accidents. DISCUSSION: So far, radiation to the thyroid from radioisotopes of iodine has caused several thousand cases of thyroid cancer but very few deaths ; exposed children were most susceptible. The focus on thyroid cancer has diverted attention from possible nonthyroid effects, such as mini-satellite instability, which is potentially important. The international response to the accident was inadequate and uncoordinated, and has been unjustifiably reassuring. Accurate assessment of Chernobyl's future health effects is not currently possible in the light of dose uncertainties, current debates over radiation actions, and the lessons from the late consequences of atomic bomb exposure. CONCLUSIONS: Because of the uncertainties over the dose from and the consequences of the Chernobyl accident, it is essential that investigations of its effects should be broadened and supported for the long term. Because of the problems with the international response to Chernobyl, the United Nations should initiate an independent review of the actions and assignments of the agencies concerned, with recommendations for dealing with future international-scale accidents. These should involve independent scientists and ensure cooperation rather than rivalry.

[Hygienic assessment of the impact of environmental factors of the Primorye Territory on the incidence of thyroid diseases].

The paper gives the ecological and hygienic characteristics of the Primorye Territory. It describes bioclimatic zones and ecological tension areas. The results of studies of the prevalence of thyroid diseases (diffuse endemic goiter, multinodular endemic goiter, subclinical hypothyroidism) associated with iodine deficiency in relation to the bioclimatic zone and the ecological situation are shown. The findings permit the planning and implementation of therapeutic-and-prophylactic measures for prevention iodine deficiency among the population of the Primorye Territory.

[Etiological assessment of hyperthyrotropinemia in children with Down's syndrome]. / Avaliação etiológica da hipertirotropinemia em crianças com síndrome de Down.

OBJECTIVE: To study the prevalence of increased TSH level and its probable cause in children with Down's syndrome treated at Policlínica Antônio Cândido. METHODS: The data were collected using medical records of 169 patients. Of these, 46 patients, whose TSH increased at some time during their follow-up, were re-evaluated. In these patients, TSH, free T4, total T4 and thyroid peroxidase autoantibody (anti-TPO) levels were measured. Thyroid ultrasound, iodine-131 scintigraphy, and a perchlorate discharge test were performed. RESULTS: In 169 children, 86 (50.8%) of whom were male, aged between 1-16 years (median 4 years), 67 (39.6%) presented increased TSH levels. Out of these 67 patients, 46 were prospectively studied. In 31 (67.4%) of them serum TSH returned to normal levels; in 11, TSH remained between 5 and 10 microU/ml, three (6.5%) had a TSH level over 10 microU/ml and one (2.2%) had hyperthyroidism. The diagnoses in 34 patients who were fully studied were: goiter in five (14.7%); Hashimoto's thyroiditis in four (5.9%); hypoplasia in three (8.8%) and iodide organification defect in one (2.9%). The increased TSH levels had a statistically positive relationship with anti-TPO (p = 0.02), but not with gender, abnormal ultrasound or scintigraphy findings. TSH levels did not have any relationship with persistent hyperthyrotropinemia. CONCLUSIONS: In patients with Down's syndrome, slightly elevated and transient TSH levels are frequently detected. Positive anti-TPO antibody test is a key factor in the follow-up of these patients because of its potential risk of progression to manifest thyroid disease.

Avaliação etiológica da hipertirotropinemia em crianças com síndrome de Down / Etiological assessment of hyperthyrotropinemia in children with Down's syndrome

OBJETIVO: Analisar a prevalência de hipertirotropinemia e estudar sua possível etiologia em crianças com síndrome de Down atendidas na Policlínica Municipal Antônio Cândido, em Belo Horizonte. MÉTODOS: Foram utilizados os dados dos prontuários de todas as crianças com síndrome de Down atendidas na policlínica para o cálculo da prevalência da alteração do hormônio estimulante da tireóide (TSH). As crianças que tiveram TSH elevado (maior que 5 µUI/ml) em pelo menos um exame foram convocadas para novas dosagens de TSH, T4livre, T4total e auto-anticorpo antiperoxidase (ATPO), realização de ultra-som da tireóide, tireograma com iodo-131 e teste de descarga do perclorato. As alterações encontradas nos exames das crianças que permaneceram com TSH elevado foram comparadas com as das que normalizaram os valores de TSH. RESULTADOS: Foram encontradas, em 169 crianças com síndrome de Down, 86 (50,8 por cento) masculinas, idade entre 1-6 anos (mediana de 4 anos), 67 (39,6 por cento) com TSH aumentado, as quais foram convocadas para novas avaliações, comparecendo 46. Nesses pacientes, o TSH se normalizou em 31 (67,4 por cento); em 11 (23,9 por cento) permaneceu entre 5-10 µUI/ml; em três (6,5 por cento) ficou acima de 10 µUI/mL; e em uma (2,2 por cento) constatou-se hipertireoidismo. Os diagnósticos realizados nos pacientes com propedêutica completa (n = 34) foram: bócio (14,7 por cento), hipoplasia (8,8 por cento), tireoidite de Hashimoto (5,9 por cento), defeito na organogênese de iodo (2,9 por cento). Não se evidenciou relação entre as amplitudes dos valores de TSH e a persistência da hipertirotropinemia. Crianças com ATPO positivo estavam associadas a TSH elevado (p = 0,02). CONCLUSÕES: Na síndrome de Down, são freqüentes valores de TSH discretamente elevados e instáveis, sendo suas etiologias variáveis. A presença de ATPO mostrou-se importante no seguimento dessas crianças pelo risco potencial de evolução para doença tireoidiana manifesta.

Thyroid disease in northern Italian children born around the time of the Chernobyl nuclear accident.

BACKGROUND: The Chernobyl nuclear accident of 1986 caused a dramatic increase in the incidence of thyroid cancers in exposed children in Belarus. Airborne radioactivity from the reactor spread over northern Italy, where rainout gave rise to low levels of radioactivity at ground level. PATIENTS AND METHODS: As the latency between exposure to ionising radiation and development of thyroid cancer is thought to be about 10 years, in 1996/1997 all children born in 1985 and 1986 and attending school in an area of Milan, Italy were examined for thyroid nodules. A total of 3949 children were examined by two physicians blinded to the examination and diagnosis of the other. The children were to be reassessed in 2001/2002. RESULTS: In total, 1% had palpable nodules. The nodule diagnoses were: Hurtle cell adenoma (one), thyroglossal duct cyst (one), thyroid cyst (four) and thyroiditis (four). The prevalence of thyroid disease in the cohort was indistinguishable from that of populations not exposed to radioactive pollution. Only 10 children re-presented for examination 5 years later; all were negative. The direct costs of the study were estimated at 21,200 Euros. CONCLUSION: The high cost of the study in relation to reassuring lack of increase in thyroid nodule prevalence suggests that further studies are not justified.

Toxicology review and risk assessment of resorcinol: thyroid effects.

Resorcinol administered at high doses to rodents can disrupt thyroid hormone synthesis and can produce goitrogenic effects. These effects were not seen in a 2-year bioassay at doses of up to 520 mg/kg/day. There are species-specific differences in synthesis, binding, and transport of thyroid hormone that complicate interpretation of goitrogenesis in rodents. Clinical case reports from patients undergoing resorcinol therapy for dermatological indications reveal thyroid side effects when copious amounts of resorcinol-containing ointments are applied to integrity-compromised skin for months to years. Effect levels were greater than 34 mg/kg/day. Occupational epidemiology studies provide no evidence that exposure to resorcinol at levels greater than found in the general environment causes thyroid dysfunction. Studies investigating the relationship between endemic goiter and exposure to "phenolics," including resorcinol, in drinking water do not fulfill accepted scientific criteria for establishing resorcinol as a cause of thyroid disease. Those reports neither quantify exposure levels nor demonstrate dose-response relationships or rule out confounding by the multiple other chemicals present in water supplies, by bacterial contamination of water, or by nutritional factors. A risk assessment comparing potential worst-case exposures to resorcinol through its use in dermatological preparations supports the conclusion that under real-world conditions, human exposures to resorcinol are not expected to cause adverse effects on thyroid function.

Prevalence of thyroid diseases in Nevada counties with respect to perchlorate in drinking water.

Perchlorate is well-known to inhibit the uptake of iodine by the thyroid and has been shown to do so at doses in the milligrams-per-day range and higher. Perchlorate has been found in the water supply of Clark County (Las Vegas), Nevada, at 4 to 24 micrograms/L (parts per billion) and may provide exposure dosages in the tens of micrograms per day. An analysis of the Medicaid database from Nevada was undertaken to determine whether an increase in the prevalence of any thyroid disease was associated with that level of perchlorate content. The prevalence of persons being seen for thyroid disease or for specific thyroid diseases (goiter, nodule, thyrotoxicosis, congenital hypothyroidism, acquired hypothyroidism, thyroiditis, and other thyroid disorders) and for thyroid cancer among the Medicaid-eligible population of each county was calculated for the 2-year period 1997 to 1998. The prevalences in Clark County were compared with those in Washoe County (i.e., Reno), the second most populous county in the state, and with those for the rest of the state. There was no evidence of an increased rate of thyroid disease (or of any specific thyroid disease) associated with perchlorate exposure. Generally, the prevalences in the metropolitan parts of the state were lower than for the rest of the state, particularly for acquired hypothyroidism. This analysis found no evidence that perchlorate-containing drinking water at the given level increased the prevalence of acquired hypothyroidism or of any other thyroid condition.

[The use of a thyroid collar for intraoral radiography]. / Het gebruik van een loodkraag bij intraorale röntgenopnamen.

OBJECTIVE: To determine whether a thyroid collar is a reasonable measure to reduce patient exposure from intraoral radiography (cost benefit analysis). DESIGN: In the thyroid gland of a Rando phantom dose measurements were carried out to determine the effect of a thyroid collar during intraoral radiography. SETTING: Department of Oral Radiology at ACTA, Amsterdam. METHODS: Dose measurements were carried out using LTDs. The average absorbed dose to the thyroid gland with and without thyroid collar from intraoral radiography was compared using an analysis of variance. RESULTS: For periapical radiographs the equivalent dose to the thyroid gland was significantly lower (p < 0.05) when a thyroid collar was used. For bitewing radiography there were no significant effects of the thyroid collar (p > 0.05). The cost benefit analysis showed that it takes more than 40 years before the benefits of a thyroid collar exceed the costs. CONCLUSION: Collective use of thyroid collars therefore does not seem to be a reasonable measure to optimize radiological protection during intraoral radiography.

Dose assessment activities in the Republic of the Marshall Islands.

Dose assessments, both retrospective and prospective, comprise one important function of a radiological study commissioned by the Republic of the Marshall Islands (RMI) government in late 1989. Estimating past or future exposure requires the synthesis of information from historical data, results from a recently completed field monitoring program, laboratory measurements, and some experimental studies. Most of the activities in the RMI to date have emphasized a pragmatic rather than theoretical approach. In particular, most of the recent effort has been expended on conducting an independent radiological monitoring program to determine the degree of deposition and the geographical extent of weapons test fallout over the nation. Contamination levels on 70% of the land mass of the Marshall Islands were unknown prior to 1994. The environmental radioactivity data play an integral role in both retrospective and prospective assessments. One recent use of dose assessment has been to interpret environmental measurements of radioactivity into annual doses that might be expected at every atoll. A second use for dose assessment has been to determine compliance with a dose action level for the rehabilitation of Rongelap Island. Careful examination of exposure pathways relevant to the island lifestyle has been necessary to accommodate these purposes. Examples of specific issues studied include defining traditional island diets as well as current day variations, sources of drinking water, uses of tropical plants including those consumed for food and for medicinal purposes, the nature and microvariability of plutonium particles in the soil and unusual pathways of exposure, e.g., that which might be associated with cooking and washing outdoors and inadvertent soil ingestion. A study on the prevalence of thyroid disease is also being conducted and the geographic pattern of disease may be useful as a bioindicator of the geographic pattern of exposure to radioiodine. Finally, an examination is underway of gummed film, fixed-instrument, and aerial survey data accumulated during the 1950's by the Health and Safety Laboratory of the U.S. AEC. This article gives an overview of these many different activities and a summary of recent dose assessments.

[Clinico-ultrasonographic assessment of the thyroid volume and function in chronic enteritis and colitis: preliminary data]. / Valutazione clinico-ecografica del volume e della funzione tiroidea nelle enteriti e coliti croniche: dati preliminari.

Inflammatory bowel diseases (IBD) such as Crohn's disease (CD) and ulcerative colitis (UC) have frequent extraintestinal (hepatobiliary, cutaneous, ocular, articular, urinary) complications. On the contrary, no data are available about possible thyroid involvement. We studied thyroid morphology and function in 39 patients affected with active IBD (13 UC; 26 CD) before (all) and 45 and 90 days after onset of therapy (21/39), and in 55 normal control subjects. Every time, the following exams were performed: thyroid US (parenchymal assessment, thyroid volume calculation), hormone and immunologic assays (T3, T4, FT3, FT4, TSH; antithyroglobulin and antithyroid microsomal/peroxidase antibodies). A statistically significant increase in thyroid volume was found in IBD (mean: 22.1 ml) compared to control subjects (mean: 15.6 ml), more frequently in CD (18/26 patients; 69.2%) than in UC (2/13 patients; 15.4%). Parenchymal structure was inhomogeneous in the two groups of patients (88.4% CD; 15.4% UC) more frequently than in control subjects (12.7%). Hormone assays demonstrated increased FT4 values in UC (9/13 patients; 69.2%) and decreased T4 values in CD (14/26 patients; 53.8%). IBD patients increased frequency of antithyroglobulin and antithyroid microsomal/peroxidase antibodies. Such abnormalities subsided only partially after therapy. Our data suggest that in IBD there is a frequent thyroid involvement with morphological, hormone, and immunologic abnormalities.

Surgery still has a role in Graves' hyperthyroidism.

BACKGROUND: A recent survey of American thyroidologists defining their management of a 43-year-old woman with hyperthyroid Graves' disease and a thyroid weighing 40 to 50 grams revealed that 69% recommended iodine 131 therapy, 30% prolonged antithyroid drug therapy, and only 1% operation. If the patient was younger or had a larger thyroid, 4% to 7% of the respondents recommended operation. METHODS: In our clinic we often recommend operation for young adult patients with large goiters who have had recurrent hyperthyroidism after antithyroid drug (ATD) therapy, have allergic reactions to ATD, are not compliant, are ATD failures, or refuse 131I therapy. Thus operation for Graves' disease is recommended more frequently in our clinic than this survey indicates. From 1980 to 1992, 81 patients with Graves' disease (15 men and 66 women; mean age, 30 years) underwent a subtotal thyroidectomy. Patients had been pretreated with antithyroid drugs and saturated solution of potassium iodide, and thyroid conditions were normal at the time of operation. All patients underwent subtotal thyroidectomy by one surgeon and 3 to 5 grams of thyroid were left on each side. RESULTS: There was no permanent recurrent nerve damage or hypoparathyroidism. Hyperthyroidism recurred in one patient (1.2%). Hypothyroidism developed in 59% of our patients, 77% within 1 year after operation, which was easily managed with replacement doses of levothyroxine. Ophthalmopathy had not developed or progressed in any patient, as has recently been suggested to occur after 131I therapy of Graves' disease. CONCLUSIONS: Because our patients are almost always hospitalized for no more than 24 to 36 hours, have had no complications except for hypothyroidism, have had their disease abruptly terminated, did not have ophthalmopathy, required far fewer physician visits and laboratory tests compared with patients treated with ATD or 131I, surgery remains a reasonable approach to the management of Graves' disease.

An assessment of the risk of developing hyperparathyroidism and thyroid disorders subsequent to neck irradiation in middle-aged women.

We investigated the occurrence of thyroid and parathyroid disorders in 100 women (age 66-70 years) irradiated for cervical spondylosis on average 25 years previously and in 100 control women of similar age. Hyperparathyroidism (HPT), proven by operation, was diagnosed in one patient of each group, and three additional cases were diagnosed biochemically among irradiated women. The difference in incidence is not significant. Nor was there any significant difference in incidence of thyroid disorders. No thyroid carcinoma was found in either group. Even if there is a moderate increase of HPT after neck irradiation in middle-aged women the risk is not so great as to warrant organised follow-up.