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Calcaterra V, Mameli C, Rossi V, Massini G, Gambino M, Baldassarre P, Zuccotti G. The Iodine Rush: Over- or Under-Iodination Risk in the Prophylactic Use of Iodine for Thyroid Blocking in the Event of a Nuclear Disaster. Front Endocrinol (Lausanne) 2022; 13:901620. [PMID: 35692388 PMCID: PMC9178126 DOI: 10.3389/fendo.2022.901620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Iodine is an essential element for the production of thyroid hormones (THs). Both deficient and excess iodine intakes may precipitate in adverse thyroidal events. Radioactive iodine (RI) is a common byproduct of nuclear fission processes. During nuclear emergencies RI may be released in a plume, or cloud, contaminating the environment. If inhaled or ingested, it may lead to internal radiation exposure and the uptake of RI mainly by the thyroid gland that absorbs stable iodine (SI) and RI in the same way. A dose of radiation delivered to the thyroid gland is a main risk factor for the thyroid cancer development. The SI prophylaxis helps prevent childhood thyroid cancer. The thyroid gland saturation with prophylactic SI ingestion, reduces the internal exposure of the thyroid by blocking the uptake of RI and inhibiting iodide organification. However, negative impact of inadequate SI intake must be considered. We provide an overview on the recommended iodine intake and the impact of SI and RI on thyroid in children and adolescents, discussing the benefits and adverse effects of the prophylactic SI for thyroid blocking during a nuclear accident. The use of SI for protection against RI may be recommended in cases of radiological or nuclear emergencies, moreover the administration of iodine for prophylactic purposes should be cautious. Benefits and risks should also be considered according to age. Adverse effects from iodine administration cannot be excluded. Precise indications are mandatory to use the iodine for thyroid blocking. Due to this natural adaption mechanism it's possible to tolerate large doses of iodine without clinical effects, however, a prolonged assumption of the iodine when not needed can be dangerous and may precipitate in severe thyroidal and non-thyroidal negative effects.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- *Correspondence: Valeria Calcaterra,
| | - Chiara Mameli
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Giulia Massini
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Mirko Gambino
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Paola Baldassarre
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
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Leung AM, Bauer AJ, Benvenga S, Brenner AV, Hennessey JV, Hurley JR, Milan SA, Schneider AB, Sundaram K, Toft DJ. American Thyroid Association Scientific Statement on the Use of Potassium Iodide Ingestion in a Nuclear Emergency. Thyroid 2017; 27:865-877. [PMID: 28537500 PMCID: PMC5561443 DOI: 10.1089/thy.2017.0054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This document serves to summarize the issues and the American Thyroid Association (ATA) position regarding the use of potassium iodide as a thyroid blocking agent in the event of a nuclear accident. The purpose is to provide a review and updated position statement regarding the advanced distribution, stockpiling, and availability of potassium iodide in the event of nuclear radiation emergencies in the United States.
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Affiliation(s)
- Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The University of Pennsylvania, The Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina School of Medicine, Messina, Italy
- Interdepartmental Program of Molecular and Clinical Endocrinology and Women's Endocrine Health, University hospital Policlinico G Martino, Messina, Italy
| | - Alina V. Brenner
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - James V. Hennessey
- Department of Endocrinology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - James R. Hurley
- Division of Endocrinology, Diabetes, and Metabolism; Joan and Sanford I. Weill Department of Medicine; Weill Cornell Medical College, New York, New York
| | - Stacey A. Milan
- Department of General Surgery, Division of Endocrine Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Arthur B. Schneider
- Section of Endocrinology, Diabetes and Metabolism; University of Illinois College of Medicine, Chicago, Illinois
| | | | - Daniel J. Toft
- Division of Endocrinology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Sudbrock F, Herrmann A, Fischer T, Zimmermanns B, Baus W, Drzezga A, Schomäcker K. Influence of iodine supply on the radiation-induced DNA-fragmentation. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2017; 166:157-161. [PMID: 27452911 DOI: 10.1016/j.jenvrad.2016.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
The protective effect of stable iodide against radiation on thyroid cells was investigated. One physiological effect of stable iodine is well-rooted: stable iodine leads to a reduced thyroid uptake of radioactive iodine. This work wants to focus on an intrinsic effect of stable iodine by which DNA-damage in cells is prevented. To investigate this intrinsic effect thyroid cells (FRTL-5) were externally irradiated by use of a linear accelerator (LINAC) applying energy doses of 0.01 Gy-400 Gy and by incubation with various activity concentrations of 131I (0.1-50 MBq/ml for 24 h). We added stable iodine (NaI) to the cells prior to external irradiation and investigated the effect of the concentration of stable iodine (1, 5, 15 μg/ml). In order to clarify whether thyroid cells have a distinctive and iodine-dependent reaction to ionizing radiation, keratinocytes (HaCaT) without NIS were exposed in the same way. As indicators for the cellular reaction, the extent of DNA fragmentation was determined (Roche, Mannheim, Germany). Both cell types showed distinct ability for apoptosis as proven with camptothecin. The addition of "cold" iodine from 1 to 15 μg/ml without irradiation ("negative control") did not change the response in both cell types. Plausibly, the radio-sensitivity of both cell types did increase markedly with increasing radiation dose but the radiation effect is diminished if iodine is added to the thyroid cells beforehand. The DNA-damage in thyroid cells after addition of cold iodine is reduced by a factor of 2-3. The skin cells did not show an significant change of radio-sensitivity depending on the presence of cold iodine. Elementary iodine possibly acts as a radical scavenger and thus markedly reduces the secondary radiation damage caused by the formation of cytotoxic radicals. This intrinsic radioprotective effect of iodine is seen only in cells with NIS.
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Affiliation(s)
- F Sudbrock
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne 50924, Germany.
| | - A Herrmann
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne 50924, Germany
| | - T Fischer
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne 50924, Germany
| | - B Zimmermanns
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne 50924, Germany
| | - W Baus
- Department of Radiation Oncology, University Hospital of Cologne, Cologne 50924, Germany
| | - A Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne 50924, Germany
| | - K Schomäcker
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne 50924, Germany
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Pfinder M, Dreger S, Christianson L, Lhachimi SK, Zeeb H. The effects of iodine blocking on thyroid cancer, hypothyroidism and benign thyroid nodules following nuclear accidents: a systematic review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:R112-R130. [PMID: 27655110 DOI: 10.1088/0952-4746/36/4/r112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A potential radiation protection method to reduce the risk of adverse health outcomes in the case of accidental radioactive iodine release is the administration of potassium iodide (KI). Although KI administration is recommended by WHO's Guidelines for Iodine Prophylaxis following Nuclear Accidents, a systematic review of the scientific evidence for the guidelines is lacking. Therefore, this study aims to systematically review the effects of KI administration in the case of accidental radioactive iodine release on thyroid cancer, hypothyroidism and benign thyroid nodules. We applied standard systematic review methodology for a search of the literature, selection of eligible studies, data extraction, assessment of risk of bias, assessment of heterogeneity, data synthesis, and the assessment of the quality of the evidence. We searched MEDLINE (via PubMed) and EMBASE. We found one cross-sectional study, one analytic cohort study and two case-control studies relating to our question. The number of participants ranged from 886-12 514. Two studies were conducted in children and two other studies in children and adults. It was not possible to conduct a meta-analysis. We identified low to very low-quality evidence that KI administration after a nuclear accident resulted in a reduction of the risk of thyroid cancer in children; however, the KI administration and dose was not well described in the studies. None of the studies investigated the effects of KI administration in the case of a nuclear accident on hypothyroidism and benign thyroid nodules. Low to very low-quality evidence suggests that KI intake following a nuclear accident may reduce the risk of thyroid cancer in children. No conclusions can be drawn about the effectiveness of KI intake with respect to the prevention of hypothyroidism and benign thyroid nodules.
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Affiliation(s)
- M Pfinder
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany. Collaborative Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany. Institute for Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany. Department of Health Promotion and Occupational Health Management, AOK Baden-Wuerttemberg, Stuttgart, Germany
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Dreger S, Pfinder M, Christianson L, Lhachimi SK, Zeeb H. The effects of iodine blocking following nuclear accidents on thyroid cancer, hypothyroidism, and benign thyroid nodules: design of a systematic review. Syst Rev 2015; 4:126. [PMID: 26420738 PMCID: PMC4588908 DOI: 10.1186/s13643-015-0106-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the most efficient radiation protection methods to reduce the risk of adverse health outcomes in case of accidental radioactive iodine release is the administration of potassium iodine (KI). Although KI administration is recommended by WHO's guidelines for iodine prophylaxis following nuclear accidents and is also widely implemented in most national guidelines, the scientific evidence for the guidelines lacks as the guidelines are mostly based on expert opinions and recommendations. Therefore, this study will provide evidence by systematically reviewing the effects of KI administration in case of accidental radioactive iodine release on thyroid cancer, hypothyroidism, and benign nodules. METHODS We will apply standard systematic review methodology for the identification of eligible studies, data extraction, assessment of risk of biases, heterogeneity, and data synthesis. The electronic database search will be conducted in MEDLINE (via PubMed) and EMBASE, and covers three search blocks with terms related to the health condition, intervention, and occurrence/location. We have no date or language restrictions, but restrictions to humans only. We will include studies comparing the effects of KI administration on thyroid cancer, hypothyroidism, and benign thyroid nodules in a population exposed to radioactive iodine release. The quality of the studies will be graded. If feasible, a meta-analysis will be conducted. DISCUSSION This proposed systematic review will update the existing WHO guideline from 1999. New evidence on the efficacy of KI administration to reduce thyroid cancer, hypothyroidism, and benign thyroid nodules in the event of an accidental release of radioactive iodine to the environment will provide the basis for an update of the WHO guideline for iodine prophylaxis following nuclear accidents. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015024340.
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Affiliation(s)
- Steffen Dreger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH (BIPS), Achterstrasse 30, PO Box 28359, Bremen, Germany.
| | - Manuela Pfinder
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH (BIPS), Achterstrasse 30, PO Box 28359, Bremen, Germany. .,Collaborative Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH (BIPS), Bremen, Germany. .,Institute for Public Health and Nursing Research, Health Sciences Bremen, Bremen University, Bremen, Germany.
| | - Lara Christianson
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH (BIPS), Achterstrasse 30, PO Box 28359, Bremen, Germany.
| | - Stefan K Lhachimi
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH (BIPS), Achterstrasse 30, PO Box 28359, Bremen, Germany. .,Collaborative Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH (BIPS), Bremen, Germany. .,Institute for Public Health and Nursing Research, Health Sciences Bremen, Bremen University, Bremen, Germany.
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH (BIPS), Achterstrasse 30, PO Box 28359, Bremen, Germany. .,Health Sciences Bremen, Bremen University, Bremen, Germany.
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Whitcomb RC, Ansari AJ, Buzzell JJ, McCurley MC, Miller CW, Smith JM, Evans DL. A public health perspective on the U.S. response to the Fukushima radiological emergency. HEALTH PHYSICS 2015; 108:357-63. [PMID: 25627948 PMCID: PMC4558551 DOI: 10.1097/hp.0000000000000198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
On 11 March 2011, northern Japan was struck by first a magnitude 9.0 earthquake off the eastern coast and then by an ensuing tsunami. At the Fukushima Dai-ichi Nuclear Power Plant (NPP), these twin disasters initiated a cascade of events that led to radionuclide releases. Radioactive material from Japan was subsequently transported to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to cause health effects, but the presence of this material in the environment was enough to require a response from the public health community. Events during the response illustrated some U.S. preparedness challenges that previously had been anticipated and others that were newly identified. Some of these challenges include the following: (1) Capacity, including radiation health experts, for monitoring potentially exposed people for radioactive contamination are limited and may not be adequate at the time of a large-scale radiological incident; (2) there is no public health authority to detain people contaminated with radioactive materials; (3) public health and medical capacities for response to radiation emergencies are limited; (4) public health communications regarding radiation emergencies can be improved to enhance public health response; (5) national and international exposure standards for radiation measurements (and units) and protective action guides lack uniformity; (6) access to radiation emergency monitoring data can be limited; and (7) the Strategic National Stockpile may not be currently prepared to meet the public health need for KI in the case of a surge in demand from a large-scale radiation emergency. Members of the public health community can draw on this experience to improve public health preparedness.
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Affiliation(s)
- Robert C. Whitcomb
- Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Armin J. Ansari
- Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Jennifer J. Buzzell
- Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - M. Carol McCurley
- Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
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Abstract
Hospital planning for chemical or radiological events is essential but all too often treated as a low priority. Although some other types of disasters like hurricanes and tornadoes may be more frequent, chemical and radiological emergencies have the potential for major disruptions to clinical care. Thorough planning can mitigate the impact of a chemical or radiological event. Planning needs to include all 4 phases of an event: mitigation (preplanning), preparation, response, and recovery. Mitigation activities should include the performance of a hazards vulnerability analysis and identification of local subject-matter experts and team leaders.
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