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Nadolnik LI, Niatsetskaya ZV, Basinsky VA, Vinogradov VV. Morphological and functional changes in rat thyroid gland after a year following chronic exposure to low and intermediate doses of γ-radiation. Int J Radiat Biol 2023; 100:343-352. [PMID: 37934053 DOI: 10.1080/09553002.2023.2280012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/13/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Thyroid function depends on iodine uptake by the body as well as on exposure to various harmful environmental hazards (stress, ionizing radiation). AIM The aim of the work was to assess the effect of exposure to low and intermediate doses of external γ-radiation on the thyroid structure and function in young female rats at remote periods after radiation. MATERIALS AND METHODS Forty female rats were used to study remote effects of external γ-radiation exposure during 20 d (at daily doses of 0.1, 0.25 and 0.5 Gy) on the functional activity (levels of thyroid hormones, iodine metabolism) and the morphological structure of the rat thyroid) after 12 months following the radiation exposure. RESULTS An increase in thyroid mass and a decrease in total thyroid protein concentration along with a reduction of blood T3 and T4 was shown only in rat groups exposed to 0.25 and 0.5 Gy. Both the concentration of total iodine and its protein-bound fraction (1.2-1.4 fold, p < .01) and the protein-bound to total iodine ratio were decreased in the thyroids of all irradiated animals. The 0.1-Gy group showed elevated thyroperoxidase (TPO) activity along with increased catalase activity, which may indicate the activation of iodine oxidation by thyrocytes. Only the 0.5-Gy group demonstrated reduced urinary excretion of iodine (2.1 fold, p < .01).The reduction of thyroid function at radiation doses of 0.25 and 0.5 Gy was characterized by a microfollicular structure and the development of atrophic changes in the parenchyma, desquamation of thyroid epithelium and an increase in epithelium proliferation. The diameter of the thyrocyte nuclei was increased in rats exposed to 0.25 and 0.5 Gy, which indicates functional tension of thyrocytes. CONCLUSION Our research shows that after a year, the exposure to external γ-radiation of 0.1, 0.25 and 0.5-Gy caused changes in the structure and function of the rat thyroid which are manifested by the development of hypothyroiditis (0.5 Gy), 'subclinical' hypothyroiditis (0.25 Gy) and functional tension of thyrocytes. The mechanisms of thyroid dysfunction - impaired- uptake of iodine and its organification against the background of activation of free radical processes - suggest disturbances in the function of the sodium/iodide symporter (NIS), TPO and thyroglobulin synthesis. In contrast to the intermediate doses, the effects of the 0.1-Gy dose were mostly found at the remote periods compared to the earlier periods (180 days).
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Affiliation(s)
- Liliya I Nadolnik
- Institute of Biochemistry of Biologically Active Compounds of the National Academy of Sciences of Belarus, Grodno, Belarus
| | - Zoya V Niatsetskaya
- Institute of Biochemistry of Biologically Active Compounds of the National Academy of Sciences of Belarus, Grodno, Belarus
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Vladimir V Vinogradov
- Institute of Biochemistry of Biologically Active Compounds of the National Academy of Sciences of Belarus, Grodno, Belarus
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Reiners C, Hänscheid H, Schneider R. High-dose radiation exposure and hypothyroidism: aetiology, prevention and replacement therapy. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:R125-R139. [PMID: 34547726 DOI: 10.1088/1361-6498/ac28ee] [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: 06/13/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
Without any doubt, high dose radiation exposure can induce hypothyroidism. However, there are open questions related to the mechanisms of its induction, corresponding dose thresholds and possible countermeasures. Therefore, this review addresses the aetiology, prevention and therapy of radiation induced hypothyroidism. External beam radiotherapy with several 10 Gy to the head and neck region and radioiodine therapy with several 100 Gy thyroid absorbed dose can destroy the thyroid gland and can induce autoantibodies against thyroid tissue. According to recent literature, clinical hypothyroidism is observed at threshold doses of ∼10 Gy after external beam radiotherapy and of ∼50 Gy after radioiodine therapy, children being more sensitive than adults. In children and adolescents exposed by the Chernobyl accident with mean thyroid absorbed doses of 500-800 mGy, subclinical hypothyroidism has been detected in 3%-6% of the cases with significant correlation to thyroid absorbed doses above 2.5 Gy. In case of nuclear emergencies, iodine thyroid blocking (ITB) is the method of choice to keep thyroid absorbed doses low. Large doses of stable iodine affect two different steps of internalization of radioiodine (transport and organification); perchlorate affecting the transport only may be an alternative to iodine. Administered before radioiodine incorporation, the effect of 100 mg iodide or more is still about 90% after 1 days, 80% after 2 days, and 50% or less after 3 days. If administered (too) late after exposure to radioiodine, the theoretically expected protective effect of ITB is about 50% after 6 h, 25% after 12 h, and about 6% after 24 h. In case of repeated or continuous exposure, repeated administration of 50 mg of iodide daily is indicated. If radiation-induced hypothyroidism cannot be avoided, thyroid hormone replacement therapy with individualized dosing and regular monitoring in order to maintain thyroid-stimulating hormone levels within the normal range ensures normal life expectancy.
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Affiliation(s)
- Christoph Reiners
- Department of Nuclear Medicine and WHO REMPAN Collaboration Center, University Hospital, Würzburg, Germany
| | - Heribert Hänscheid
- Department of Nuclear Medicine and WHO REMPAN Collaboration Center, University Hospital, Würzburg, Germany
| | - Rita Schneider
- Department of Nuclear Medicine and WHO REMPAN Collaboration Center, University Hospital, Würzburg, Germany
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Sapuppo G, Tavarelli M, Cannata E, La Spina M, Russo M, Scollo C, Spadaro A, Masucci R, Lo Nigro L, Russo G, Di Cataldo A, Pellegriti G. Risk of Benign and Malignant Thyroid Disorders in Subjects Treated for Paediatric/Adolescent Neoplasia: Role of Morphological and Functional Screening. CHILDREN-BASEL 2021; 8:children8090767. [PMID: 34572198 PMCID: PMC8468117 DOI: 10.3390/children8090767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
Background: Patients treated for paediatric/adolescent (P/A) neoplasia have a high incidence of both benign and malignant thyroid diseases. Given the high incidence of sequelae, literature data show a clinical benefit of morpho-functional thyroid screening in paediatric/adolescent cancer survivors and a careful lifetime follow-up. Patients and methods: The incidence of thyroid alterations was evaluated in a consecutive series of 343 patients treated with chemotherapy (CHE) and radiotherapy (RTE) or only with CHE for P/A tumours between 1976 and 2018 (mean age at time of primary paediatric malignancy 7.8 ± 4.7 years). All patients underwent thyroidal morpho-functional evaluation between 2000 and 2019. Results: 178 patients (51.9%) were treated only with CHE and 165 (48.1%) with CHE+RTE. A functional and/or structural thyroid disease was diagnosed in 147 (42.5%; 24.2% in CHE and 62.4% in CHE+RTE group; p = 0.0001). Of note, 71 (20.7%) patients with no evidence of disease at first evaluation developed a thyroid alteration during the follow-up. Primitive hypothyroidism was diagnosed in 54 patients (15.7%; 11.2% in CHE vs. 20.6% in CHE+RTE group; p = 0.01) and hyperthyroidism in 4. Sixty-three patients developed thyroid nodules (18.4%; 4.0% in CHE and 14.1% in CHE+RTE group; p < 0.001); thyroid cancer was diagnosed in 30 patients (8.7%; 4.5% in CHE and 12.4% in CHE + RTE group; p = 0.007). Conclusions: In patients treated with CHE+RTE, the prevalence of hypothyroidism and nodular pathology, both malignant and benign, were significantly greater than in patients treated with CHE. However, also in the CHE group, the frequency of thyroid disease is not negligible and the pathogenetic mechanisms remain to be clarified. Our data suggest the clinical benefit of morpho-functional thyroid screening in P/A cancer survivors.
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Affiliation(s)
- Giulia Sapuppo
- Endocrinology, Garibaldi-Nesima Medical Center, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy;
| | - Martina Tavarelli
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Emanuela Cannata
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Milena La Spina
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Marco Russo
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Claudia Scollo
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Angela Spadaro
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
| | - Romilda Masucci
- Garibaldi-Nesima Medical Center, Department of Surgical Oncology, 95122 Catania, Italy;
| | - Luca Lo Nigro
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Giovanna Russo
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Andrea Di Cataldo
- Onco-Ematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (E.C.); (M.L.S.); (L.L.N.); (G.R.); (A.D.C.)
| | - Gabriella Pellegriti
- Endocrinology, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; (M.T.); (M.R.); (C.S.); (A.S.)
- Correspondence:
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Hida A, Imaizumi M, French B, Ohishi W, Haruta D, Eguchi K, Nakamura H, Kawakami A. Association of human T-cell leukemia virus type 1 with prevalent rheumatoid arthritis among atomic bomb survivors: A cross-sectional study. Medicine (Baltimore) 2021; 100:e26297. [PMID: 34128866 PMCID: PMC8213279 DOI: 10.1097/md.0000000000026297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 05/18/2021] [Indexed: 01/04/2023] Open
Abstract
Previous studies have suggested that human T-cell leukemia virus type 1 (HTLV-1) might act as a pathogen in rheumatoid arthritis (RA), but epidemiological evidence of an association is scarce. We measured anti-HTLV-1 antibodies among Nagasaki atomic bomb survivors to determine whether HTLV-1 is related to RA and whether radiation exposure is associated with HTLV-1 and RA prevalence.This is a cross-sectional study among atomic bomb survivors who participated in biennial health examinations from 2006 to 2010. Serum levels of anti-HTLV-1 antibodies were measured using a chemiluminescent enzyme immunoassay and confirmed by Western blotting. Association between HTLV-1 and RA was analyzed by a logistic regression model.Of 2091 participants (women 61.5%; median age, 73 years), 215 (10.3%) had anti-HTLV-1 antibodies. HTLV-1 prevalence was higher among women (13.1% vs 5.8%; P < .001). Twenty-two participants (1.1%) were diagnosed with RA. HTLV-1 prevalence among RA participants was significantly higher than that among non-RA participants (27.3% vs 10.1%; P = .020). After adjustment for age, sex, and hepatitis C virus infection, HTLV-1 was significantly associated with prevalent RA (odds ratio, 2.89; 95% confidence interval, 1.06, 7.03). There was no association between radiation dose and either the prevalence of HTLV-1 or RA.This study, among a well-defined group of atomic bomb survivors, suggests that HTLV-1 is associated with RA.
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Affiliation(s)
- Ayumi Hida
- Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki and Hiroshima
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki and Hiroshima
| | - Benjamin French
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima
| | - Waka Ohishi
- Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki and Hiroshima
| | - Daisuke Haruta
- Department of Clinical Studies, Radiation Effects Research Foundation, Nagasaki and Hiroshima
| | - Katsumi Eguchi
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Reiners C, Drozd V, Yamashita S. Hypothyroidism after radiation exposure: brief narrative review. J Neural Transm (Vienna) 2020; 127:1455-1466. [PMID: 33034734 PMCID: PMC7578155 DOI: 10.1007/s00702-020-02260-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/28/2020] [Indexed: 01/07/2023]
Abstract
The thyroid gland is among the organs at the greatest risk of cancer from ionizing radiation. Epidemiological evidence from survivors of radiation therapy, atomic bombing, and the Chernobyl reactor accident, clearly shows that radiation exposure in childhood can cause thyroid cancer and benign thyroid nodules. Radiation exposure also may induce hypothyroidism and autoimmune reactions against the thyroid, but these effects are less well-documented. The literature includes only a few, methodologically weak animal studies regarding genetic/molecular mechanisms underlying hypothyroidism and thyroid autoimmunity after radiation exposure. Rather, evidence about radiation-induced hypothyroidism and thyroid autoimmunity derives mainly from follow-up studies in patients treated with external beam radiotherapy (EBRT) or iodine-131, and from epidemiological studies in the atomic bombing or nuclear accident survivors. Historically, hypothyroidism after external irradiation of the thyroid in adulthood was considered not to develop below a 10-20 Gy dose threshold. Newer data suggest a 10 Gy threshold after EBRT. By contrast, data from patients after iodine-131 "internal radiation therapy" of Graves´ disease indicate that hypothyroidism rarely occurs below thyroid doses of 50 Gy. Studies in children affected by the Chernobyl accident indicate that the dose threshold for hypothyroidism may be considerably lower, 3-5 Gy, aligning with observations in A-bomb survivors exposed as children. The reasons for these dose differences in radiosensitivity are not fully understood. Other important questions about the development of hypothyroidism after radiation exposure e.g., in utero, about the interaction between autoimmunity and hypofunction, and about the different effects of internal and external irradiation still must be answered.
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Affiliation(s)
- Christoph Reiners
- Department of Nuclear Medicine, University Hospital, Oberduerbacherstr.6, 97080, Wuerzburg, Germany.
| | | | - Shunichi Yamashita
- Global Exchange Center, Fukushima Medical University, Fukushima, Japan
- Center for Advanced Radiation Emergency Medicine, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Applegate KE, Rühm W, Wojcik A, Bourguignon M, Brenner A, Hamasaki K, Imai T, Imaizumi M, Imaoka T, Kakinuma S, Kamada T, Nishimura N, Okonogi N, Ozasa K, Rübe CE, Sadakane A, Sakata R, Shimada Y, Yoshida K, Bouffler S. Individual response of humans to ionising radiation: governing factors and importance for radiological protection. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:185-209. [PMID: 32146555 DOI: 10.1007/s00411-020-00837-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/26/2020] [Indexed: 05/23/2023]
Abstract
Tissue reactions and stochastic effects after exposure to ionising radiation are variable between individuals but the factors and mechanisms governing individual responses are not well understood. Individual responses can be measured at different levels of biological organization and using different endpoints following varying doses of radiation, including: cancers, non-cancer diseases and mortality in the whole organism; normal tissue reactions after exposures; and, cellular endpoints such as chromosomal damage and molecular alterations. There is no doubt that many factors influence the responses of people to radiation to different degrees. In addition to the obvious general factors of radiation quality, dose, dose rate and the tissue (sub)volume irradiated, recognized and potential determining factors include age, sex, life style (e.g., smoking, diet, possibly body mass index), environmental factors, genetics and epigenetics, stochastic distribution of cellular events, and systemic comorbidities such as diabetes or viral infections. Genetic factors are commonly thought to be a substantial contributor to individual response to radiation. Apart from a small number of rare monogenic diseases such as ataxia telangiectasia, the inheritance of an abnormally responsive phenotype among a population of healthy individuals does not follow a classical Mendelian inheritance pattern. Rather it is considered to be a multi-factorial, complex trait.
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Affiliation(s)
| | - W Rühm
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Radiation Medicine, Neuherberg, Germany
| | - A Wojcik
- Centre for Radiation Protection Research, MBW Department, Stockholm University, Stockholm, Sweden
| | - M Bourguignon
- Department of Biophysics and Nuclear Medicine, University of Paris Saclay (UVSQ), Verseilles, France
| | - A Brenner
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - K Hamasaki
- Department of Molecular Biosciences, Radiation Effects Research Foundation, Hiroshima, Japan
| | - T Imai
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - M Imaizumi
- Department of Nagasaki Clinical Studies, Radiation Effects Research Foundation, Nagasaki, Japan
| | - T Imaoka
- Department of Radiation Effects Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan
| | - S Kakinuma
- Department of Radiation Effects Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan
| | - T Kamada
- QST Hospital, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan
| | - N Nishimura
- Department of Radiation Effects Research, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan
| | - N Okonogi
- QST Hospital, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan
| | - K Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - C E Rübe
- Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
| | - A Sadakane
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - R Sakata
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Y Shimada
- National Institute for Quantum and Radiological Science and Technology, Chiba, Japan
- Institute for Environmental Sciences, Aomori, Japan
| | - K Yoshida
- Immunology Laboratory, Department of Molecular Biosciences, Radiation Effects Research Foundation, Hiroshima, Japan
| | - S Bouffler
- Radiation Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilto, Didcot, UK
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Sreekumar A, Jayalekshmi PA, Nandakumar A, Nair RRK, Ahammed R, Sebastian P, Koriyama C, Akiba S, Nakamura S, Konishi J. Thyroid nodule prevalence among women in areas of high natural background radiation, Karunagappally, Kerala, India. Endocrine 2020; 67:124-130. [PMID: 31637657 DOI: 10.1007/s12020-019-02071-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Radiation exposure has been reported to cause thyroid nodules. The study area was Karunagapally, which has several areas with high natural radiation levels derived from thorium and its decay products. Since thyroid abnormalities are more common in women, the focus was only on women. METHODS The examinations included interview, ultrasonography of the thyroid and serum assays of free thyroxine (FT4), thyrotropin (TSH), and anti-thyroglobulin levels. Cumulative dose during the childhood and lifetime cumulative dose (lagged by 5 years) were estimated. RESULTS We examined 524 female residents aged 17-73 years and found 75 cases of solitary solid thyroid nodules. The prevalence of thyroid nodules were 14.1 % (n = 42) in high dose panchayats and 14.5% (n = 33) in low-dose panchayats. In the logistic regression analysis adjusted for age, the prevalence of solitary thyroid nodule was not linearly related to childhood cumulative dose (P for trend = 0.159) and lifetime cumulative dose (P for trend = 0.333). The prevalence of thyroiditis and hypothyroidism was not related to natural radiation exposure. Serum levels of FT4 or TSH were not related to natural radiation exposure. CONCLUSIONS The results obtained from the present study do not support the increase of solitary thyroid nodule, thyroiditis or hypothyroidism in relation to high-natural-background-radiation exposure.
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Affiliation(s)
| | - Padmavathy Amma Jayalekshmi
- Regional Cancer Center Thiruvananthapuram, Thiruvananthapuram, Kerala, India
- Natural Background Radiation Cancer Registry, Karunagapally, Kerala, India
| | - Athira Nandakumar
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Korimoto, Kagoshima, 890-8580, Japan
| | - Raghu Ram K Nair
- Health Research Foundation, Research Institute for Production Development, Bldg.4F, 15 Shimogamo-morimoto-cho, Sakyo-ku, Kyoto, 606-0805, Japan
| | - Riyaz Ahammed
- Natural Background Radiation Cancer Registry, Karunagapally, Kerala, India
| | - Paul Sebastian
- Regional Cancer Center Thiruvananthapuram, Thiruvananthapuram, Kerala, India
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Korimoto, Kagoshima, 890-8580, Japan
| | - Suminori Akiba
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Korimoto, Kagoshima, 890-8580, Japan
- Health Research Foundation, Research Institute for Production Development, Bldg.4F, 15 Shimogamo-morimoto-cho, Sakyo-ku, Kyoto, 606-0805, Japan
| | - Seiichi Nakamura
- Health Research Foundation, Research Institute for Production Development, Bldg.4F, 15 Shimogamo-morimoto-cho, Sakyo-ku, Kyoto, 606-0805, Japan
| | - Junji Konishi
- Health Research Foundation, Research Institute for Production Development, Bldg.4F, 15 Shimogamo-morimoto-cho, Sakyo-ku, Kyoto, 606-0805, Japan
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Inskip PD, Veiga LHS, Brenner AV, Sigurdson AJ, Ostroumova E, Chow EJ, Stovall M, Smith SA, Leisenring W, Robison LL, Armstrong GT, Sklar CA, Lubin JH. Hyperthyroidism After Radiation Therapy for Childhood Cancer: A Report from the Childhood Cancer Survivor Study. Int J Radiat Oncol Biol Phys 2019; 104:415-424. [PMID: 30769174 PMCID: PMC6818231 DOI: 10.1016/j.ijrobp.2019.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/21/2018] [Accepted: 02/05/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE The association of hyperthyroidism with exposure to ionizing radiation is poorly understood. This study addresses the risk of hyperthyroidism in relation to incidental therapeutic radiation dose to the thyroid and pituitary glands in a large cohort of survivors of childhood cancer. METHODS AND MATERIALS Using the Childhood Cancer Survivor Study's cohort of 5-year survivors of childhood cancer diagnosed at hospitals in the United States and Canada between 1970 and 1986, the occurrence of hyperthyroidism through 2009 was ascertained among 12,183 survivors who responded to serial questionnaires. Radiation doses to the thyroid and pituitary glands were estimated from radiation therapy records, and chemotherapy exposures were abstracted from medical records. Binary outcome regression was used to estimate prevalence odds ratios (ORs) for hyperthyroidism at 5 years from diagnosis of childhood cancer and Poisson regression to estimate incidence rate ratios (RRs) after the first 5 years. RESULTS Survivors reported 179 cases of hyperthyroidism, of which 148 were diagnosed 5 or more years after their cancer diagnosis. The cumulative proportion of survivors diagnosed with hyperthyroidism by 30 years after the cancer diagnosis was 2.5% (95% confidence interval [CI], 2.0%-2.9%) among those who received radiation therapy. A linear relation adequately described the thyroid radiation dose response for prevalence of self-reported hyperthyroidism 5 years after cancer diagnosis (excess OR/Gy, 0.24; 95% CI, 0.06-0.95) and incidence rate thereafter (excess RR/Gy, 0.06; 95% CI, 0.03-0.14) over the dose range of 0 to 63 Gy. Neither radiation dose to the pituitary gland nor chemotherapy was associated significantly with hyperthyroidism. Radiation-associated risk remained elevated >25 years after exposure. CONCLUSIONS Risk of hyperthyroidism after radiation therapy during childhood is positively associated with external radiation dose to the thyroid gland, with radiation-related excess risk persisting for >25 years. Neither radiation dose to the pituitary gland nor chemotherapy exposures were associated with hyperthyroidism among childhood cancer survivors through early adulthood.
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Affiliation(s)
- Peter D Inskip
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland; Retired.
| | - Lene H S Veiga
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland
| | - Alina V Brenner
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland; Radiation Effects Research Foundation, Hiroshima, Japan
| | - Alice J Sigurdson
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland; Retired
| | - Evgenia Ostroumova
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland; International Agency for Research on Cancer, Lyon, France
| | - Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Marilyn Stovall
- Retired; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wendy Leisenring
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jay H Lubin
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland
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Ozasa K, Cullings HM, Ohishi W, Hida A, Grant EJ. Epidemiological studies of atomic bomb radiation at the Radiation Effects Research Foundation. Int J Radiat Biol 2019; 95:879-891. [PMID: 30676179 DOI: 10.1080/09553002.2019.1569778] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epidemiological studies of people who were exposed to atomic bomb radiation and their children who were conceived after parental exposure to radiation (F1) have investigated late health effects of atomic bomb radiation and its transgenerational effects. Those studies were initiated by the Atomic Bomb Casualty Commission (ABCC) in the 1950s. ABCC was reorganized to the Radiation Effects Research Foundation (RERF) in 1975, which continued the work of the ABCC. Follow-up of vital status and cause of death is performed for all RERF cohorts, including the atomic bomb survivors (the Life Span Study: LSS), in utero survivors, and the children of the survivors (F1). Cancer incidence is investigated for accessible subpopulations of the cohorts. Health examinations for subcohorts of the LSS and in utero survivors are conducted as the Adult Health Study (AHS); a program of health examinations for a subcohort of the F1 study is called the F1 Offspring Clinical Study (FOCS). Participants of all clinical programs are asked to donate their blood and urine for storage and future biomedical investigations. Epidemiological studies have observed increased radiation risks for malignant diseases among survivors including those exposed in utero, and possible risks for some noncancer diseases. No increased risks due to parental exposure to radiation have been observed for malignancies or other diseases in F1, but continuing investigations are required.
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Affiliation(s)
- Kotaro Ozasa
- a Department of Epidemiology , Radiation Effects Research Foundation , Hiroshima , Japan
| | - Harry M Cullings
- b Department of Statistics , Radiation Effects Research Foundation , Hiroshima , Japan
| | - Waka Ohishi
- c Department of Clinical Studies , Radiation Effects Research Foundation , Hiroshima , Japan
| | - Ayumi Hida
- d Department of Clinical Studies , Radiation Effects Research Foundation , Nagasaki , Japan
| | - Eric J Grant
- e Associate Chief of Research, Radiation Effects Research Foundation , Hiroshima , Japan
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Imaizumi M, Furukawa K, Ohishi W, Hida A. THYROID DISEASES AMONG ATOMIC BOMB SURVIVORS. RADIATION PROTECTION DOSIMETRY 2018; 182:62-66. [PMID: 30165685 DOI: 10.1093/rpd/ncy157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Indexed: 06/08/2023]
Abstract
Systematic epidemiological studies of Hiroshima and Nagasaki atomic bomb survivors have made substantial contributions to the understanding of radiation effects on human health. A recent study of atomic bomb survivors reported that an increased risk of thyroid cancer associated with childhood exposure might have persisted for more than 50 years after exposure. In analyses of non-cancer thyroid diseases, several cross-sectional studies, including the latest study focusing on survivors exposed in childhood, suggested that the risk of thyroid nodules increased, while risks of thyroid dysfunction and autoimmunity were not apparent several decades after radiation exposure. However, careful interpretations are needed because only limited data from cross-sectional studies are available. Further longitudinal studies are necessary to improve our understanding of the effect of radiation on the thyroid and its function.
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Affiliation(s)
- Misa Imaizumi
- Department of Nagasaki Clinical Studies, Radiation Effects Research Foundation, 1-8-6 Nakagawa, Nagasaki, Japan
| | - Kyoji Furukawa
- Department of Statistics, Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima, Japan
| | - Waka Ohishi
- Department of Hiroshima Clinical Studies, Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima, Japan
| | - Ayumi Hida
- Department of Nagasaki Clinical Studies, Radiation Effects Research Foundation, 1-8-6 Nakagawa, Nagasaki, Japan
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Nagayama Y. Radiation-related thyroid autoimmunity and dysfunction. JOURNAL OF RADIATION RESEARCH 2018; 59:ii98-ii107. [PMID: 29069397 PMCID: PMC5941148 DOI: 10.1093/jrr/rrx054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/20/2017] [Indexed: 05/17/2023]
Abstract
The thyroid gland is vulnerable not only to external radiation but also to internal radiation, because the thyroid cells can incorporate radioactive iodine when synthesizing thyroid hormones. Since radiation-induction of thyroid neoplasia, including thyroid cancer, is well recognized, the data on radiation-related thyroid autoimmunity and dysfunction are summarized and reviewed. High-dose irradiation, irrespective of being external or internal, is strongly associated with a risk of hypothyroidism (with the prevalence ranging from 2.4% to 31%) and of Graves' hyperthyroidism (with the prevalence being up to 5%). It is easy to understand that high-dose irradiation induces hypothyroidism with some frequency, because high-dose irradiation destroys the thyroid gland. On the other hand, the basis for development of hyperthyroidism is mechanistically unclear, and it is merely speculative that autoantigens may be released from damaged thyroid glands and recognized by the immune system, leading to the development of anti-thyrotropin receptor antibodies and Graves' hyperthyroidism in subjects who are immunologically predisposed to this ailment. In contrast, the data on moderate to low-dose irradiation on thyroid autoimmunity and dysfunction are inconsistent. Although it is difficult to draw a definitive conclusion, some data may suggest a transient effect of moderate- to low-dose irradiation on hypothyroidism and autoimmune thyroiditis, implying that the effect, if it exists, is reversible. Finally, no report has shown a statistically significant increase in the prevalence of moderate- to low-dose irradiation-induced Graves' hyperthyroidism.
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Affiliation(s)
- Yuji Nagayama
- Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
- Corresponding author: Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan. Tel: +81-95- 819-7173; Fax: +81-95-819-7175;
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