Subclinical Hypothyroidism after Radioiodine Exposure: Ukrainian-American Cohort Study of Thyroid Cancer and Other Thyroid Diseases after the Chornobyl Accident (1998-2000)

By Ostroumova, Evgenia; Brenner, Alina et al. | Environmental Health Perspectives, May 2009 | Go to article overview

Subclinical Hypothyroidism after Radioiodine Exposure: Ukrainian-American Cohort Study of Thyroid Cancer and Other Thyroid Diseases after the Chornobyl Accident (1998-2000)


Ostroumova, Evgenia, Brenner, Alina, Oliynyk, Valery, McConnell, Robert, Robbins, Jacob, Terekhova, Galina, Zablotska, Lydia, Likhtarev, llya, Bouville, Andre, Shpak, Viktor, Markov, Valentin, Masnyk, Ihor, Ron, Elaine, Tronko, Mykola, Hatch, Maureen, Environmental Health Perspectives


BACKGROUND: Hypothyroidism is the most common thyroid abnormality in patients treated with high doses of iodine-131 ([.sup.131.I]). Data on risk of hypothyroidism from low to moderate [.sup.131.I] thyroid doses are limited and inconsistent.

OBJECTIVE: This study was conducted to quantify the risk of hypothyroidism prevalence in relation to [.sup.131.I] doses received because of the Chornobyl accident.

METHODS: This is a cross-sectional (1998-2000) screening study of thyroid diseases in a cohort of 11,853 individuals < 18 years of age at the time of the accident, with individual thyroid radioactivity measurements taken within 2 months of the accident. We measured thyroid-stimulating hormone (TSH), free thyroxine, and antibodies to thyroid peroxidase (ATPO) in serum.

RESULTS: Mean age at examination of the analysis cohort was 21.6 years (range, 12.2-32.5 years), with 49% females. Mean [.sup.131.I] thyroid dose was 0.79 Gy (range, 0-40.7 Gy). There were 719 cases with hypothyroidism (TSH > 4 mIU/L), including 14 with overt hypothyroidism. We found a significant, small association between [.sup.131.I] thyroid doses and prevalent hypothyroidism, with the excess odds ratio (EOR) per gray of 0.10 (95% confidence interval, 0.03-0.21). EOR per gray was higher in individuals with ATPO [less than or equal to] 60 U/mL compared with individuals with ATPO > 60 U/mL (p > 0.001).

CONCLUSIONS: This is the first study to find a significant relationship between prevalence of hypothyroidism and individual [.sup.131.I] thyroid doses due to environmental exposure. The radiation increase in hypothyroidism was small (10% per Gy) and limited largely to subclinical hypothyroidism. Prospective data are needed to evaluate the dynamics of radiation-related hypothyroidism and clarify the role of antithyroid antibodies.

KEY WORDS: Chernobyl nuclear accident, Chornobyl, dose-response relationship, hypothyroidism, ionizing radiation. Environ Health Perspect 117:745-750 (2009). doi:10.1289/ehp.0800184 available via http://dx.doi.org/ [Online 15 December 2008]

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The 26 April 1986 accident at the Chornobyl (Chernobyl) nuclear power plant contaminated large areas of northern Ukraine as well as parts of Belarus and the Russian Federation. The environmental fallout included radionuclides of iodine, primarily iodine-131 ([.sup.131.I]), which concentrates in the thyroid gland (United Nations Scientific Committee on the Effects of Atomic Radiation 2000). The scientific evidence accumulated since the accident points clearly to a substantial increase in thyroid cancer among those exposed as children (Cardis et al. 2005; Ivanov et al. 2006; Jacob et al. 1999; Likhtarov et al. 2006; Tronko et al. 2006b). However, research into possible effects of exposure on thyroid function has been limited, and the results have been inconsistent, largely because of issues in study design and lack of individual dose estimates (Eheman et al. 2003; Goldsmith et al. 1999; Kasatkina et al. 1997; Pacini et al. 1998; Quastel et al. 1997; Saiko et al. 1997; Vermiglio et al. 1999; Vykhovanets et al. 1997). A significant upward shift in thyroid-stimulating hormone (TSH) levels and increased rates of juvenile hypothyroidism in children exposed in Belarus and Ukraine because of the Chornobyl accident have been reported in some ecologic studies (Goldsmith et al. 1999; Quastel et al. 1997; Vykhovanets et al. 1997), but not in others (Kasatkina et al. 1997; Pacini et al. 1998; Saiko et al. 1997; Vermiglio et al. 1999). Several, studies, including ours (Tronko et al. 2006a), suggested effects on thyroid autoimmunity (Pacini et al. 1998; Vermiglio et al. 1999; Vykhovanets et al. 1997). We have assessed the prevalence of autoimmune thyroiditis (AIT) and elevated antibodies to thyroid peroxidase (ATPO) in a cohort of 12,240 individuals from Ukraine who were < 18 years of age at the time of the Chornobyl accident, with individual thyroid radioactivity measurements taken shortly after the accident (Tronko et al. …

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