Gland and Hormone Related Diseases

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Iodine

Cadexomer iodine

Martha Linet, M.D.

Background:

* An inadequate filtering system at the Mayak nuclear weapons production facility in Ozyorsk, Russia, allowed the release of various radioactive materials, particularly I-131 (radioactive iodine) into the city's atmosphere during the 1950s.
* A recent pilot study found a higher prevalence of thyroid nodules in Ozyorsk residents who were exposed to the radiation in childhood during years of heavy atmospheric emissions (1952-1953) than in children exposed in later years (between 1967 and 1991) when there were almost no radioactive releases.
* Understanding the role of I-131 in the development of thyroid disease is important because I-131 is commonly used in medicine (e.g., to treat hyperthyroidism and thyroid cancer and to diagnose thyroid disease), and it is the major source of thyroid gland exposure in fallout from atomic bomb explosions, nuclear power plant accidents, and atmospheric venting from plutonium manufacturing facilities.

Objectives:

-To expand the pilot study to include 350 Ozyorsk residents who were exposed in childhood to moderate levels of radiation in order to evaluate thyroid disease in relation to the dose of I-131 exposure.

Eligibility:

-People who were born and living in Ozyorsk, Russia between 1954 and 1955, the period of mild radioactive releases from the Mayak nuclear weapons plant.

Design:

* Participants' thyroid gland and structure are examined with an ultrasound examination and blood tests.
* Participants with a possible thyroid gland disorder are referred to specialists for additional diagnostic procedures.

We plan to expand a completed pilot study that evaluated the prevalence of thyroid abnormalities in relation to childhood exposure to atmospheric emissions of radioactive iodines from the Mayak Nuclear Weapons Plant in Ozyorsk, Russia. The pilot study population was composed of a defined cohort of approximately 900 Ozyorsk residents who were born between January 1, 1952 and December 31, 1953. The exposed population was comprised of persons who lived in Ozyorsk during the years of heavy atmospheric releases (1952-1953). Members of the nonexposed group moved to Ozyorsk between 1967 and 1991, i.e. when there were almost no radioactive releases. Results from the pilot study suggest an elevated prevalence of thyroid nodules in the exposed population. Given the positive results from the pilot study and the US Department of Energy's (DOE) decision to fund a dose reconstruction project for the Ozyorsk population, we intend to expand the study to include an additional 350 people born and living in Ozyorsk between 1954 and 1955, i.e. exposed to moderate levels of radiation .

Methods similar to those used in the pilot study will be used in the expanded study. Members of the study population will be invited to participate in a special thyroid screening protocol when they come for their annual routine medical examination at the Ozyorsk automated dispensary system (ASDOC). The thyroid gland is clinically examined by two ASDOC physicians specifically trained in thyroid palpation. Thyroid abnormalities will be detected based on physical examinations, assessment of TSH levels, and ultrasound imaging. Biochemical laboratory tests, including Free T(4), and anti-thyroperoxidase antibodies will be assayed as necessary. Patients are sent to a consulting endocrinologist if the palpation, ultrasound or laboratory findings suggest a thyroid disorder. Fine needle aspiration (FNA) biopsy is performed when a tumor is suspected. Although the FNA is not be done as part of the study research, but rather as part of the regular Ozyorsk medical system, the results will be given to the study staff to help make diagnostic decisions. Patients with complicated thyroid disease will be referred to an experienced consulting thyroid specialist. Patients with diagnosed thyroid disease are treated within the regular medical system in Ozyorsk.

Thyroid Abnormalities Associated With Exposure to Atmospheric Emissions of Radioactive Iodine

Thyroid Abnormalities Associated With Protracted Childhood I-131 Exposure From Atmospheric Emissions From the Mayak Nuclear Plant in Russia

National Cancer Institute (NCI)

Nervous System Diseases

Symptoms and General Pathology

Neoplasms

Syncope

Thyroid Neoplasms

Kiyohiko Mabuchi, M.D.

We propose to study the prevalence of thyroid nodules and cancer in relation to radiation dose, in a defined cohort of Kazakhstan residents exposed as children to radioactive fallout from atomic bomb tests at the neighboring Semipalatinsk Test Site (STS). The population near the STS is believed to have received radiation doses from fallout that were much higher than that experienced by any population of comparable size in the US. The study population is a defined cohort of 20,000 residents, half of whom, in 1960, resided in heavily-exposed villages; the other half lived in lightly-exposed villages. The population is rural, with a diet that was and is heavily dependent upon fresh milk from household or local cows and therefore likely to have led to ingestion of radioactive iodine from fallout. The study is two parts.

The first part involves a cytogenetic assay for radiation biodosimetry purposes of peripheral lymphocytes obtained from blood samples donated by 40 cohort members with individuals radiation dose estimates. Blood samples will be collected from 25 putative high-dose and 15 low-dose cohort members and processed or cytogenetic assay using fluorescent in situ hybridization (FISH) for stable chromosome aberrations in peripheral lymphocytes. This biodosimetric validation assay, will be carried out by Nailya Chaizhunusova, chief of cytogenetics at the Scientific research Institute for Radiation Medicine and Ecology, in collaboration with Dr. Tracy Yang at the NASA Johnson Space Center in Houston, Texas. It should be possible to detect gamma radiation doses as low as 150 mGy.

The second part will involve thyroid screening by ultrasound in selected villages. The population to be screened will comprise 100-1500 members of the study cohort exposed as young children to high fallout levels, and equal numbers of comparable ages exposed to little or no fallout. Fine needle aspiration biopsy will be performed, under separate informed consent, if the palpation and ultrasound results suggest presence of a tumor. Presence and malignancy of tumor will be determined by cytopathology. Subjects with evidence of thyroid disease will be referred to thyroid specialists at the Semipalatinsk State Medical Academy. Finger stick blood samples will be obtained to assess thyroid function using RIA methods with coated tube technology for T4 and TSH. The most sensitive statistical comparisons are expected to be dose-response analyses with respect to prevalence of thyroid nodules, which are common and known to be associated with radiation dose. Comparisons in terms of thyroid cancer, and benign and malignant neoplasms combined, are likely to be less sensitive but of acceptable power if risks associated with chronic radiation in this population are similar to those associated with acute exposure to X-ray or gamma radiation in other populations.

We propose to study the prevalence of thyroid nodules and cancer in relation to radiation dose, in a defined cohort of Kazakhstan residents exposed as children to radioactive fallout from atomic bomb tests at the neighboring Semipalatinsk Test Site (STS). The population near the STS is believed to have received radiation doses from fallout that were much higher than that experienced by any population of comparable size in the US. The study population is a defined cohort of 20,000 residents, half of whom, in 1960, resided in heavily-exposed villages; the other half lived in lightly-exposed villages. The population is rural, with a diet that was and is heavily dependent upon fresh milk from household or local cows and therefore likely to have led to ingestion of radioactive iodine from fallout. The study is two parts.

The first part involves a cytogenetic assay for radiation biodosimetry purposes of peripheral lymphocytes obtained from blood samples donated by 40 cohort members with individuals radiation dose estimates, and electron paramagnetic resonance (EPR) assays of about 110 stored tooth samples. The two techniques are complementary. Blood samples will be collected from 25 putative high-dose and 15 low-dose cohort members and processed or cytogenetic assay using fluorescent in situ hybridization (FISH) for stable chromosome aberrations in peripheral lymphocytes. This biodosimetric validation assay, will be carried out by Nailya Chaizhunusova, chief of cytogenetics at the Scientific research Institute for Radiation Medicine and Ecology, in collaboration with Dr. Tracy Yang at the NASA Johnson Space Center in Houston, Texas. It should be possible to detect gamma radiation doses as low as 150 mGy.

The EPR investigation will take advantage of a repository of teeth extracted by local dentists during medical and dental programs in 1966-67 and 1999, stored, and catalogued by our collaborators in Kazakhstan (not in connection with this study). Tooth samples are identified by village of exposure, but not individually within villages. However, the identities of the donors, and therefore their ages and exposure histories, are known to our collaborators in Kazakhstan; therefore it will be possible to compare the EPR results with gamma dose estimates calculated on the basis of exposure history. It is intended that the EPR assays will be carried out at the National Institute of Standards and Technology under a purchase order agreement.

The second part will involve thyroid screening by ultrasound in selected villages. The population to be screened will comprise 1000-1500 members of the study cohort exposed as young children to high fallout levels, and equal numbers of comparable ages exposed to little or no fallout. Fine needle aspiration biopsy will be performed, under separate informed consent, if the palpation and ultrasound results suggest presence of a tumor. Presence and malignancy of tumor will be determined by cytopathology. Subjects with evidence of thyroid disease will be referred to thyroid specialists at the Semipalatinsk State Medical Academy. Finger stick blood samples will be obtained to assess thyroid function using RIA methods with coated tube technology for T4 and TSH. The most sensitive statistical comparisons are expected to be dose-response analyses with respect to prevalence of thyroid nodules, which are common and known to be associated with radiation dose. Comparisons in terms of thyroid cancer, and benign and malignant neoplasms combined, are likely to be less sensitive but of acceptable power if risks associated with chronic radiation in this population are similar to those associated with acute exposure to X-ray or gamma radiation in other populations.

Studies of Thyroid Abnormalities in Northeastern Kazakhstan Associated With Nuclear Weapons Testing

Study title	NCT ID	Conditions	Eligibility	Organization
Thyroid Abnormalities Associated With Exposure to Atmospheric Emissions of Radioactive Iodine	NCT00342693	Thyroid Abnorma...	51 Years - 52 Years	National Institutes of Health Clinical Center (CC)
Studies of Thyroid Abnormalities in Northeastern Kazakhstan Associated With Nuclear Weapons Testing	NCT00341185	Thyroid Cancer	63 Years - 71 Years	National Institutes of Health Clinical Center (CC)
Thyroid Abnormalities Associated With Exposure to Atmospheric Emissions of Radioactive Iodine	NCT00342693	Thyroid Abnorma...	51 Years - 52 Years	National Institutes of Health Clinical Center (CC)

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