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da Silva Lopes JP, Barbosa J, Dinis-Oliveira RJ. Clinical and forensic aspects of potassium iodide: Suddenly in high demand across Europe due to fears of radiation poisoning from a nuclear attack in Ukraine. Basic Clin Pharmacol Toxicol 2024. [PMID: 38989660 DOI: 10.1111/bcpt.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/20/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
Potassium iodide has demonstrated several therapeutic applications over time, being the choice for shielding the thyroid during radiation emergencies involving radioiodine release. Amidst the ongoing military conflict between Ukraine and Russia and the growing concern regarding the potential deployment of nuclear weapons, there has been a surge in the demand for potassium iodide across Europe. This work aimed to comprehensively review the current knowledge regarding the pharmacology, physiology, adverse effects, the protective role in reducing the risk of thyroid cancer and recommendations for potassium iodide use during radiation emergencies. Evidence on adverse effects is scarce, as potassium iodide is generally well-tolerated. Guidelines for thyroid blocking with potassium iodide during radiation emergencies suggest that, among populations vulnerable to radioiodine exposure, the benefits of potassium iodide outweigh the risks of adverse effects. Controversial topics surrounding the utilization of potassium iodide in radiation emergencies include the prophylaxis in iodine-deficient regions and following the detonation of dirty bombs, whether granule formulations versus tablets should be used and mental health concerns. Although the rise in demand seems to be a justified security measure, it is essential to recognize that potassium iodide protects the thyroid from radioiodine and does not impact the body's absorption of other radioactive materials or defend against external radiation exposure.
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Affiliation(s)
- João Pedro da Silva Lopes
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Barbosa
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, University Institute of Health Sciences - CESPU, Gandra, Portugal
- UCIBIO - Research Unit on Applied Molecular Biosciences, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), Gandra, Portugal
| | - Ricardo Jorge Dinis-Oliveira
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, University Institute of Health Sciences - CESPU, Gandra, Portugal
- UCIBIO - Research Unit on Applied Molecular Biosciences, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), Gandra, Portugal
- FOREN - Forensic Science Experts, Lisbon, Portugal
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Lynch KA, Merdjanoff AA. Impact of Disasters on Older Adult Cancer Outcomes: A Scoping Review. JCO Glob Oncol 2023; 9:e2200374. [PMID: 37290025 PMCID: PMC10497294 DOI: 10.1200/go.22.00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE There is an urgent need to address the growing global cancer burden in the context of complex disaster events, which both disrupt access to oncology care and facilitate carcinogenic exposures. Older adults (65 years and older) are a growing population with multifaceted care needs, making them especially vulnerable to disasters. The objective of this scoping review is to characterize the state of the literature concerning older adult cancer-related outcomes and oncologic care after a disaster event. METHODS A search was conducted in PubMed and Web of Science. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, articles were extracted and screened for inclusion. Eligible articles were summarized using descriptive and thematic analyses. RESULTS Thirty-five studies met all criteria for full-text review. The majority focused on technological disasters (60%, n = 21), followed by climate-amplified disasters (28.6%, n = 10) and geophysical disasters (11.4%, n = 4). Thematic analysis classified the current evidence into three major categories: (1) studies concerned with carcinogenic exposure and cancer incidence related to the disaster event, (2) studies examining changes in access to cancer care and cancer treatment disruptions as a result of the disaster event, and (3) studies exploring the psychosocial experiences of patients with cancer affected by a disaster event. Few studies focused on older adults specifically, and most of the current evidence focuses on disasters in the United States or Japan. CONCLUSION Older adult cancer outcomes after a disaster event are understudied. Current evidence suggests that disasters worsen cancer-related outcomes among older adults by disrupting continuity of care and access to timely treatment. There is a need for prospective longitudinal studies following older adult populations postdisaster and studies focused on disasters in low- and middle-income country contexts.
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Affiliation(s)
- Kathleen A. Lynch
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY
| | - Alexis A. Merdjanoff
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY
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Caveats in the use of potassium iodide for thyroid blocking. Eur J Nucl Med Mol Imaging 2022; 49:2120-2121. [DOI: 10.1007/s00259-022-05797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
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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: 2] [Impact Index Per Article: 1.0] [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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Matsunaga H, Orita M, Taira Y, Takamura N. Awareness of the implementation of stable iodine prophylaxis by parental guardians living in the urgent protective action planning zone of an operating nuclear power plant in Japan. BMC Public Health 2021; 21:2235. [PMID: 34879848 PMCID: PMC8656062 DOI: 10.1186/s12889-021-12349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this study was to clarify the characteristics and awareness of the need for protection against ionizing radiation, such as sheltering, evacuation, and implementing stable iodine prophylaxis, of guardians parenting young children living in an urgent protective action planning zone (UPZ) of an operating nuclear power plant in Japan. Methods Self-administered questionnaires were distributed to approximately 3000 guardians through 26 kindergartens located within a UPZ. Responses were obtained from 1172 who lived in the UPZ and were included in the analysis. Results Of the 1172 guardians, 460 (39.2%) responded that sheltering is not useful to reduce the dose of radiation exposure. On the other hand, 395 (33.7%) guardians responded that implementing stable iodine (SI) prophylaxis could prevent exposure from all radionuclides, and 876 (74.7%) responded that pregnant women should also implement SI prophylaxis in a nuclear emergency. Furthermore, 83.0% (973) responded that they wanted to receive pre-distribution of stable iodine (PDSI) for their children. On the other hand, 38.9% (456) of guardians had not known about SI before the study, and 71.8% (841) of guardians felt anxious about implementing SI prophylaxis for their children. Conclusion Most guardians had expectations regarding SI and received PDSI, but they felt anxious about implementing SI prophylaxis for their children. It is essential that guardians living in the UPZ of restarted nuclear power plants be educated, and that risk communication about protection against ionizing radiation, including the side effects of implementing SI prophylaxis and radiation health effects, be conducted.
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Affiliation(s)
- Hitomi Matsunaga
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - Makiko Orita
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Yasuyuki Taira
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Noboru Takamura
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Nishikawa Y, Suzuki C, Takahashi Y, Sawano T, Kinoshita H, Clero E, Laurier D, Phan G, Nakayama T, Tsubokura M. No significant association between stable iodine intake and thyroid dysfunction in children after the Fukushima Nuclear Disaster: an observational study. J Endocrinol Invest 2021; 44:1491-1500. [PMID: 33206361 PMCID: PMC8195967 DOI: 10.1007/s40618-020-01454-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Stable iodine prophylaxis helps prevent childhood thyroid cancer in nuclear emergencies; however, there is limited information on its effect on thyroid function. This study aimed to examine thyroid function and autoimmunity among children and adolescents that took stable iodine after the Fukushima Nuclear Disaster. METHODS For this observational study, data were obtained from children and adolescents that underwent thyroid cancer screening at Hirata Central Hospital from April 2012 to March 2018. Participant characteristics, including possible hypothyroidism and hyperthyroidism, were compared between the prophylaxis and no-prophylaxis groups. Multivariable logistic regression models were used to assess for possible hypothyroidism, autoantibodies positive, and hyperthyroidism. RESULTS A total of 1,225 participants with stable iodine prophylaxis and 3,946 without prophylaxis were enrolled. Of those participants, blood samples were available for 144 and 1,201 participants in the prophylaxis and no-prophylaxis groups, respectively. There were 17 (11.8%) and 146 cases (12.2%) of possible hypothyroidism or autoantibodies positive cases in the prophylaxis and no-prophylaxis groups, respectively, and there were no cases and 3 cases (0.2%) of possible hyperthyroidism in those two groups, respectively. Multivariable analysis for possible hypothyroidism revealed no association between stable iodine intake and possible hypothyroidism or autoantibodies positive [odds ratio 0.716 (95% confidence interval 0.399-1.284)] (p = 0.262). We did not perform multivariable analysis for hyperthyroidism due to the limited number of cases. CONCLUSION Significant adverse effects of stable iodine intake on thyroid function were not observed among children and adolescents 7 years after the Fukushima Nuclear Disaster.
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Affiliation(s)
- Y Nishikawa
- Department of Internal Medicine, Hirata Central Hospital, 4, Shimizu-uchi, Kami-Yomogida, Hirata-mura, Ishikawa-gun, Fukushima, 963-8202, Japan.
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - C Suzuki
- Department of Thyroid Surgery, Hirata Central Hospital, Shimizu-uchi, Kami-Yomogida, Hirata-mura, Ishikawa-gun, Fukushima, 963-8202, Japan
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Y Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - T Sawano
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, 1, Hikariga-oka, Fukushima City, 960-1295, Japan
| | - H Kinoshita
- The Institute for Humanistic Studies, Kamakura Women's University, 6-1-3, Ofuna, Kamakura, 247-0056, Japan
| | - E Clero
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety, 92262, Fontenay-aux-Roses, France
| | - D Laurier
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety, 92262, Fontenay-aux-Roses, France
| | - G Phan
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety, 92262, Fontenay-aux-Roses, France
| | - T Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - M Tsubokura
- Department of Internal Medicine, Hirata Central Hospital, 4, Shimizu-uchi, Kami-Yomogida, Hirata-mura, Ishikawa-gun, Fukushima, 963-8202, Japan
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, 1, Hikariga-oka, Fukushima City, 960-1295, Japan
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Nishikawa Y, Kohno A, Takahashi Y, Suzuki C, Kinoshita H, Nakayama T, Tsubokura M. Stable Iodine Distribution Among Children After the 2011 Fukushima Nuclear Disaster in Japan: An Observational Study. J Clin Endocrinol Metab 2019; 104:1658-1666. [PMID: 30535265 PMCID: PMC6441009 DOI: 10.1210/jc.2018-02136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/04/2018] [Indexed: 11/27/2022]
Abstract
CONTEXT Intake of stable iodine helps prevent childhood thyroid cancer in nuclear emergencies, but there is limited case information. OBJECTIVE We identified the intake rate and the factors associated with no intake among children who did not take stable iodine after the Fukushima disaster. DESIGN Retrospective observational study. SETTING Data were obtained from thyroid cancer screenings performed from August through November 2017. PARTICIPANTS Children in Miharu Town, Fukushima, Japan. INTERVENTION No intervention. MAIN OUTCOME MEASURES We performed multilevel logistic regression analysis at the regional and individual levels. We qualitatively examined the reasons for no intake of stable iodine based on closed- and open-ended questions. RESULTS The rate of distribution was 94.9%, but the intake rate was only 63.5%. Intake was lower in those aged 0 to 2 years compared with those aged ≥3 years (OR, 0.21; 95% CI, 0.11 to 0.36). Parents' intake was positively associated with their children's intake (OR, 61.0; 95% CI, 37.9 to 102.9). The variance partition coefficient for regions was 0.021, suggesting that the intake of stable iodine was more likely affected by individual than by regional factors. Closed-ended questions showed that the main reason for avoiding intake was concern about safety. Open-ended questions for other reasons revealed issues related to the distribution method, information about the effects and adverse effects of iodine, and instructions for iodine intake. There were no symptomatic adverse effects claimed to the town. CONCLUSIONS The distribution and consumption of stable iodine occurred in Miharu Town after the Fukushima disaster. To prepare for future nuclear emergencies, it is important to explain to both children and parents the need for intake of stable iodine, particularly among young children.
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Affiliation(s)
- Yoshitaka Nishikawa
- Department of Internal Medicine, Hirata Central Hospital, Fukushima, Japan
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Correspondence and Reprint Requests: Yoshitaka Nishikawa, MD, Department of Internal Medicine, Hirata Central Hospital, 4, Shimizu-uchi, Kami-Yomogida, Hirata-mura, Ishikawa-gun, Fukushima 963-8202, Japan. E-mail:
| | - Ayako Kohno
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Chiaki Suzuki
- Department of Thyroid Surgery, Hirata Central Hospital, Fukushima, Japan
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirokatsu Kinoshita
- The Institute for Humanistic Studies, Kamakura Women’s University, Kanagawa, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Masaharu Tsubokura
- Department of Internal Medicine, Hirata Central Hospital, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
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