Serum thyroxine in the early diagnosis of carbon disulfide poisoning

How to Differentiate General Toxicity-Related Endocrine Effects from Endocrine Disruption: Systematic Review of Carbon Disulfide Data

This review provides an overview of the assessment of the endocrine disrupting (ED) properties of carbon disulfide (CS₂), following the methodology used at the European level to identify endocrine disruptors. Relevant in vitro, in vivo studies and human data are analyzed. The assessment presented here focuses on one endocrine activity, i.e., thyroid disruption, and two main adverse effects, neurotoxicity and cardiotoxicity. The data available on the different ED or non-ED modes of action (MoA), known to trigger these adverse effects, are described and the strength of evidence of the different MoA is weighted. We conclude that the adverse effects could be due to systemic toxicity rather than endocrine-mediated toxicity. This assessment illustrates the scientific and regulatory challenges in differentiating a specific endocrine disruption from an indirect endocrine effect resulting from a non-ED mediated systemic toxicity. This issue of evaluating the ED properties of highly toxic and reactive substances has been insufficiently developed by European guidance so far and needs to be further addressed. Finally, this example also raises questions about the capacity of the technics available in toxicology to address such a complex issue with certainty.

The menace of endocrine disruptors on thyroid hormone physiology and their impact on intrauterine development

The delivery of the appropriate thyroid hormones quantity to target tissues in euthyroidism is the result of unopposed synthesis, transport, metabolism, and excretion of these hormones. Thyroid hormones homeostasis depends on the maintenance of the circulating 'free' thyroid hormone reserves and on the development of a dynamic balance between the 'free' hormones reserves and those of the 'bound' hormones with the transport proteins. Disturbance of this hormone system, which is in constant interaction with other hormone systems, leads to an adaptational counter-response targeting to re-establish a new homeostatic equilibrium. An excessive disturbance is likely to result, however, in hypo- or hyper- thyroid clinical states. Endocrine disruptors are chemical substances forming part of 'natural' contaminating agents found in most ecosystems. There is abundant evidence that several key components of the thyroid hormones homeostasis are susceptible to the action of endocrine disruptors. These chemicals include some chlorinated organic compounds, polycyclic aromatic hydrocarbons, herbicides, and pharmaceutical agents. Intrauterine exposure to endocrine disruptors that either mimic or antagonize thyroid hormones can produce permanent developmental disorders in the structure and functioning of the brain, leading to behavioral changes. Steroid receptors are important determinants of the consequences of endocrine disruptors. Their interaction with thyroid hormones complicates the effect of endocrine disruptors. The aim of this review is to present the effect of endocrine disruptors on thyroid hormones physiology and their potential impact on intrauterine development.

Lack of Relationship between Occupational Exposure to Carbon Disulfide and Endocrine Dysfunction: A Six‐year Cohort Study of the Japanese Rayon Workers

OBJECTIVES

A six-year prospective cohort study was conducted to clarify whether the current carbon disulfide (CS2) exposure level is low enough to prevent subclinical health impairment and/or to ameliorate health effects due to previous high exposure. This paper describes the follow-up results, exposure assessment, and effects on the endocrine system.

METHODS

The study subjects were 432 male workers exposed to CS2 at one of the 11 rayon factories in Japan and 402 referent workers from the same factories, all of whom were examined in 1992-93. 251 CS2-exposed, 140 former-exposed and 359 referent workers participated in the follow-up survey (follow-up rate 89.9%) in 1998-99. Urinary 2-thiothiazolidine-4-carboxylic acid (TTCA) at the end of a shift as internal exposure index and the time-weighted average CS2 concentration as external exposure index were measured twice a year from 1992-1993. By using various blood indices, we evaluated effects on thyroid, hypophysis, and gonad function, as well as effects on glucose metabolism. Information on potential confounding factors, such as age, smoking and alcohol drinking, were collected and adjusted for.

RESULTS

When the individual exposure level was represented by arithmetic mean for TTCA and CS2 concentration, geometric means (SD) of CS2 workers were 1.61 (1.91) mg/g.crea and 5.02 (1.84) ppm, respectively. There were no exposure-related differences in glucose metabolism or any of the endocrinological indices.

CONCLUSIONS

No biologically significant effects of CS2 were found on endocrine function in Japanese rayon manufacturing workers when the average internal and external exposure levels were maintained below the current occupational exposure limit.

Elevated triglyceride and decreased high density lipoprotein level in carbon disulfide workers in Taiwan

Carbon disulfide (CS2) is a man-made product utilized primarily in the manufacture of viscose rayon. Overexposure to CS2 has been associated with an increase in coronary heart disease. The aims of this study were to examine the dose-response relationship of CS2 exposure and elevated lipid profile tests among CS2-exposed workers in Taiwan. A total of 132 workers were recruited from two viscose rayon plants. Air sampling was performed to determine the CS2 exposure of workers. Demographic data and work history were gathered by a standard self-administered questionnaire. Lipid profile tests were also performed by routine methods. The average CS2 exposure concentration was 50.6 +/- 25.6 ppm (range: 24-127 ppm) in the high-exposure group, 12.9 +/- 5 ppm (range: 5.2-22.3 ppm) in the mid-exposure group, and 3.5 +/- 1.2 ppm (range 0.97-5.2 ppm) in the low-exposure group. There were 21 out of 33 (63.7%) elevated triglyceride levels among high-CS2-exposure workers, 27 out of 64 (42.2%) among the middle-CS2-exposure, and 14 out of 35 (40%) among low-CS2-exposure workers, respectively. Compared to the low-CS2-exposure workers, the age- and weight-adjusted odds ratios (and 95% confidence intervals) of the prevalence of elevated triglyceride value were 1.12 (0.5, 2.7) for middle-CS2-exposure workers, and 2.81 (1.02, 7.8) for high-CS2-exposure workers. There was a significant linear trend between CS2 exposure and the prevalence of elevated triglyceride value (P = 0.046) after adjusting for other factors. There was also a lower prevalence of elevated HDL level in high-CS2-exposure workers than low-CS2-exposure workers (15.2% versus 31.4%). Compared to the low-CS2-exposure workers, the age- and weight-adjusted odds ratio (and 95% confidence intervals) of elevated HDL level were 0.34 (0.1, 1.18) for high-CS2-exposure workers, which was borderline significant. In conclusion, this study suggests that elevated triglyceride level and decreased HDL level are associated with CS2 exposure. The study also suggests that exposure to CS2 (concentration > 23.2 ppm, which was above the current TLV-TWA of 10 ppm) are significantly associated with increased risk and decreased protective effect for coronary heart disease.

Effects of environmental synthetic chemicals on thyroid function

Synthetic chemicals are released into the environment by design (pesticides) or as a result of industrial activity. It is well known that natural environmental chemicals can cause goiter or thyroid imbalance. However, the effects of synthetic chemicals on thyroid function have received little attention, and there is much controversy over their potential clinical impact, because few studies have been conducted in humans. This article reviews the literature on possible thyroid disruption in wildlife, humans, and experimental animals and focuses on the most studied chemicals: the pesticides DDT, amitrole, and the thiocarbamate family, including ethylenethiourea, and the industrial chemicals polyhalogenated hydrocarbons, phenol derivatives, and phthalates. Wildlife observations in polluted areas clearly demonstrate a significant incidence of goiter and/or thyroid imbalance in several species. Experimental evidence in rodents, fish, and primates confirms the potentiality for thyroid disruption of several chemicals and illustrates the mechanisms involved. In adult humans, however, exposure to background levels of chemicals does not seem to have a significant negative effect on thyroid function, while exposure at higher levels, occupational or accidental, may produce mild thyroid changes. The impact of transgenerational, background exposure in utero on fetal neurodevelopment and later childhood cognitive function is now under scrutiny. There are several studies linking a lack of optimal neurological function in infants and children with high background levels of exposure to polychlorinated biphenyls (PCBs), dioxins, and/or co-contaminants, but it is unclear if the effects are caused by thyroid disruption in utero or direct neurotoxicity.

Cross sectional observation of the effects of carbon disulphide on the nervous system, endocrine system, and subjective symptoms in rayon manufacturing workers

OBJECTIVES

A prospective cohort study was initiated to clarify whether the current level of exposure to carbon disulphide (CS2) is low enough to prevent occurrence of subclinical health impairments or to ameliorate health effects due to past high exposure. This paper describes the effects of exposure to CS2 on the nervous and endocrine systems, and the subjective symptoms in a baseline observation.

METHODS

The effects were evaluated of CS2 on the median nerve conduction velocity, neurobehavioural and psychological tests, and subjective symptoms related to solvents in 432 male workers exposed to CS2 and 402 reference workers from 11 rayon factories in Japan. Adjustment was made for potential confounding factors such as age or alcohol drinking. Exposure to CS2 was either dichotomised or categorised into three groups by job type.

RESULTS

Reductions were observed in motor (-1.9 m/s) and sensory (-0.91 m/s for orthodromic and -1.1 m/s for antidromic) nerve conduction velocities in the workers exposed to CS2 at the spinning and refining processes. Small but significant increases were found in self rated depression scale score and decrease in digit span (backward) in the workers exposed to CS2. Of 54 subjective symptoms many were increased--namely, heavy feeling in the head, light headedness, fainting after suddenly standing up, tremor, dullness, and increased sensitivity of skin in the extremities, reduced grasping power, reduced sexual desire, and increased rough skin. The endocrinological indicator--the concentration of glycosylated haemoglobin--was also increased in the workers exposed to CS2.

CONCLUSIONS

Subclinical effects on the nervous system and on glucose metabolism were found in the workers exposed to CS2. One interpretation is that relatively higher exposure to CS2 in the past may induce these, but the effects are still not entirely ameliorated under the current exposure to CS2. Another possibility is that the current exposure to CS2 may cause these positive findings. A follow up observation is necessary to clarify these questions.

Toxicology of male reproduction in animals and humans

Environmental contaminants can interfere with the male reproduction function. A review is presented of those pollutants with adverse effects on human reproduction. The possible effects of occupational and environmental exposure to various substances on male reproductive health are evaluated. This analysis considers studies showing damage of men exposed to halogenated hydrocarbons, other organic compounds, heavy metals and some physical agents, and some lifestyles, such as continuous stress, alcohol consumption, cigarette and marijuana smoking, and other addictions. Possible influences of these agents on the neuroendocrine system with the decrease of male fertility during the last decades are also discussed.

Epidemiological study of endocrinological effects of carbon disulfide

One hundred seventeen viscose rayon workers exposed to carbon disulfide, and 66 workers who were not exposed to any toxic agent in the working environment, underwent an endocrinological examination that included determination of thyroxine, luteinizing hormone, follicle-stimulating hormone, prolactin, and testosterone in serum by radioimmunoassay methods. In the viscose rayon factory, the working conditions had not changed subsequent to 1932. Personal monitoring performed in 17 jobs showed that carbon disulfide exposures varied from 4 to 112 mg/m3. A carbon disulfide cumulative exposure index was calculated for each individual. Univariate analysis of the hormone levels versus exposure showed significantly lower levels of prolactin in the exposed versus nonexposed subjects (p = .01). After adjustment for age, alcohol, smoking, body mass index, and stress level, the carbon disulfide cumulative exposure index was not associated with any of the hormones. This discrepancy from previous studies may result from differences in exposure, in selection of the population, or in confounding biases.

Failure of carbon disulfide and levothyroxine to modify the cardiovascular response of rabbits to a high-cholesterol diet

Exposure of rabbits for 12 weeks to 300 ppm carbon disulfide (CS2) for 6 h/day, 5 days/week, or to 25 mg/day of thiourea or 2% cholesterol in the diet, or to any combination thereof caused a significant reduction in the concentration of serum thyroxine (T4). The reduction of the concentration of serum T4 in rabbits by the treatments was completely offset by the inclusion of 0.1 mg/day of sodium levothyroxine in the diet. Ingestion of feed containing 2% cholesterol significantly increased the degree of atherosclerosis present in the aortic arch and significantly increased the oil red O positive lipid present in the heart and the aorta, with the aortic arch being the most severely affected. The response of the aorta and the heart to the 2% cholesterol diet was not significantly modified by concurrent exposure to CS2 by inhalation or by treatment with thiourea, a metabolite of CS2. We found no evidence that the development of cardiovascular lesions induced by a 2% cholesterol diet in rabbits was mediated by a mechanism involving a component of hypothyroidism.

Tissue disposition of carbon disulfide: I. Whole-body autoradiography of 35S- and 14C-labelled carbon disulfide in adult male mice

Occupational exposure to carbon disulfide (CS2) is associated with several adverse effects such as neurotoxicity, atherosclerosis, liver injury and endocrinal disturbances. In the present study, the distribution of CS2 and its metabolites after inhalation of 35S- or 14C-labelled CS2 was studied in adult male mice with whole-body autoradiography. CS2 itself was registered in body fat and in well-perfused tissues at survival times up to 2 hours. Very little CS2 was taken up by the brain. The distribution patterns of CS2 metabolites were very different after administration of C35S2 or 14CS2. 35S-Labelled metabolites were initially concentrated in the liver and kidney, but were rapidly eliminated from the body. There was evidence of an extensive metabolic incorporation of sulfur split off from CS2 during its biotransformation. 14C-Labelled metabolites were likewise concentrated in the liver and kidney, but were also observed in large amounts in the nasal mucosa, bronchi, bone, pancreas, thyroid, adrenal cortex and testis. A marked retention of non-extractable 14C-labelled metabolites was seen in the liver and thyroid. The results point to several sites of specific CS2-induced toxicity due to the tissue disposition of metabolites of CS2.

Endocrinologic studies in men exposed occupationally to carbon disulfide

The effect of long-term occupational exposure to CS2 on various endocrinologic parameters was studied in 15 exposed men and 16 age-matched controls. Duration of exposure varied between 10 and 36 yr. The CS2 concentrations in the viscose rayon plant have been below the Finnish threshold limit value of 30 mg/m3 (10 ppm) under normal operating conditions for the past 10 yr. Before this the exposure was considerably greater. Of the various endocrinologic parameters, serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) were significantly increased in the exposed group, seven workers having values above the reference limit. This was taken as a sign of primary gonadal insufficiency, which was considered only latent as serum testosterone values were unaffected. No changes were seen in serum prolactin values before or after stimulation with thyrotropin releasing hormone (TRH). No disturbance was seen in thyroid function as evaluated by serum thyroxine (T4), free thyroxine index (FT1), triiodothyronine (T3), and the thyrotropin response to TRH. Serum cortisol was also unchanged. These results may reflect high exposure during past decades rather than exposure to the present low CS2 concentrations.