Non cancer thyroid and other endocrine disease in children and adults exposed to ionizing radiation after the ChNPP accident

Probl Radiac Med Radiobiol. 2015 Dec;20:341-55.
[Article in En, Ukrainian]

Abstract

Study objective: To summarize the verified clinical and epidemiological data on the natural history of non cancer endocrine disease in remote period after the ChNPP accident in survivors of adult and children age.

Materials and methods: Retrospective estimation was carried out of data on 24,588 adult persons and 20,087 chil dren survived after the ChNNP accident and being healthy or having any diseases. Data were retrieved from database of the Clinical Epidemiological Registry (CER), NRCRM for the 23 years (1992-2014) of survey. Average total external radiation dose in adults was 0.187 Gy, range of thyroid dose in children was 0.1-1.55 Gy. These data were verifies in a separate clinical study. Anthropometric, laboratory biochemical and hormonal assay values, thyroid ultrasound imaging patterns and radiation dose values were retrieved for the study.

Results: Retrospective data review for the 1992-2014 period indicated that incidence of thyroid disease in all per sons survived after the ChNPP accident run at 40.29% with 35.37% among the clean up workers, 27.24% among evac uees, and 28.6% among population of contaminated territories that all is significantly (p < 0.0001) higher vs. the entire population of Ukraine (3.9%). Following non cancer endocrine diseases were most prevalent in the ChNPP acci dent survivors: nodular goiter (14.35%), chronic autoimmune thyroiditis (~8%), pre obesity and obesity (41.9% and 36.8% respectively), prediabetes and diabetes mellitus (15.5% and 21.4% respectively). Nodular goiter (21.8%), chronic autoimmune thyroiditis (12.95%), pre obesity and obesity (41.71% and 33.61% respectively), and predia betes and diabetes mellitus (8.6% and 12.15% respectively) were most often diagnosed in the ChNPP accident clean up workers. Children evacuated from the 30 kilometer exclusion zone were a critical population group. They were diagnosed diffuse non toxic goiter in 43.68%, chronic autoimmune thyroiditis in 1.74%, primary hypothyroidism in 0.96%, and nodular goiter in 2.57%. Peak prevalence of chronic autoimmune thyroiditis occurred in 2001-2003 i.e. in a period of their intensive pubertal maturation. In children (first generation) of exposed parents the thyroid dis ease was revealed in 42.64%, that exceeded the incidence in control group, chronic autoimmune thyroiditis was found rarer i.e. in 0.45%, diffuse non toxic goiter in 9.5-13.8%, nodular goiter in 1.7%.

Conclusions: Non cancer endocrine disease in children and adults exposed to ionizing radiation is frequent and reg istered in 3 53% of persons. It occurs in most of survivors 10-15 years upon the impact of radiation factor as a result of man made accident and continues to grow slowly in 30 years.

Meta doslidzhennia. Uzagal'nyty veryfikovani klinichni ta epidemiologichni dani shchodo rozvytku nezloiakisnoI en dokrynnoI patologiI u viddalenyy period avariI na ChAES u postrazhdalykh osib doroslogo i dytiachogo viku. Materialy i metody doslidzhennia. Provedena retrospektyvna otsinka danykh 24 588 osib doroslogo viku ta 20 087 ditey, postrazhdalykh v rezul'tati avariI na ChAES, iz bazy kliniko epidemiologichnogo reiestru (KER) NNTsRM za 23 roky (period 1992–2014 rr.), iaki buly zdorovymy chy maly shyrokyy spektr endokrynnoI patologiI. U doros lykh osib serednia doza zovnishn'ogo oprominennia sklala 0,187 Gr, u ditey oprominennia shchytopodibnoI zalozy – v mezhakh 0,1–1,55 Gr. Tsi dani veryfikuvalysia v okremomu klinichnomu doslidzhenni. Zalucheni antropometrychni, la boratorni biokhimichni ta gormonal'ni pokaznyky, ul'trazvukove doslidzhennia shchytopodibnoI zalozy, dozy op rominennia.Rezul'taty. Retrospektyvnyy analiz danykh 1992 2014 rr. pokazuie, shcho chastota tyreoIdnoI patologiI sered vsikh osib, postrazhdalykh vnaslidok avariI na ChAES skladaie 40,29 %, v uchasnykiv likvidatsiI naslidkiv avariI – 35,37 %, evakuyovanykh iz zony vidchuzhennia – 27,24 %, zhyteliv radiatsiyno zabrudnenykh terytoriy – 28,6 %, shcho znachno bil' she (r < 0,0001), nizh u zagal'niy populiatsiI (3,9 %) naselennia UkraIny. Naybil'sh poshyrenymy nezloiakisnymy en dokrynnymy zakhvoriuvanniamy v osib, postrazhdalykh vnaslidok avariI na ChAES buly: vuzlovyy zob – 14,35 %, khro nichnyy autoimunnyy tyreoIdyt ~ 8 %, peredozhyrinnia/ozhyrinnia 41,9 %/36,8 %, pereddiabet/diabet 15,5 %/21,4 %. Naychastishymy nezloiakisnymy endokrynnymy zakhvoriuvanniamy v osib, uchasnykiv likvidatsiI naslidkiv avariI na ChAES buly vuzlovyy zob – 21,8 %, khronichnyy autoimunnyy tyreoIdyt – 12,95 %, peredozhyrinnia/ozhyrinnia – 41,71 %/33,61 %, pereddiabet/diabet– 8,6 %/12,15 %. Krytychnoiu grupoiu ditey buly evakuyovani z 30 km zony vidchuzhennia, opromineni u vitsi 3 6 rokiv. U nykh dyfuznyy netoksychnyy zob vstanovleno u 43,68 %, khronichnyy au toimunnyy tyreoIdyt– 1,74 %, pervynnyy gipotyreoz – 0,96 %, vuzlovyy zob – 2,57 %, a pik poshyrenosti khronichnogo autoimunnogo tyreoIdytu prypav na 2001–2003 rr. – period Ikh aktyvnogo statevogo dozrivannia. Se red ditey, iaki buly narodzheni vid oprominenykh bat'kiv (pershe pokolinnia), zakhvoriuvannia shchytopodibnoI zalozy vyiavyly u 42,64 %, shcho perevyshchuvalo chastotu v grupi kontroliu, khronichnyy autoimunnyy tyreoIdyt vyiavlialy pomitno ridshe – u 0,45 %, dyfuznyy netoksychnyy zob u 9,5–13,8 %, vuzlovyy zob u 1,7 %.Vysnovky. Nezloiakisna endokrynna patologiia u oprominenykh doroslykh i ditey ie chastoiu, zustrichaiet'sia u 3–53 % osib, vynykaie u bil'shosti postrazhdalykh cherez 10–15 rokiv pislia vplyvu radiatsiynogo faktora v rezul'tati tekh nogennoI avariI chy intsydentu, prodovzhuie povil'no narostaty cherez 30 rokiv.

Keywords: ChNPP accident; accident clean up workers; accident survivors; children; diabetes mellitus; endocrine sys tem; hormone; ionizing radiation; obesity; thyroid.