Thyroid Research and Practice

EDITORIAL
Year
: 2019  |  Volume : 16  |  Issue : 3  |  Page : 93--94

Thyroidology and public health: Challenges within the medical profession


Sanjay Kalra 
 Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India

Correspondence Address:
Dr. Sanjay Kalra
Department of Endocrinology, Bharti Hospital, Karnal - 132 001, Haryana
India




How to cite this article:
Kalra S. Thyroidology and public health: Challenges within the medical profession.Thyroid Res Pract 2019;16:93-94


How to cite this URL:
Kalra S. Thyroidology and public health: Challenges within the medical profession. Thyroid Res Pract [serial online] 2019 [cited 2019 Dec 15 ];16:93-94
Available from: http://www.thetrp.net/text.asp?2019/16/3/93/271159


Full Text



In 2011, Thyroid Research and Practice carried an editorial describing the public health challenges faced in thyroidology. This discussed iodine and selenium insufficiency, maternal hypothyroidism, water pollution, insecticide use, and radioactive iodine exposure as well-known causes of thyroid disease. The authors also highlighted the potential perils of direct access testing of thyroid function.[1] All these have varying impact on the health of our communities.

The 2011 editorial took a patient-centric viewpoint of community health. In this editorial, we describe thyroid-related public health issues from a health-care provider's perspective.

Fluoroscopy is an integral part of many doctor's professional careers, including cardiologists, neurosurgeons' radiologists, and orthopedic surgeons.[2] Yet, many physicians report suboptimal interest, knowledge, and awareness regarding radiation safety.[3],[4] Media reports have highlighted the increased radiation exposure to the thyroid during procedures such as mammography and dental X-rays.[5] While consensus suggests that patients do not need a thyroid shield during most procedures, this is not true for health-care providers.

Repeated exposure to irradiation may harm the thyroid which is an extremely radiosensitive organ.[6] Radiation can lead to two types of adverse effects, namely, deterministic and stochastic. While deterministic effects do not occur below a particular threshold, stochastic effects may occur at any level of exposure.[7] These include carcinogenesis and teratogenesis.

From a thyroid perspective, thyroid shields are essential for radiosafety. The thyroid gland can tolerate a maximum dose of 300 msv per annum.[8] Radiation safety can be enhanced by reducing the time of exposure to radiation, increasing one's distance from the source of radiation, and shielding oneself from radiation. Proper use of a thyroid shield can help halve total exposure to radiation. For this, a shield with ≥0.5 mm lead equivalent thickness must be worn tightly and properly, or loosely in combination with bismuth masking reagent. The thyroid shield should also be checked for damage by annual inspection.[9]

As responsible endocrinologists, we should take on the responsibility of educating and raising awareness of fellow medical professionals. The incidence of thyroid carcinoma is increasing rapidly. Evidence from persons with accidental exposure to radioactivity, including Chernobyl and Fukushima, suggests that this is a major cause of thyroid cancer.[10] Health-care professionals should, therefore, take appropriate action to protect themselves from such exposure. The availability and utility of potassium iodate as a prophylactic against thyrocarcinogenesis should also be explained.

References

1Kalra S, Unnikrishnan AG, Sahay R. Thyroidology and public health: The challenges ahead. Indian J Endocrinol Metab 2011;15:S73-5.
2Meisinger QC, Stahl CM, Andre MP, Kinney TB, Newton IG. Radiation protection for the fluoroscopy operator and staff. AJR Am J Roentgenol 2016;207:745-54.
3Dr. Oz, Thyroid Shields & Mammography — The Popular TV Host Sparks a Debate With Radiology. Available from: https://www.radiologytoday.net/archive/rt0611p18.shtml. [Last accessed on 2019 Nov 05].
4Kim TH, Hong SW, Woo NS, Kim HK, Kim JH. The radiation safety education and the pain physicians' efforts to reduce radiation exposure. Korean J Pain 2017;30:104-15.
5Memon A, Godward S, Williams D, Siddique I, AlSaleh K. Dental x-rays and the risk of thyroid cancer: A case-control study. Acta Oncol 2010;49:447-53,
6Rehani MM, Ciraj-Bjelac O, Vañó E, Miller DL, Walsh S, Giordano BD, et al. ICRP publication 117. Radiological protection in fluoroscopically guided procedures performed outside the imaging department. Ann ICRP 2010;40:1-02.
7Gaussen A, Legal JD, Beron-Gaillard N, Laplanche A, Travagli JP, Caillou B, et al. Radiosensitivity of human normal and tumoral thyroid cells using fluorescence in situ hybridization and clonogenic survival assay. Int J Radiat Oncol Biol Phys 1999;44:683-91.
8Mettler FA. Medical effects and risks of exposure to ionising radiation. J Radiol Prot 2012;32:N9-13.
9López PO, Dauer LT, Loose R, Martin CJ, Miller DL, Vañó E, et al. ICRP publication 139: Occupational radiological protection in interventional procedures. Ann ICRP 2018;47:1-18.
10Socolow EL, Hashizume A, Neriishi S, Niitani R. Thyroid carcinoma in man after exposure to ionizing radiation. A summary of the findings in Hiroshima and Nagasaki. N Engl J Med 1963;268:406-10.