Overt Primary Hypothyroidism in an Industrial Area in São Paulo, Brazil: The Impact of Public Disclosure.

Maria Angela Zaccarelli-Marino,Julio M Singer,Carmen Diva Saldiva André

doi:10.3390/ijerph13111161

Abstract

Background: Primary hypothyroidism (PH) is the most common thyroid pathology. Purpose: to evaluate the impact of public disclosure of an unexpected number of PH cases on the frequency of patients seeking medical evaluation for endocrinological diseases. Methods: data on 6306 subjects (3356 living in the surroundings of a petrochemical complex and 2950 in a control region) were collected over a 15-year time span. Thyroid function was determined by serum levels of triiodothyronine, thyroxine, free thyroxine and thyrotrophin. Antithyroglobulin and antithyroperoxidase antibodies and sonographic scans of the thyroid were performed in all patients. The data were analyzed via log-linear models to compute odds and odds ratios. Results: An increasing trend in the odds of PH was detected along the observation period with greater slope in the study region than in the control region. The odds of PH in the post-disclosure period (2002 to 2004) are greater than the corresponding ones in the pre-disclosure period (1989 to 2001). Conclusions: This study shows that living in the surroundings of a petrochemical complex may be an important risk factor for PH for both adults and children. Furthermore, public disclosure of such risk factor contributes to the awareness of the problem and to the possibility of an early diagnosis.

Highlights

In 1989, a patient diagnosed with overt primary hypothyroidism (PH), originated from a chronic autoimmune thyroiditis (CAT), called the attention of the first author of this study because he was a 37 year old male, working in a chemical industry and known to wash his hands with trichloroethylene, a volatile organic compound still used in industry as a degreasing agent
We compare two periods: the first consisting of 12 years (1989 to 2001), when the patients living in Region A spontaneously searched an endocrinology clinic located in Santo André, SP, Brazil and the second consisting of a 3 year period (2002 to 2004), starting after the first author notified the Epidemiological Surveillance Center (ESC) of the Department of Health of the State of São Paulo regarding the excessive number of Primary hypothyroidism (PH) observed in her endocrinology clinic
Landrigan et al [26] showed that environmental pollutants, chemicals, solid waste and pharmaceuticals have a negative impact on the developing immune system of children and this may justify the increased odds of PH in Region A reported for children since all the children diagnosed with PH were diagnosed with CAT

Summary

Introduction

In 1989, a patient diagnosed with overt primary hypothyroidism (PH), originated from a chronic autoimmune thyroiditis (CAT), called the attention of the first author of this study because he was a 37 year old male, working in a chemical industry and known to wash his hands with trichloroethylene, a volatile organic compound still used in industry as a degreasing agent.It is well known that trichloroethylene is highly toxic and considered as an important water and soil pollutant [1]. Hypothyroidism can generate alterations of cardiac and cognitive functions, myxedema, hypercholesterolemia and incapacity to work or to lead a healthy family life [2,3,4,5]. In children, it may have deleterious effects on growth, school performance and pubertal development. Conclusions: This study shows that living in the surroundings of a petrochemical complex may be an important risk factor for PH for both adults and children. Public disclosure of such risk factor contributes to the awareness of the problem and to the possibility of an early diagnosis

Objectives

Discussion

Conclusion