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Radiation Dose-Response Relationships for Thyroid Nodules and Autoimmune Thyroid Diseases in Hiroshima and Nagasaki Atomic Bomb Survivors 55-58 Years After Radiation Exposure
Misa Imaizumi, MD;
Toshiro Usa, MD;
Tan Tominaga, MD;
Kazuo Neriishi, MD;
Masazumi Akahoshi, MD;
Eiji Nakashima, PhD;
Kiyoto Ashizawa, MD;
Ayumi Hida, MD;
Midori Soda, MD;
Saeko Fujiwara, MD;
Michiko Yamada, MD;
Eri Ejima, MD;
Naokata Yokoyama, MD;
Masamichi Okubo, MD;
Keizo Sugino, MD;
Gen Suzuki, MD;
Renju Maeda, MD;
Shigenobu Nagataki, MD;
Katsumi Eguchi, MD
JAMA. 2006;295:1011-1022.
Context Effects of irradiation on thyroid diseases such as thyroid nodules and autoimmune thyroid diseases have not been evaluated among people exposed to radiation more than 50 years in the past.
Objective To evaluate the prevalence of thyroid diseases and their radiation-dose responses in atomic bomb survivors.
Design, Setting, and Participants Survey study comprising 4091 cohort members (mean age, 70 [SD, 9] years; 1352 men and 2739 women) who participated in the thyroid study at the Radiation Effects Research Foundation. Thyroid examinations were conducted between March 2000 and February 2003.
Main Outcome Measures Prevalence of thyroid diseases, including thyroid nodules (malignant and benign) and autoimmune thyroid diseases, and the dose-response relationship of atomic bomb radiation in each thyroid disease.
Results Thyroid diseases were identified in 1833 (44.8%) of the total participants (436 men [32.2% of men] and 1397 women [51.0% of women]) (P<.001). In 3185 participants, excluding persons exposed in utero, not in the city at the time of the atomic bombings, or with unknown radiation dose, the prevalence of all solid nodules, malignant tumors, benign nodules, and cysts was 14.6%, 2.2%, 4.9%, and 7.7%, respectively. The prevalence of positive thyroid antibodies, antithyroid antibody–positive hypothyroidism, and Graves disease was 28.2%, 3.2%, and 1.2%, respectively. A significant linear dose-response relationship was observed for the prevalence of all solid nodules, malignant tumors, benign nodules, and cysts (P<.001). We estimate that about 28% of all solid nodules, 37% of malignant tumors, 31% of benign nodules, and 25% of cysts are associated with radiation exposure at a mean and median thyroid radiation dose of 0.449 Sv and 0.087 Sv, respectively. No significant dose-response relationship was observed for positive antithyroid antibodies (P = .20), antithyroid antibody–positive hypothyroidism (P = .92), or Graves disease (P = .10).
Conclusions A significant linear radiation dose response for thyroid nodules, including malignant tumors and benign nodules, exists in atomic bomb survivors. However, there is no significant dose response for autoimmune thyroid diseases.
Author Affiliations: Departments of Clinical Studies (Drs Imaizumi, Neriishi, Akahoshi, Ashizawa, Hida, Soda, Fujiwara, Yamada, Suzuki, and Maeda) and Statistics (Dr Nakashima), Radiation Effects Research Foundation, Nagasaki and Hiroshima; First Department of Internal Medicine, Graduate School of Biochemical Sciences, Nagasaki University, Nagasaki (Drs Imaizumi, Usa, Ejima, and Eguchi); Sasebo Chuo Hospital, Nagasaki (Dr Tominaga); Nagasaki Saiseikai Hospital (Dr Yokoyama); Hisayasu Clinic, Hiroshima (Dr Okubo); Tsuchiya General Hospital, Hiroshima (Dr Sugino); and Japan Radioisotope Association, Tokyo (Dr Nagataki), Japan.
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