Environmental contamination with metals as a risk factor causing developing autoimmune thyroiditis in children in zones influenced by emissions from metallurgic enterprises
I.Е. Shtina, S.L. Valina, К.P. Luzhetskiy, М.Т. Zenina, О.Yu. Ustinova
Federal Scientific Center for Medical and Preventive Health Risk Management Technologies, 82 Monastyrskaya Str., Perm, 614045, Russian Federation
Chemical environmental factors trophic for the endocrine system and its organs produce negative influence on it that becomes apparent through growing incidence and pathomorphism of endocrine diseases.
Our test group was made up of 102 children with diagnosed autoimmune thyroiditis (AIT) who were chronically exposed to metals (lead, manganese, nickel, chromium, and zinc) being components in emissions from metallurgic enterprises in Perm region. Our reference group included 46 children with AIT who lived beyond zones influenced by the aforementioned enterprises in areas with the sanitary-hygienic situation being relatively favorable. We comparatively analyzed the results of clinical and ultrasound examinations that focused on evaluating children’s thyroidal and immune state.
A growth in incidence with thyroiditis amounted to 63.6 % on the test territory over 10 years and it was 1.6 times higher than on average in the region (40.8 %); there was no growth in the indicator detected on the reference territory. Concentrations of chromium, nickel, lead, zinc, and manganese higher than regional background level were 1.7–5.5 times more frequently detected in blood of children from the test group against the reference one. A number of AIT cases was higher among exposed boys (by 2.0 times, p = 0.070); exposed children also had higher Ig A, M, and G contents in blood serum (by up to 2.9 times, p = 0.015–0.056), higher TSH levels (by 2.0 times, p = 0.096), and lower free T4 contents (by 5.4 times, p = 0.057). Diffuse damage to the thyroid gland was by 1.3 times more frequent under exposure to adverse factors created by metallurgic production; AIT combined with other diseases was also more frequent (p = 0.041).
Rates and growth in incidence of thyroid gland diseases and thyroiditis are by 1.3–2.3 times higher among children and teenagers living on territories where metallurgic enterprises are located against the same indicators on territories where sanitary-hygienic situation is relatively favorable. We detected less apparent gender-related differences in AIT frequency, a greater number of improper thyroidal state, elevated risks of diffuse changes in the thyroid gland and activation of humoral immune response that was by 2.2–3.4 times more frequent together with concomitant damage to other systems under elevated contents of metals in blood.
- Ogryzko Е., Shelepova Е., Kuznetsova V. Dynamics of thyroid gland incidence among children at the age of 0–17 years in the Russian Federation. Sovremennye problemy zdravookhraneniya i meditsinskoi statistiki, 2020, no. 3, pp. 341–356. DOI: 10.24411/2312-2935-2020-00076 (in Russian).
- Gerasimov G.A. Sad statistics. Klinicheskaya i eksperimental'naya tireoidologiya, 2015, vol. 11, no. 4, pp. 6–12. DOI: 10.14341/ket201546-12 (in Russian).
- Terekhov P.A., Rybakova A.A., Terekhova M.A., Troshina E.A. Awareness of the population in Russian Federation about iodine deficiency, its effects and methods for prevention of iodine deficiency disorders. Klinicheskaya i eksperimental'naya tireoidologiya, 2019, vol. 15, no. 3, pp. 118–123. DOI: 10.14341/ket12239 (in Russian).
- Hanley P., Lord K., Bauer A.J. Thyroid Disorders in Children and Adolescents: A Review. JAMA Pediatr., 2016, vol. 170, no. 10, pp. 1008–1019. DOI: 10.1001/jamapediatrics.2016.0486
- Litvitskiy P. Pathology of endocrine system: etiology and pathogenesis of endocrinopathies. Disorders of hypathalamohypophysial system. Voprosy sovremennoi pediatrii, 2011, vol. 10, no. 4, pp. 47–60 (in Russian).
- Gladkaya V.S., Gritsinskaya V.L. Prevention of iodine deficiency: awareness and consumer choice of the university students. Zdravookhranenie Rossiiskoi Federatsii, 2020, vol. 64, no. 4, pp. 196–201. DOI: 10.46563/0044-197X-2020-64-4-196-201 (in Russian).
- Urmanova Yu.M., Azimova Sh.Sh., Rikhsieva N.T. Prevalence and structure of thyroid diseases in children and adolescents according to the data of appealability. Mezhdunarodnyi endokrinologicheskii zhurnal, 2018, vol. 14, no. 2, pp. 163–167. DOI: 10.22141/2224-07184.108.40.2068.130562 (in Russian).
- Troshina E.A, Platonova N.M, Panﬁlova E.A, Panﬁlov K.O. The analytical review of monitoring of the basic epidemiological characteristics of iodine deﬁciency disorders among the population of the Russian Federation for the period 2009–2015. Problemy endokrinologii, 2018, vol. 64, no. 1, pp. 21–37. DOI: 10.14341/probl9308 (in Russian).
- Gel'tser B.I., Zdor V.V., Kotel'nikov V.N. Evolution of the views on pathogenesis of autoimmune thyroid diseases and pro-spects for their target therapy. Klinicheskaya meditsina, 2017, vol. 95, no. 6, pp. 524–534. DOI: 10.18821/0023-2149-2017-95-6-524-534 (in Russian).
- Rozhko V.A. Current state of the autoimmune thyroiditis problem. Problemy zdorov'ya i ekologii, 2019, no. 2 (60), pp. 4–13 (in Russian).
- Palagina L.N. Clinical and epidemiological features of endocrine pathology in children due to the influence of environmental factors. Vestnik Permskogo universiteta. Seriya: Biologiya, 2011, no. 2, pp. 69–72 (in Russian).
- Ambient (outdoor) air pollution. World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health (25.09.2021).
- Pasala P., Francis G.L. Autoimmune thyroid diseases in children. Expert Rev. Endocrinol. Metab., 2017, vol. 12, no. 2, pp. 129–142. DOI: 10.1080/17446651.2017.1300525
- Hybenova M., Hrda P., Procházková J., Stejskal V., Sterzl I. The role of environmental factors in autoimmune thyroiditis. Neuro Endocrinol. Lett., 2010, vol. 31, no. 3, pp. 283–289.
- Zimmermann M.B., Molinari L., Spehl M., Weidinger-Toth J., Podoba J., Hess S., Delange F. Updated Provisional WHO/ICCIDD Reference Values for Sonographic Thyroid Volume in Iodine-Replete School-age Children. IDD Newsletter, 2001, vol. 17, no. 1, pp. 12.
- Geger E.V. Influence of environmental factors on morbidity rate of thyroid pathology. Zdorov'e naseleniya i sreda obitaniya, 2014, vol. 250, no. 1, pp. 10–11 (in Russian).
- Luzhetskiy K.P., Tsinker M.Yu., Vekovshinina S.A. Structural and dynamic analysis of endocrine pathology in the Russian Federation with different levels of spectrum and environmental pollution. Zdorov'e naseleniya i sreda obitaniya, 2017, vol. 290, no. 5, pp. 7–11. DOI: 10.35627/2219-5238/2017-290-5-7-11 (in Russian).
- Kiyaev A.V., Saveliev L.I., Gerasimova L.Yu., Koroleva N.P., Boyarsky S.N., Tsvirenko S.V. The Prevalence of Thyroid Disease in the Children and Teenagers in Iodine-Deficient Region. Klinicheskaya i eksperimental'naya tireoidologiya, 2007, vol. 3, no. 2, pp. 33–38. DOI: 10.14341/ket20073233-38 (in Russian).
- Shirokova V.I., Golodenko V.I., Demin V.F., Morozova N.V., Fitin A.F., Cheltsova O.V., Stolyarova S.A. Iodine deficiency: diagnosis and correction. Pediatriya. Zhurnal im. G.N. Speranskogo, 2005, vol. 84, no. 6, pp. 68–72 (in Russian).
- Kucharska A.M., Witkowska-Sȩdek E., Labochka D., Rumińska M. Clinical and Biochemical Characteristics of Severe Hypothyroidism Due to Autoimmune Thyroiditis in Children. Front. Endocrinol. (Lausanne), 2020, vol. 11, pp. 364. DOI: 10.3389/fendo.2020.00364
- Demirbilek H., Kandemir N., Gonc E.N., Ozon A., Alikasifoglu A., Yordam N. Hashimoto’s thyroiditis in children and ado-lescents: a retrospective study on clinical, epidemiological and laboratory properties of the disease. J. Pediatr. Endocrinol. Metab., 2007, vol. 20, no. 11, pp. 1199–1205. DOI: 10.1515/jpem.2007.20.11.1199
- Taranushenko T.Е., Kiseleva N.G. Diagnosis of thyroid disease in pediatric practice. Pediatriya. Prilozhenie k zhurnalu Consilium Medicum, 2018, no. 3, pp. 92–98. DOI: 10.26442/2413-8460_2018.3.92-98 (in Russian).
- Alferova V.I., Mustafina S.V., Rymar O.D. Iodine status of the population in Russia and the world: what do we have for 2019? Klinicheskaya i eksperimental'naya tireoidologiya, 2019, vol. 15, no. 2, pp. 73–82. DOI: 10.14341/ket10353 (in Russian).
- Marwaha R.K., Tandon N., Kanwar R., Ganie M.A., Bhattacharya V., Reddy D.H., Gopalakrishnan S., Aggarwal R. [et al.]. Evaluation of the role of ultrasonography in diagnosis of autoimmune thyroiditis in goitrous children. Indian Pediatr., 2008, vol. 45, no. 4, pp. 279–284.