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Increased risk for hypothyroidism after anticholinesterase pesticide poisoning: a nationwide population-based study

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Abstract

Purpose

Previous animal studies have reported that acute anticholinesterase pesticide (organophosphate and carbamate) poisoning may affect thyroid hormones. However, there is no human study investigating the association between hypothyroidism and anticholinesterase pesticide poisoning, and therefore, we conducted a retrospective nationwide population-based cohort study to delineate this issue.

Methods

We identified 10,372 anticholinesterase pesticide poisoning subjects and matched 31,116 non-anticholinesterase pesticide poisoning subjects between 2003 and 2012 from the Nationwide Poisoning Database and the Longitudinal Health Insurance Database 2000, respectively, in a 1:3 ratio by index date, age, and sex for this study. We compared the cumulative incidence of hypothyroidism between the two cohorts by following up until 2013. Independent predictors for hypothyroidism were also investigated.

Results

In total, 75 (0.72%) anticholinesterase pesticide poisoning subjects and 184 (0.59%) non-anticholinesterase pesticide poisoning subjects were diagnosed with hypothyroidism during the follow-up. Cox proportional hazard regression analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects (adjusted hazard ratio: 1.47, 95% confidence interval: 1.11–1.95) after adjusting for age, sex, hypertension, malignancy, liver disease, renal disease, atrial fibrillation or flutter, thyroiditis, goiter, other endocrine disorders, and mental disorder. Stratified analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects in terms of the age subgroup of 40–64 years, female sex, past history of goiter, follow-up of <1 month, and anticholinesterase pesticide poisoning subjects without atropine treatment (incidence rate ratio [IRR]: 1.66, 95% confidence interval: 1.20–2.30). Female sex, malignancy, renal disease, thyroiditis, goiter, mental disorder, and anticholinesterase pesticide poisoning without atropine treatment were independent predictors for hypothyroidism.

Conclusions

Anticholinesterase pesticide poisoning is associated with increased risk for hypothyroidism. Early evaluation of thyroid function in anticholinesterase pesticide poisoning subjects is suggested, especially in subjects without atropine treatment, aged 40–64 years, female sex, and past history of goiter.

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References

  1. T.J. Lin, F.G. Walter, D.Z. Hung et al. Epidemiology of organophosphate pesticide poisoning in Taiwan. Clin. Toxicol. 46, 794–801 (2008)

    Article  Google Scholar 

  2. Y.P. Lim, C.L. Lin, D.Z. Hung, W.C. Ma, Y.N. Lin, C.H. Kao, Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with organophosphate intoxication: a nationwide prospective cohort study. Medicine 94, e341 (2015)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. H.S. Huang, C.C. Hsu, S.F. Weng et al. Acute anticholinesterase pesticide poisoning caused a long-term mortality increase: a nationwide population-based cohort study. Medicine (Baltimore) 94, e1222 (2015)

    Article  CAS  Google Scholar 

  4. É. Campos, C. Freire, Exposure to non-persistent pesticides and thyroid function: a systematic review of epidemiological evidence. Int. J. Hyg. Environ. Health 219, 481–497 (2016)

    Article  CAS  PubMed  Google Scholar 

  5. M. Boas, K.M. Main, U. Feldt-Rasmussen, Environmental chemicals and thyroid function: an update. Curr. Opin. Endocrinol. Diabetes Obes. 16, 385–391 (2009)

    Article  CAS  PubMed  Google Scholar 

  6. L.H. Duntas, Chemical contamination and the thyroid. Endocrine 48, 53–64 (2015)

    Article  CAS  PubMed  Google Scholar 

  7. R.C. Smallridge, F.E. Carr, H.G. Fein, Diisopropylfluorophosphate (DFP) reduces serum prolactin, thyrotropin, luteinizing hormone, and growth hormone and increases adrenocorticotropin and corticosterone in rats: involvement of dopaminergic and somatostatinergic as well as cholinergic pathways. Toxicol. Appl. Pharmacol. 1082, 284–295 (1991)

    Article  Google Scholar 

  8. K. Van den Berg, J. Van Raaij, P. Bragt, W. Notten, Interactions of halogenated industrial chemicals with transthyretin and effects on thyroid hormone levels in vivo. Arch. Toxicol. 65, 15–19 (1991)

    Article  PubMed  Google Scholar 

  9. H. Sun, O.X. Shen, X.L. Xu, L. Song, X.R. Wang, Carbaryl, 1-naphthol and 2-naphthol inhibit the beta-1 thyroid hormone receptor-mediated transcription in vitro. Toxicology 249, 238–242 (2008)

    Article  CAS  PubMed  Google Scholar 

  10. S. De Angelis, R. Tassinari, F. Maranghi, Developmental exposure to chlorpyrifos induces alterations in thyroid and thyroid hormone levels without other toxicity signs in CD-1 mice. Toxicol. Sci. 108, 311–319 (2009)

    Article  PubMed  Google Scholar 

  11. F. Coperchini, O. Awwad, M. Rotondi, F. Santini, M. Imbriani, L. Chiovato, Thyroid disruption by perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA). J. Endocrinol. Invest. 40, 105–121 (2017)

    Article  CAS  Google Scholar 

  12. M. Lacasaña, I. López-Flores, M. Rodríguez-Barranco, Association between organophosphate pesticides exposure and thyroid hormones in floriculture workers. Toxicol. Appl. Pharmacol. 243, 19–26 (2010)

    Article  Google Scholar 

  13. J.D. Meeker, D.B. Barr, R. Hauser, Thyroid hormones in relation to urinary metabolites of non-persistent insecticides in men of reproductive age. Reprod. Toxicol. 22, 437–442 (2006)

    Article  CAS  PubMed  Google Scholar 

  14. National Health Insurance Research Database. Background. (2017), http://nhird.nhri.org.tw/en/index.htm

  15. R. Ryhänen, J. Herranen, K. Korhonen, I. Penttilä, M. Polvilampi, E. Puhakainen, Relationship between serum lipids, lipoproteins and pseudocholinesterase during organophosphate poisoning in rabbits. Int. J. Biochem. 16, 687–690 (1984)

    Article  PubMed  Google Scholar 

  16. A.K. Srivastava, N.N. Singh, Effects of acute exposure to methyl parathion on carbohydrate metabolism of Indian catfish (Heteropneustes fossilis). Basic Clin. Pharmacol. Toxicol. 48, 26–31 (1981)

    CAS  Google Scholar 

  17. K.M. Crofton, Thyroid disrupting chemicals: mechanisms and mixtures. Int. J. Androl. 31, 209–223 (2008)

    Article  CAS  PubMed  Google Scholar 

  18. K. Chuhara, A. Arimura, A.V. Schally, Effect of intraventricular injection of dopamine, norepinephrine, acetylcholine, and 5-hydroxytryptamine on immunoreactive somatostatin release into rat hypophyseal portal blood. Endocrinology 104, 1656–1662 (1979)

    Article  Google Scholar 

  19. S.H. Jeong, B.Y. Kim, H.G. Kang, H.O. Ku, J.H. Cho, Effect of chlorpyrifos-methyl on steroid and thyroid hormones in rat F0-and F1-generations. Toxicology 220, 189–202 (2006)

    Article  CAS  PubMed  Google Scholar 

  20. M. Ghisari, E.C. Bonefeld-Jorgensen, Impact of environmental chemicals on the thyroid hormone function in pituitary rat GH3 cells. Mol. Cell. Endocrinol. 244, 31–41 (2005)

    Article  CAS  PubMed  Google Scholar 

  21. S. Satar, D. Satar, S. Kirim, H. Leventerler, Effects of acute organophosphate poisoning on thyroid hormones in rats. Am. J. Ther. 12, 238–342 (2005)

    PubMed  Google Scholar 

  22. S. Lee, A.P. Farwell, Euthyroid Sick Syndrome. Compr. Physiol. 6, 1071–1080 (2016)

    Article  PubMed  Google Scholar 

  23. E. Fliers, A.C. Bianco, L. Langouche, A. Boelen, Thyroid function in critically ill patients. Lancet Diabetes Endocrinol. 3, 816–825 (2015)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. P.W. Ladenson, P.A. Singer, K.B. Ain et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch. Intern. Med. 160, 1573–1575 (2000)

    Article  CAS  PubMed  Google Scholar 

  25. American thyroid association, Goiter (2017), http://www.thyroid.org/goiter/

  26. Y. Carter, R.S. Sippel, H. Chen, Hypothyroidism after a cancer diagnosis: etiology, diagnosis, complications, and management. Oncologist 19, 34–43 (2014)

    Article  CAS  PubMed  Google Scholar 

  27. G. Basu, A. Mohapatra, Interactions between thyroid disorders and kidney disease. Indian J. Endocrinol. Metab. 16, 204–213 (2012)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. T.D. Geracioti, Identifying hypothyroidism’s psychiatric presentations. Curr. Psychiatry 5, 98–117 (2006)

    Google Scholar 

  29. T.Y. Chen, C.C. Hsu, I.J. Feng et al. Higher risk for thyroid diseases in physicians than in the general population: a Taiwan nationwide population-based secondary analysis study. QJM 110, 163–168 (2017)

    PubMed  Google Scholar 

  30. P. Fallahi, S.M. Ferrari, I. Ruffilli et al. The association of other autoimmune diseases in patients with autoimmune thyroiditis: review of the literature and report of a large series of patients. Autoimmun. Rev. 15, 1125–1128 (2016)

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was support by Grants CMFHR10636 from Chi-Mei Medical Center. This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by the National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the National Health Insurance Administration, Department of Health, or the National Health Research Institutes.

Author contributions

H.S.H., C.C. Huang, and H.J.L. designed the study, interpreted the data, and wrote the manuscript. C.H.H. did the statistical analysis. K.W.L., S.B.S., and J.J.W. provided clinical experience and helped in drafting the manuscript. C.C. Huang and H.J.L. supervised the whole study and were responsible for all communication. All authors read and approved the final manuscript.

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    Authors and Affiliations

    1. Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan

      Hung-Sheng Huang, Chien-Chin Hsu, Hung-Jung Lin & Chien-Cheng Huang

    2. Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan

      Hung-Sheng Huang, Shih-Bin Su & Chien-Cheng Huang

    3. Division of Cardiovascular Diseases, Department of Internal Medicine, Chi-Mei Medical Center, Chiali, Tainan, Taiwan

      Keng-Wei Lee

    4. Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan

      Chung-Han Ho & Jhi-Joung Wang

    5. Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

      Chung-Han Ho

    6. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

      Chien-Chin Hsu & Hung-Jung Lin

    7. Department of Leisure, Recreation, and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan

      Shih-Bin Su

    8. Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan

      Shih-Bin Su

    9. Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan

      Hung-Jung Lin

    10. Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan

      Chien-Cheng Huang

    11. Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

      Chien-Cheng Huang

    12. Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan

      Chien-Cheng Huang

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    1. Hung-Sheng Huang
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    Correspondence to Hung-Jung Lin or Chien-Cheng Huang.

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    The authors declare that they have no competing interests.

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    Hung-Sheng Huang and Keng-Wei Lee contributed equally to this work.

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    Huang, HS., Lee, KW., Ho, CH. et al. Increased risk for hypothyroidism after anticholinesterase pesticide poisoning: a nationwide population-based study. Endocrine 57, 436–444 (2017). https://doi.org/10.1007/s12020-017-1373-7

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    • DOI: https://doi.org/10.1007/s12020-017-1373-7

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