Managing Terrorism or Accidental Nuclear Errors, Preparing for Iodine-131 Emergencies: A Comprehensive Review

Abstract

Chernobyl demonstrated that iodine-131 (131I) released in a nuclear accident can cause malignant thyroid nodules to develop in children within a 300 mile radius of the incident. Timely potassium iodide (KI) administration can prevent the development of thyroid cancer and the American Thyroid Association (ATA) and a number of United States governmental agencies recommend KI prophylaxis. Current pre-distribution of KI by the United States government and other governments with nuclear reactors is probably ineffective. Thus we undertook a thorough scientific review, regarding emergency response to 131I exposures. We propose: (1) pre-distribution of KI to at risk populations; (2) prompt administration, within 2 hours of the incident; (3) utilization of a lowest effective KI dose; (4) distribution extension to at least 300 miles from the epicenter of a potential nuclear incident; (5) education of the public about dietary iodide sources; (6) continued post-hoc analysis of the long-term impact of nuclear accidents; and (7) support for global iodine sufficiency programs. Approximately two billion people are at risk for iodine deficiency disorder (IDD), the world’s leading cause of preventable brain damage. Iodide deficient individuals are at greater risk of developing thyroid cancer after 131I exposure. There are virtually no studies of KI prophylaxis in infants, children and adolescents, our target population. Because of their sensitivity to these side effects, we have suggested that we should extrapolate from the lowest effective adult dose, 15–30 mg or 1–2 mg per 10 pounds for children. We encourage global health agencies (private and governmental) to consider these critical recommendations.

Being Unprepared for Nuclear Terrorism Would Lead to Panic and Fear in America

“…One safe, efficient, and inexpensive way to do this is to assure the widespread availability of potassium iodide (KI) for children and young adults. In an earlier report by Braverman, et al [5] timely potassium iodide (KI) administration can prevent the development of thyroid cancer and the American Thyroid Association (ATA) and some United States governmental agencies recommend KI prophylaxis [1]. Importantly, KI's effectiveness at blocking RAI from being absorbed by the thyroid is well known.…”

“…In recognition, the NRC's accident response planning guidelines specifically caution reactor Approximately two billion people are at risk for iodine deficiency disorder (IDD), the world's leading cause of preventable brain damage. Iodide deficient individuals are at higher risk of developing thyroid cancer after I-131 exposure [5]. The impact of iodine deficiency on fetal radiation damages is mainly that on radiation damages to the thyroid [10].…”

“…It is assumed that the fast food and prepared food industries currently use noniodized salt for economic reasons and because rarely people have an allergy. One teaspoon of iodized salt contains approximately 4000 mcg iodine [5,14,15].…”

Toxicology of Repeated Iodine Thyroid Blocking in Adult Rat

“…In the event of a nuclear reactor accident and when radioactive material is released into the atmosphere, 131 I will be concentrated in the thyroid gland by 10 to 30% through inhalation or ingestion of contaminated food and milk [11][12][13]. As a part of 131 I decay process, β-radiation is emitted and affects the thyroid and its surrounding tissue, and my lead to adverse health outcomes such as thyroid dysfunctions and thyroid cancer [12].…”

Sorafenib in the treatment of thyroid cancer

“…Among the risk factors for TC, ionizing radiations play an important role, in particular, considering exposure in the early life (about 2-4% of the subjects exposed to radiation during childhood or adolescence show TC) [5]. The exposure to nuclear explosions or nuclear accidents constitutes a risk factor for TC [6]. In fact, the incidence of TC rapidly increased in childhood after the nuclear accident of Chernobyl (in 1986), in the regions of Belarus and Ukraine, led to exposure to the radiation fallout [7].…”