This document serves to summarize the issues and the American Thyroid Association (ATA) position regarding the use of potassium iodide as a thyroid blocking agent in the event of a nuclear accident. The purpose is to provide a review and updated position statement regarding the advanced distribution, stockpiling, and availability of potassium iodide in the event of nuclear radiation emergencies in the United States.
Get full access to this article
View all access options for this article.
References
1.
BeckerDV, BravermanLE, DunnJT, GaitanE, GormanC, MaxonH, SchneiderAB, Van MiddlesworthL, WolffJ. 1984. The use of iodine as a thyroidal blocking agent in the event of a reactor accident. Report of the Environmental Hazards Committee of the American Thyroid Association. JAMA, 252:659–661.
2.
American Thyroid Association. American Thyroid Association endorses potassium iodide for radiation emergencies. Available at: www.thyroid.org/ata-endorses-potassium-iodide-for-radiation-emergencies/ (accessed August15, 2016).
3.
SchneiderAB, SmithJM. 2012. Potassium iodide prophylaxis: what have we learned and questions raised by the accident at the Fukushima Daiichi Nuclear Power Plant. Thyroid, 22:344–346.
4.
Committee to Assess the Distribution and Administration of Potassium Iodide in the Event of a Nuclear Accident Incident; Board on Radiation Effects Research; Division on Earth and Life Sciences; National Research Council 2004 Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident. National Academies Press, Washington, DC.
5.
ReinersC, SchneiderR, AkashiM, AklEA, JourdainJR, LiC, MurithC, Van BladelL, YamashitaS, ZeebH, VittiP, CarrZ. 2016. The first meeting of the WHO guideline development group for the revision of the WHO 1999 guidelines for iodine blocking. Radiat Prot Dosimetry, 171:47–56.
6.
U.S. Department of Health & Human Services Radiation Emergency Medical Management. Potassium iodide. Available at: www.remm.nlm.gov/potassiumiodide.htm (accessed August18, 2016).
7.
SchneiderM, FroggartA.The World Nuclear Industry Status Report. Available at: www.worldnuclearreport.org/-2015-.html (accessed September18, 2016).
8.
International Atomic Energy Association. The database on nuclear power reactors. Available at: www.iaea.org/pris (accessed July11, 2016).
9.
United States Nuclear Regulatory Commission. Map of power reactor sites. Available at: www.nrc.gov/reactors/operating/map-power-reactors.html (accessed August3, 2016).
10.
United States Nuclear Regulatory Commission. Backgrounder on research and test reactors. Available at: www.nrc.gov/reading-rm/doc-collections/fact-sheets/research-reactors-bg.html (accessed September1, 2016).
11.
National Center for Disaster Preparedness. Nuclear power plants and earthquake risk. Available at: http://ncdp.columbia.edu/library/mapsmapping-projects/nuclear-power-plants-earthquake-risk/ (accessed July11, 2016).
12.
U.S. Food and Drug Administration. Public Health Safety and Bioterrorism Preparedness and Response Act of 2002 (PL107-188), Letter from Center Director. Available at: www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/FoodDefense/ucm111086.htm (accessed August24, 2016).
13.
Endocrinology & Metabolism News 2008 White House Decision on Potassium Iodide Distribution Leaves Many Baffled. J Clin Endocrinol Metab, 93(3):17a-20a; DOI: https://doi.org/10.1210/jcem.93.3.9993.
14.
United States Nuclear Regulatory Commission. Consideration of potassium iodide in emergency planning. Available at: www.nrc.gov/about-nrc/emerg-preparedness/about-emerg-preparedness/potassium-iodide.html#distribution-ki (accessed August25, 2016).
15.
FitzgeraldJ, WollnerSB, AdaljaAA, MorhardR, CiceroA, InglesbyTV. 2012. After Fukushima: managing the consequences of a radiological release. Biosecur Bioterror, 10:228–236.
16.
European Commission. Radiation Protection No 165—Medical effectiveness of iodine prophylaxis in a nuclear reactor emergency situation and overview of European practices. Available at: https://ec.europa.eu/energy/sites/ener/files/documents/165.pdf (accessed August3, 2016).
17.
United States Nuclear Regulatory Commission 2011 Developing an Emergency Risk Communication (ERC)/Joint Information Center (JIC) Plan for a Radiological Emergency. Center for Risk Communication, New York, New York.
18.
MurakamiM, OnoK, TsubokuraM, NomuraS, OikawaT, OkaT, KamiM, OkiT. 2015. Was the risk from nursing-home evacuation after the Fukushima accident higher than the radiation risk?. PLoS One, 10:e0137906.
19.
TanigawaK, HosoiY, HirohashiN, IwasakiY, KamiyaK. 2012. Loss of life after evacuation: lessons learned from the Fukushima accident. Lancet, 379:889–891.
20.
United States Nuclear Regulatory Commission. Emergency planning zones. Available at: www.iaea.org/pris (accessed June23, 2016).
21.
United Nations Scientific Committee on the Effects of Atomic Radiation. UNSCEAR sssessments of the Chernobyl accident. Available at: www.unscear.org/unscear/en/chernobyl.html (accessed August3, 2016).
22.
BravermanER, BlumK, LoeffkeB, BakerR, KreukF, YangSP, HurleyJR. 2014. Managing terrorism or accidental nuclear errors, preparing for iodine-131 emergencies: a comprehensive review. Int J Environ Res Public Health, 11:4158–4200.
23.
DauerLT, ZanzonicoP, TuttleRM, QuinnDM, StraussHW. 2011. The Japanese tsunami and resulting nuclear emergency at the Fukushima Daiichi power facility: technical, radiologic, and response perspectives. J Nucl Med, 52:1423–1432.
24.
CardisE, HoweG, RonE, BebeshkoV, BogdanovaT, BouvilleA, CarrZ, ChumakV, DavisS, DemidchikY, DrozdovitchV, GentnerN, GudzenkoN, HatchM, IvanovV, JacobP, KapitonovaE, KenigsbergY, KesminieneA, KopeckyKJ, KryuchkovV, LoosA, PincheraA, ReinersC, RepacholiM, ShibataY, ShoreRE, ThomasG, TirmarcheM, YamashitaS, ZvonovaI. 2006. Cancer consequences of the Chernobyl accident: 20 years on. J Radiol Prot, 26:127–140.
25.
FaggianoA, CoulotJ, BellonN, TalbotM, CaillouB, BidartJM, SchlumbergerM. 2004. Age-dependent variation of follicular size and expression of iodine transporters in human thyroid tissue. J Nucl Med, 45:232–237.
26.
SaadAG, KumarS, RonE, LubinJH, StanekJ, BoveKE, NikifurovYE. 2006. Proliferative activity of human thyroid cells in various age groups and its correlation with the risk of thyroid cancer after radiation exposure. J Clin Endocrinol Metab, 91:2672–2677.
Report of the President's Commission on the accident at Three Mile Island. Available at: www.threemileisland.org/downloads/188.pdf (accessed August22, 2016).
29.
SmallWE. 1979. Mobilizing for Three Mile Island—the disaster that wasn't. Am Pharm, 19:8–9.
30.
Radiation and health effects. A report of the TMI-2 accident and related health studies. Available at: www.threemileisland.org/downloads/224.pdf (accessed August20, 2016).
31.
United States Nuclear Regulatory Commission. Backgrounder on Three Mile Island accident. Available at: www.nrc.gov/reading-rm/doc-collections/fact-sheets/3mile-isle.html (accessed August22, 2016).
32.
GoyalN, CamachoF, ManganoJ, GoldenbergD. 2012. Thyroid cancer characteristics in the population surrounding Three Mile Island. Laryngoscope, 122:1415–1421.
33.
LevinRJ, De SimoneNF, SlotkinJF, HensonBL. 2013. Incidence of thyroid cancer surrounding Three Mile Island nuclear facility: the 30-year follow-up. Laryngoscope, 123:2064–2071.
34.
HanYY, YoukAO, SasserH, TalbottEO. 2011. Cancer incidence among residents of the Three Mile Island accident area: 1982–1995. Environ Res, 111:1230–1235.
35.
NagatakiS. 2014. Radiation Health Effects and Countermeasures: Lessons from Past Nuclear Disasters from Atomic Bomb to Fukushima. Maruzen Publishing Co. Ltd., Tokyo, Japan.
36.
United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and effects of ionizing radiation. Report to the general assembly. 2008. Annex D: Health effects due to radiation from the Chernobyl accident. Available at: www.unscear.org/docs/reports/2008/11-80076_Report_2008_Annex_D.pdf (accessed August17, 2016).
37.
SaenkoV, IvanovV, TsybA, BogdanovaT, TronkoM, DemidchikY, YamashitaS. 2011. The Chernobyl accident and its consequences. Clin Oncol (R Coll Radiol), 23:234–243.
38.
LikhtarevIA, ChumackVV, RepinVS. 1994. Analysis of the effectiveness of emergency countermeasures in the 30-km zone during the early phase of the Chernobyl accident. Health Phys, 67:541–544.
39.
MettlerF, RoyalH, HurleyJ. 1992. Administration of stable iodine to the population around the Chernobyl nuclear power plant. J Radiol Prot, 12:159–165.
40.
NaumanJ, WolffJ. 1993. Iodine prophylaxis in Poland after the Chernobyl reactor accident: benefits and risks. Am J Med, 94:524–532.
41.
BouvilleA, LikhtarevIA, KovganLN, MinenkoVF, ShinkarevSM, DrozdovitchVV. 2007. Radiation dosimetry for highly contaminated Belarusian, Russian and Ukrainian populations, and for less contaminated populations in Europe. Health Phys, 93:487–501.
42.
ShakhtarinVV, TsybAF, StepanenkoVF, OrlovMY, KopeckyKJ, DavisS. 2003. Iodine deficiency, radiation dose, and the risk of thyroid cancer among children and adolescents in the Bryansk region of Russia following the Chernobyl power station accident. Int J Epidemiol, 32:584–591.
BrometEJ, HavenaarJM, GueyLT. 2011. A 25 year retrospective review of the psychological consequences of the Chernobyl accident. Clin Oncol (R Coll Radiol), 23:297–305.
45.
RonE, LubinJH, ShoreRE, MabuchiK, ModanB, PotternLM, SchneiderAB, TuckerMA, BoiceJD. 1995. Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res, 141:259–277.
46.
International Atomic Energy Agency. The Fukushima Daiichi accident. Available at: www-pub.iaea.org/books/IAEABooks/10962/The-Fukushima-Daiichi-Accident (accessed March3, 2017).
47.
NagatakiS, TakamuraN. 2014. A review of the Fukushima nuclear reactor accident: radiation effects on the thyroid and strategies for prevention. Curr Opin Endocrinol Diabetes Obes, 21:384–393.
48.
World Health Organization. Preliminary dose estimation from the nuclear accident after the 2011 great East Japan earthquake and tsunami. Available at: www.who.int/entity/ionizing_radiation/pub_meet/fukushima_dose_assessment/en/ (accessed August17, 2016).
49.
ShimuraT, YamaguchiI, TeradaH, Robert SvendsenE, KunugitaN. 2015. Public health activities for mitigation of radiation exposures and risk communication challenges after the Fukushima nuclear accident. J Radiat Res, 56:422–429.
50.
OhiraT, TakahashiH, YasumuraS, OhtsuruA, MidorikawaS, SuzukiS, FukushimaT, ShimuraH, IshikawaT, SakaiA, YamashitaS, TanigawaK, OhtoH, AbeM, GroupFHMS. 2016. Comparison of childhood thyroid cancer prevalence among 3 areas based on external radiation dose after the Fukushima Daiichi nuclear power plant accident: the Fukushima Health Management Survey. Medicine (Baltimore), 95:e4472.
51.
SuzukiS, FukushimaT, MidorikawaS, ShimuraH, MatsuzukaT, IshikawaT, TakahashiH, OhtsuruA, SakaiA, HosoyaM, YasumuraS, NolletKE, OhiraT, OhtoH, AbeM, KamiyaK, YamashitaS. 2016. Comprehensive survey results of childhood thyroid ultrasound examinations in Fukushima in the first four years after the Fukushima Daiichi nuclear power plant accident. Thyroid, 26:843–851.
52.
United Nations Scientific Committee on the Effects of Atomic Radiation. Report to the General Assembly. 2013. Scientific annex A: levels and effects of radiation exposure due to the nuclear accident after the 2011 great East-Japan earthquake and tsunami. Available at: www.unscear.org/docs/reports/2013/13-85418_Report_2013_Annex_A.pdf (accessed August22, 2016).
53.
TaniK, KuriharaO, KimE, YoshidaS, SakaiK, AkashiM. 2015. Implementation of iodine biokinetic model for interpreting I-131 contamination in breast milk after the Fukushima nuclear disaster. Sci Rep, 5:12426.
54.
MisawaM, NagamoriF. 2008. System for prediction of environmental emergency dose information network system. Fujitsu Sci Tech J, 44:377–398.
55.
ZhangH, YanW, ObaA, ZhangW. 2014. Radiation-driven migration: the case of Minamisoma City, Fukushima, Japan, after the Fukushima nuclear accident. Int J Environ Res Public Health, 11:9286–9305.
56.
World Health Organization. Guidelines for Iodine Prophylaxis Following Radiation Accidents. Available at: www.who.int/ionizing_radiation/pub_meet/Iodine_Prophylaxis_guide.pdf (accessed August18, 2016).
57.
MiskaH. 2016. Evaluation of the response to the Fukushima accident. Health Phys, 111:218–222.
58.
YoshidaS, OjinoM, OzakiT, HatanakaT, NomuraK, IshiiM, KoriyamaK, AkashiM. 2014. Guidelines for iodine prophylaxis as a protective measure: information for physicians. Japan Med Assoc J, 57:113–123.
59.
SimonSI, ColemanCN, NoskaMA, BowmanT. 2012. Response of the U.S. Department of Health and Human Services in protecting civilian Americans in Japan during the Fukushima nuclear crisis. Health Phys, 102(5).
60.
StoneR. 2016. Nuclear safety. Near miss at Fukushima is a warning for U.S. Science, 352:1039–1040.
61.
SternthalE, LipworthL, StanleyB, AbreauC, FangSL, BravermanLE. 1980. Suppression of thyroid radioiodine uptake by various doses of stable iodine. N Engl J Med, 6:1083–1088.
62.
United States Federal Emergency Management Agency (FEMA). Nuclear reactor emergency preparedness. Available at: www.nukepills.com/docs/FEMA_Nuclear_Power_Plant_Emergency.pdf (accessed September18, 2016).
63.
OnishiN, FacklerM. 2011. Japan held nuclear data, leaving evacuees in peril. New York Times, August8.
64.
United States Food and Drug Administration. Frequently asked questions on potassium iodide (KI). Available at: www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072265.htm (accessed August3, 2016).
65.
DavisS, StepanenkoV, RivkindN, KopeckyKJ, VoillequéP, ShakhtarinV, ParshkovE, KulikovS, LushnikovE, AbrosimovA, TroshinV, RomanovaG, DoroschenkoV, ProshinA, TsybA. 2004. Risk of thyroid cancer in the Bryansk Oblast of the Russian Federation after the Chernobyl Power Station accident. Radiat Res, 162:241–248.
United States Centers for Disease Control and Prevention. Emergency preparedness and response: Breastfeeding. Available at: http://emergency.cdc.gov/radiation/breastfeeding.asp (accessed August18, 2016).
68.
U.S. Food and Drug Administration. Potassium iodide (“KI”): instructions to make potassium iodide solution for use during a nuclear emergency (liquid form). Available at: www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072248.htm (accessed August3, 2016).
