John Buffum sent email about his duty at Operation Dominic.
Date: Sun, 11 Mar 2001
From: John Buffum groovul@itsa.ucsf.edu
To: pdxavets@aracnet.com
Subject: Radiation and Grave's Disease
Hi Keith,
I was aboard USS Medregal SS480 for Operation Dominic, Shot Frigate Bird
on May 6, 1962. I was a FTGSN standing lookout and planesman duties. When we surfaced I
had to go up from the control room to the bridge. The boat was only on
the surface for a few minutes before the Captain ordered us to submerge
because we were getting rained on. USS Medregal SS480 was submerged 17
miles from ground zero. We were equipped with Bhang meters and other
blast measuring equipment to record size and yield of the explosion of
an operational Polaris missile warhead launched by USS Ethan Allen. We
surfaced right after the blast. The periscope picture of the cloud was
taken from USS Carbonero some 30 miles from ground zero. I was one of four crew members on the bridge when we
surfaced under the cloud after the detonation. Although I was wearing a
film badge I never heard anything about whether I was exposed to any
radiation. Because it was raining out of the cloud the Captain ordered
us to submerge.
We didn't feel the shock wave. We were told about it, and how we
should be on the balls of our feet when it hit, but we didn't feel a
thing. Most were surprised and thought the blast had been a dud or that
it had been too far away to feel. I was in the control room not the
conning tower so I don't know if anyone was looking through the
periscope. I assume they were, as I know the periscope was up to
measure the blast. When we surfaced we were not in the stem of the
cloud but it had spread out above us and we were directly beneath it. I
don't know if anyone on the bridge was measuring radiation. There were
probably radiation detectors somewhere on the boat that someone was
monitoring. Everyone on the boat had film badges. My job as lookout
was to immediately scan (with binoculars) for other surface contacts
when I got up to my lookout platform above the bridge. Needless to say
I was fascinated by the cloud. It was the most evil, awesome looking
thing I have ever seen in my life.
In 1998 I was diagnosed with Grave's Disease. Because of the
association of radiation exposure with the formation of thyroid
antibodies I have submitted a claim to the VA for service connection.
Thyroid antibodies have been has observed in Chernobyl radiation
victims.
I would like to know if NAAV has any information on this subject.
Thanks.
John Buffum
Pharm.D.
Pharmacist Specialist in Psychiatry
VA Medical Center (retired)
San Francisco, CA
Associate Clinical Professor of Pharmacy
University of California at San Francisco
groovul@itsa.ucsf.edu
Keith Whittle
March 18, 2001
update Feb 3, 2002
Radiation-Induced Graves’ Disease as a Result of Nuclear Test Exposure
John C. Buffum, Pharm.D.
Introduction
Graves’ disease is an autoimmune disorder of the thyroid hormone
regulating system. It is characterized by excess thyroid hormone
production, resulting in such symptoms as tremor, muscle weakness,
weight loss, cardiac symptoms (palpations) and exophthalmos.1
“Susceptibility to Graves’ disease is determined by a mixture of
genetic, environmental, and endogenous factors, which are responsible
for the emergence of autoreactivity of T and B cells to the thyrotropin
receptor. The mechanisms involved are unknown.”1
This review summarizes what is known about the association of Graves’
disease with radiation exposure.
Pathogenesis of Graves’ Disease (autoimmune hyperthyroidism)
“Excess production of thyroid hormone is caused by the activation of
thyrotropin receptors by thyroid-stimulating antibodies (TSAb) produced
within and outside the thyroid gland.”1 .”It is now widely accepted that
all patients with Graves’ disease possess these auto antibodies which
bind to (TSH-R) and cause its activation, resulting in the uncontrolled
production and release of thyroid hormones.”2
Epidemiology of Graves’ Disease
“The annual incidence in women over a 20-year period is around 0.5 per
1000, with the highest risk of onset between the ages of 40 and 60
years; it is thus the most prevalent autoimmune disorder in the United
States. Graves’ disease is one fifth to one tenth as common in men as
in women and is unusual in children”1 This would reflect an incidence
in men of 0.05-0.1 per 1000 or 0.005-0.01%
“Another study reported the annual incidence in English men was less
than 10 per 100,000, approximately eight to ten fold lower than in
women, in keeping with gender differences seen in other thyroid
diseases.”2 This would reflect an incidence of 0.01%.
Therapeutic Radiation-induced Graves’ Disease
Graves’ disease has been triggered by treatment of goiter with
radioiodine.3-9 Serum levels of TSH receptor antibodies, which were
undetectable before treatment became elevated following treatment with
131I. Direct irradiation of the thyroid may increase the incidence of
Graves’ disease.10, 11
Radiation-induced Graves’ Disease Due to Radioactive Fallout
“Six to eight years after the Chernobyl accident, a significant increase
in thyroid autoimmunity was found in children exposed to radioactive
fallout.12-15
The Hanford Thyroid Disease Study found that 6 of the 1569 men in the
study (0.4%) were diagnosed with Graves’ disease.16 The incidence of
0.4% in the Hanford study is 40-80 times the incidence of Grave’s
disease reported in the general population (0.005-0.01%).
Conclusion
Graves’ disease has been triggered by radiation. Appearance of
autoimmune thyroid disease has occurred many years following the
exposure to radiation. The incidence of Graves’ disease in a
population (Hanford) exposed to radioactive fallout was determined to be
40-80 times that in the general population.
References
1. Weetman AP. Graves' disease. N Engl J Med 2000; 343: 1236-48.
2. McIver B, Morris JC. The pathogenesis of Graves' disease. Endocrinol
Metab Clin North Am 1998; 27: 73-89.
3. Nygaard B, Metcalfe RA, Phipps J, Weetman AP, Hegedus L. Graves'
disease and thyroid associated ophthalmopathy triggered by 131I
treatment of non-toxic goiter. J Endocrinol Invest 1999; 22: 481-5.
4. Nygaard B, Faber J, Veje A, Hegedus L, Hansen JM. Transition of
nodular toxic goiter to autoimmune hyperthyroidism triggered by 131I
therapy. Thyroid 1999; 9: 477-81.
5. Nygaard B, Knudsen JH, Hegedus L, Scient AV, Hansen JE. Thyrotropin
receptor antibodies and Graves' disease, a side-effect of 131I treatment
in patients with nontoxic goiter. J Clin Endocrinol Metab 1997; 82:
2926-30.
6. Nygaard B, Faber J, Veje A, Hegedus L, Hansen JM. Appearance of
Graves'-like disease after radioiodine therapy for toxic as well as
non-toxic multinodular goitre. Clin Endocrinol (Oxf) 1995; 43: 129-30.
7. Huysmans AK, Hermus RM, Edelbroek MA et al. Autoimmune
hyperthyroidism occurring late after radioiodine treatment for volume
reduction of large multinodular goiters. Thyroid 1997; 7: 535-9.
8. Regalbuto C, Salamone S, Scollo C, Vigneri R, Pezzino V. Appearance
of anti TSH-receptor antibodies and clinical Graves' disease after
radioiodine therapy for hyperfunctioning thyroid adenoma. J Endocrinol
Invest 1999; 22: 147-50.
9. Chiovato L, Santini F, Vitti P, Bendinelli G, Pinchera A. Appearance
of thyroid stimulating antibody and Graves' disease after radioiodine
therapy for toxic nodular goitre. Clin Endocrinol (Oxf) 1994; 40: 803-6.
10. DeGroot LJ. Radiation and thyroid disease. Baillieres Clin
Endocrinol Metab 1988; 2: 777-91.
11. Hancock SL, McDougall IR, Constine LS. Thyroid abnormalities after
therapeutic external radiation. Int J Radiat Oncol Biol Phys 1995; 31:
1165-70.
12. Pacini F, Vorontsova T, Molinaro E et al. Prevalence of thyroid
autoantibodies in children and adolescents from Belarus exposed to the
Chernobyl radioactive fallout. Lancet 1998; 352: 763-6.
13. Pacini F, Vorontsova T, Molinaro E et al. Thyroid consequences of
the Chernobyl nuclear accident. Acta Paediatr Suppl 1999; 88: 23-7.
14. Kasatkina EP, Shilin DE, Rosenbloom AL et al. Effects of low level
radiation from the Chernobyl accident in a population with iodine
deficiency. Eur J Pediatr 1997; 156: 916-20.
15. Quastel MR, Goldsmith JR, Mirkin L et al. Thyroid-stimulating
hormone levels in children from Chernobyl. Environ Health Perspect 1997;
105 Suppl 6: 1497-8.
16. Sciences NAo. Review of the Hanford Thyroid Disease Study Draft
Final Report. National Academy Press, Washington, DC, 2000.
[ Operation Dominic ]