Published: 2019-01-25

Cytomorphological alterations of thyroid gland consequent upon fluorosis

Jwalaram Kumar Chaluvadi, Srinivasulu Kande, Viswa Kumar Ramalinga, Vijay Kumar Kutala, Vijay Kumar J.


Background: Study aimed at assessing the impact of elevated fluoride from drinking water on thyroid gland structure and function in fluorosis prone areas. Iodine is incorporated in the thyroid synthesis by thyroid gland but in the presence of low Iodine levels fluoride is likely to interfere with the concentrating capacity of thyroid of iodine in thyroid production, consequently reflecting changes in thyroid parameters and also cytomorphological features manifesting hypothyroidism in association with different pathological entities.

Methods: Prakasam district in Andhra Pradesh is fluorosis prone zone and subjects are picked up from highly vulnerable zone in this district and their specimens are collected to study cytomorphological changes of the thyroid gland and biochemical parameters of blood samples for thyroid function test were considered. Cytological study by way of Fine Needle Aspiration Cytology (FNAC) of thyroid gland, biochemical parameters pertaining to function of thyroid gland namely Free triiodothyronine (FT3), Free Thyroxine (FT4) and Thyroid stimulating hormone (TSH) were assessed in the subjects from fluorosis prone zone.

Results: The results were statistically significant with concurrent association of different cytological alterations of thyroid gland in these subjects like Hashimoto’s thyroiditis of hypothyroidism, adenomatous goitre, colloid goitre and few of follicular adenoma/neoplasm. FNAC makes cytological changes evident showing different morphological features that comprise different pathological entities largely with an evidence of hypothyroidism in most of the cases in the given study.

Conclusions: The results of the study strongly suggest assessing the magnitude of the problem of fluorosis and also magnitude of its influence on thyroid structure and function that warrants assessment of the thyroid function by biochemical and cytological studies.


Fluorosis, Fine needle aspiration cytology, Hypothyroidism, Iodine uptake, Thyroid function tests

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Zhao W, Zhu H, Yu Z, Aoki K, Misumi J, Zhang X. Long-term effects of various iodine and fluorine doses on the thyroid and fluorosis in mice. Endocrine Reg. 1998;32(2):63-70.

Khageshan AP, Muzaffer Z. Cytolomorphological, biochemical and radiological correlation in hashimoto’s thyroiditis. Ind J Pathol Oncol. 2016;3(1):73-6.

Kheradpisheh Z, Mirzaei M, Mahvi AH, Mokhtari M, Azizi R, Fallahzadeh H, et al. Impact of drinking water fluoride on human thyroid hormones: a case-control study. Sci Rep. 2018;8(1):2674.

Singla S, Shashi A. Thyroid peroxidase activity as toxicity target for fluoride in patients with thyroid dysfunction. Curr Res Microbiol Biotechnol. 2013;1:53-7.

Augustsson A, Berger T. Assessing the risk of an excess fluoride intake among Swedish children in households with private wells-expanding static single-source methods to a probabilistic multi-exposure-pathway approach. Env Inter. 2014;68:192-9.

Delshad H. History of the iodine deficiency in the world and iran. Iran J Endocrinol Metab. 2008;9(4):439-53.

Alipourzamani S, Movassagh MH, Nouri M. Goiter in the sheep slaughtered in Tabriz slaughterhouse, Iran. Ann Biol Res. 2011;2(3):242-6.

Vanderpump MP. The epidemiology of thyroid disease. Brit Med Bulletin. 2011;99(1).

NRC (National Research Council). Fluoride in drinking water: a scientific review of epa’s standards. Washington, DC: National Academies Press; 2006.

Bouaziz H, Ammar E, Ghorbel H, Ketata S, Jamoussi K, Ayadi F, et al. Effect of fluoride ingested by lactating mice on the thyroid function and bone maturation of their suckling pups. Fluoride. 2004;37(2):133-42.

Gas' kov A, Savchenkov MF, Iushkov NN. The specific features of the development of iodine deficiencies in children living under environmental pollution with fluorine compounds. Gigiena Sanitariia. 2005:53-5.

Hong LI, Cai QI, Wang D. Effects of fluoride on rat thyroid morphology, thyroid peroxidase activity and the expression of thyroid peroxidase protein. Chinese Journal of Endemiology. 2012 Jan 1;31(3):271-4.

Amador RD. Abstracts of the 27th Annual Conference of the International Society for Environmental Epidemiology (ISEE), 30 August-3 September 2015, Centro de Convenções Rebouças, São Paulo, Brazil. Environ Health Perspect. 2015 Aug 28;123(S1).

Susheela AK, Bhatnagar M, Vig K, Mondal NK. Excess fluoride ingestion and thyroid hormone derangements in children living in Delhi, India. Fluoride. 2005;38(2):98-108.

Zeng Q, Cui YS, Zhang L, Fu G, Hou CC, Zhao L, et al. Studies of fluoride on the thyroid cell apoptosis and mechanism. Chinese J Preventive Med. 2012;46(3):233-6.

Ruiz-Payan A, Duarte-Gardea M, Ortiz M. and Hurtado R. Chronic effects of fluoride on growth, blood chemistry, and thyroid hormones in adolescents residing in three communities in Northern Mexico. Abstracts ISFR Conference, Wiesbaden, Germany; 2005:26-29.

Basha PM, Rai P, Begum S. Fluoride toxicity and status of serum thyroid hormones, brain histopathology, and learning memory in rats: a multigenerational assessment. Bio Trace Element Res. 2011;144(1-3):1083-94.

Singh N, Verma KG, Verma P, Sidhu GK, Sachdeva S. A comparative study of fluoride ingestion levels, serum thyroid hormone and TSH level derangements, dental fluorosis status among school children from endemic and non-endemic fluorosis areas. Springerplus. 2014;3(1):7.

Xiang Q, Chen L, Liang Y, Wu M, Chen B. Fluoride and thyroid function in children in two villages in China. J Toxicol Env Health Sci. 2009;1(3):054-9.

Negoita S, Swamp L, Kelley B, Carpenter DO. Chronic diseases surveillance of St. Regis Mohawk Health Service patients. JPHMP. 2001;7(1):84-91.

Eroschenko VP, Di Fiore MS, eds. DiFiore's atlas of histology with functional correlations. Lippincott Williams and Wilkins; 2013.

Uma P, Kartheek BV, Himaja S, Lekha JC, Babu AK, Lakshmi AB. Lymphocytic thyroiditis: a correlation of cytological grades with clinical, biochemical and ultrasound findings. Inter J Res Med Sci. 2017;1(4):523-31.

Rathi M, Ahmad F, Budania SK, Awasthi S, Kumar A, Dutta S. Cytomorphological aspects of hashimoto's thyroiditis: our experience at a tertiary center. clinical medicine insights: pathology. 2014:CPath-S13580.