(drinking water fluoride ranging from 1.1 to 14.3 mg/L) and 21 children without enamel fluorosis (0.14-0.81 mg/L fluoride in drinking water) in areas where iodine supplementation was considered adequate.4 Forty-nine children (54.4%) in the sample group had “well-defined hormonal derangements”; findings were borderline in the remaining 41 children. The types of hormonal derangements included elevated TSH and normal T4 and T3 (subclinical hypothyroidism); low T3 and normal T4 and TSH (“low T3 syndrome”); elevated T3 and TSH and normal T4 (possible T3 toxicosis); elevated TSH, low T4, and normal T3 (usually indicative of primary hypothyroidism and iodine deficiency); and low T3, high TSH, and normal T4. All but the first category are considered to be associated with or potentially caused by abnormal activity of deiodinases. The authors concluded that fluoride in excess may be inducing diseases that have usually been attributed to iodine deficiency and that iodine supplementation may not be adequate when excess fluoride is being consumed.

Thyroid hormone disturbances were also noted in the control children, and urine and fluoride concentrations in the control children reflect higher fluoride intake than can be accounted for by the drinking water alone (Susheela et al. 2005). Thus, the authors recommend that end points such as hormone concentrations should be examined with respect to serum or urinary fluoride concentrations, not just drinking water fluoride concentrations. In addition, they note that all hormone endpoints (T3, T4, and TSH) should be examined, lest some of the abnormalities be missed.

Mikhailets et al. (1996) detected thyroid abnormalities (moderate reduction of iodine uptake, low T3, normal T4, and increased TSH) in 165 aluminum workers with signs of chronic fluorosis and an estimated average fluoride intake of 10 mg/working day. A tendency toward increased TSH was observed with increased exposure time and with more severe fluorosis. Workers with more than 10 years of service had a significant decrease in T3 concentration in comparison to controls. The frequency of individuals with low concentrations of T3 (corresponding to hypothyroidism) was 65% among workers with more than 10 years of service and 54% among workers with Stage 2 fluorosis. The highest frequency of occurrence of low T3 (76%) was observed in people with chronic fluoride intoxication including liver damage (moderate cytolysis), suggesting a disorder in peripheral conversion of T4 to T3 (deiodination). The possibility of indirect effects of fluorine on enzymatic deiodination was also suggested.

Tokar′ et al. (1989) and Balabolkin et al. (1995) have also reported


The lower range of fluoride in drinking water in the fluorosis group is not much different from the higher range for the controls; however, in India, fluoride concentrations below 1 mg/L in drinking water are considered “safe” (Trivedi et al. 1993; Susheela et al. 2005) so the demarcation is at least a logical one.

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