thyroid effects in fluoride- or fluorine-exposed workers; full details of these studies are not available in English. Balabolkin et al. (1995) found that 51% of the workers examined had subclinical hypothyroidism with reduced T3.

No changes in thyroid function were detected in two studies of osteoporosis patients treated with NaF for 6 months or several years (Eichner et al. 1981; Hasling et al. 1987; for details, see Appendix E, Table E-7). These study populations are not necessarily representative of the general population, especially with respect to age and the fact that they usually receive calcium supplements. In an earlier clinical study to examine the reported effects of fluoride on individuals with hyperthyroidism, Galletti and Joyet (1958) found that, in 6 of 15 patients, both basal metabolic rate and protein-bound iodine fell to normal concentrations, and the symptoms of hyperthyroidism were relieved after fluoride treatment. Fluoride was considered clinically ineffective in the other 9 patients, although improvement in basal metabolic rate or protein-bound iodine was observed in some of them. In the 6 patients for whom fluoride was effective, tachycardia and tremor disappeared within 4-8 weeks, and weight loss was stopped. The greatest clinical improvement was observed in women between 40 and 60 years old with a moderate degree of thyrotoxicosis; young patients with the classic symptoms of Graves’ disease did not respond to fluoride therapy. Radioiodine uptake tests were performed on 10 of the patients, 7 of whom showed an inhibitory effect on initial 131I uptake by the thyroid.

Discussion (Effects on Thyroid Function)

In studies of animals with dietary iodine sufficiency, effects on thyroid function were seen at fluoride doses of 3-6 mg/kg/day (Stolc and Podoba 1960; Bobek et al. 1976; Guan et al. 1988; Zhao et al. 1998); in one study, effects were seen at doses as low as 0.4-0.6 mg/kg/day (Bobek et al. 1976). In low-iodine situations, more severe effects on thyroid function were seen at these doses (Stolc and Podoba 1960; Guan et al. 1988; Zhao et al. 1998). Effects on thyroid function in low-iodine situations have also been noted at fluoride doses as low as 0.06 mg/kg/day (Zhao et al. 1998), ≤0.7 mg/kg/day (Hillman et al. 1979), and 1 mg/kg/day (Guan et al. 1988). Studies showing no effect of fluoride on thyroid function did not measure actual hormone concentrations (Gedalia et al. 1960; Choubisa 1999), did not report iodine intakes (Gedalia et al. 1960; Clay and Suttie 1987; Choubisa 1999), used fluoride doses (<1.5 mg/kg/day) below those (3-6 mg/kg/day) associated with effects in other studies (Gedalia et al. 1960; Clay and Suttie 1987), or did not discuss a possibly complicating factor of the experimental procedure used (Siebenhüner et al. 1984). Only one animal study (Hara 1980) measured TSH concentrations, although that is considered a “precise and



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