The situation of thyrotoxicosis outbreaks in Thai prisons during 2016-2019
Keywords:
Thyrotoxicosis, Disease Outbreaks, Prisons, Prisoners, Thyroid-contaminated foodAbstract
Background: Thyrotoxicosis is defined as an elevated level of free thyroid hormone in serum resulting in palpitation, hand tremor, weight loss, insomnia, tiredness, fatigue, and even death. The major causes are an increased production of thyroid hormone or an ingestion of exogenous thyroid hormone. There were reported cases and outbreaks of thyrotoxicosis caused by thyroid-contaminated food in many countries. However, they have never been reported in Thailand.
Methods: We reviewed data of thyrotoxicosis outbreaks during 2016-2019 through Department of Disease Control (DDC)’s event-based surveillance database. We also reviewed executive summaries of the DDC’s joint investigation teams for the events occurred during 1 January 2016 to 31 December 2019. The dataset was analyzed for ratio and proportion.
Results: During 2016-2019, there were 10 outbreaks of thyrotoxicosis occurred in many provinces of Thailand with a total of 1,047 cases. (Attack rate: 4.5%) almost all of them were prisoners. Male to female ratio was 13.1 to 1. Thirty of them had to be hospitalized. Common manifestations were limb weakness, palpitation, and fatigue. About 60% of cases had low level of Thyroid stimulating hormone. Provided food for prisoners was suspected to be the cause. It was found that pork or beef in many events was contaminated with trachea. Furthermore, thyroid tissues were identified. For the outbreak occurred in Sakon Nakhon, pork and chicken had a bit higher levels of both T3 and T4 than control group. However, both T3 and T4 levels were found higher among pork offals than pork or chicken. From case-control study in the outbreak occurred in Mae Hong Son indicated that pork consumption was significantly associated with the outbreak. For all events, after refraining the suspected meat, a decrease in the number of cases to the baseline was observed.
Conclusion: During 2016-2019, confirmed thyrotoxicosis outbreaks in prisons of Thailand were reported. Most of the cases were male prisoners. Thyroid-contamination in provided food for prisoners may be the cause. Nationwide-surveillance system for thyrotoxicosis in prison, as well as mandatory food standards for prisoners should be established. Clinicians and healthcare personnel should beware of exogenous thyrotoxicosis, especially when cluster of hyperthyroidism with unknown cause was identified.
References
Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2 0 1 6 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct 1;26(10):1343–421.
Bahn RS, Burch HB, Cooper DS, Garber JR, Carol Greenlee M, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the american thyroid association and American association of clinical endocrinoloigists. Endocr Pract. 2011 May 1;17(3):456–520.
Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: A populationbased study. Arch Intern Med [Internet]. 2004 Aug 9 [cited 2020 Mar 4];164(15):1675–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15302638
Parmar MS, Sturge C. Recurrent hamburger thyrotoxicosis. CMAJ [Internet]. 2003 Sep 2 [cited 2020 Mar 4];169(5) : 415–7 . Available from: http://www.ncbi.nlm.nih.gov/pubmed/12952802
Hendriks LEL, Looij BJ. Hyperthyroidism caused by excessive consumption of sausages. Neth J Med. 2010 Mar;68(3):135–7.
Hedberg CW, Fishbein DB, Janssen RS, Meyers B, McMillen JM, MacDonald KL, et al. An outbreak of thyrotoxicosis caused by the consumption of bovine thyroid gland in ground beef. N Engl J Med [Internet]. 1987 [cited 2020 Mar 4] ;316 (16):993–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed /3561455
Kinney JS, Hurwitz ES, Fishbein DB, Woolf PD, Pinsky PF, Lawrence DN, et al. Community outbreak of thyrotoxicosis: epidemiology, immunogenetic characteristics, and long-term outcome. Am J Med [Internet]. 1988 Jan [cited 2020 Mar 4];84(1):10–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3257352
Conrey EJ, Lindner C, Estivariz C, Pereira M, Welsh J, Vignolo J, et al. Thyrotoxicosis outbreak linked to consumption of minced beef and chorizo: Minas, Uruguay, 2003-2004. Public Health [Internet]. 2008 [cited 2020 Mar 4];122(11):1264–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18602654
Ioos V, Das V, Maury E, Baudel J-L, Guéchot J, Guidet B, et al. A thyrotoxicosis outbreak due to dietary pills in Paris. Ther Clin Risk Manag [Internet]. 2 0 0 8 Dec [cited 2020 Mar 4];4(6):1375–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19337445
Matsubara S, Inoh M, Tarumi Y, Sato M, Takahara J. An outbreak (159 cases) of transient thyrotoxicosis without hyperthyroidism in Japan. Intern Med [Internet]. 1995 [cited 2020 Mar 4];34(6):514–9. Available from: http://www.ncbi.nlm.nih.gov/pub med/7549134
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Weekly Epidemiological Surveillance Report
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Responsibility and Copyright
1. Author Responsibility and Editorial Disagreement
The content and data in all articles published in WESR are the direct opinions and responsibility of the article authors, and the Journal's Editorial Board is not necessarily in agreement with, or jointly responsible for, them.
2. Copyright and Referencing
All articles, data, content, figures, etc., published in WESR are considered the copyright of the academic journal. If any individual or entity wishes to disseminate all or any part of the published material, appropriate citation of the article is required.
