IN THIS POST WE HAVE CLEAR INFORMATION ON IODINE THAT A TEAM OF PEOPLE PUT TOGETHER FOR ALL OF US.
WE WILL HAVE MORE INFORMATION ON KELP AND NATURAL REMEDIES IN MORE DETAIL COMING……
ALSO A VIDEO ON KELP IS ALSO COMING FROM Leija Turunen FROM YOUTUBE.

Information on Iodine for Nuclear fallout from Japan and natural remedies

The next section of information was complied by Tish McNamara and we thank her for her hard work!
Please go to Facebook and keep adding to this page in the comments and share share share on facebook as well so we can get this valuable information to the public.
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Here’s the shortlist of shortlists. Simple as 1-2-3.

(This is a collection of information, not medical advisement)

1) What is the danger?

Exposure to radioactive substances released into the environment. Outside the immediate vicinity of the reactor (or bomb), the danger is primarily airborne particles of radioactive ‘dust’ comprising 200+ radioactive elements, including radioactive iodine and boron, which are substances stored in the body. Radio-iodine is of special concern as it is quickly concentrated in the thyroid gland in the throat and the dangers and means of mitigation for this are well-documented. The key response is first to limit physical exposure to the radioactive particles and second to limit their absorption and affect in the body.

2) How to limit exposure?

Exposure risk is to both the rays of radiation and the radioactive particles themselves, mainly in the form of fall-out from releases/explosions. Airborne particles disperse in a path determined by prevailing wind forces, weather and the weight of the particles. The effort is to keep from breathing, ingesting, tracking and absorbing particles while also buffering your body, food, water and animals from radiation in the environment. Learn what the potential region of exposure is, the anticipated amount of radiation (RADs) and the possible time-frame of emissions and stay updated via radio, internet, community networks and other available media (use multiple sources). Prepare for evacuation or shelter and get the supplies needed for the expected duration for those in your care. More info on these below.

3) How to limit the effects?

Top-up (maximize but do not exceed the limits of) natural body levels of iodine and boron in people and animals in your care so that radioactive particles of these elements breathed, ingested or absorbed will not be stored and will pass quickly out of the body. Consume nutritious foods and plenty of water to optimize body metabolism, repair and elimination functions. Increase the consumption of foods and supplements that boost the immune system and repair damage from radiation poisoning so that the active constituents are at effective levels. Do not consume foods or beverages that may have been contaminated (such as animals who ingested radioactive particles) for up to a month after exposure. More details below.

1.0 About the Danger.

Radiation levels and symptoms:

(Mark Strauch © All Rights Reserved)

80-120 rads – 10% chance of vomiting and nausea for a few days

130-170 rads – 25% chance of vomiting and contracting other symptoms

180-220 rads – 50% chance of vomiting and other severe physical effects

270-330 rads – 20% chance of death in 6 weeks, or recovery in a few months.

400-500 rads – 50% chance of death

550-750 rads – Nausea within a few hours ; no survivors

1000 rads – Immediate incapacitation; death within a week or less.

Rate of Radioactive Decay (Reduction of Radioactivity)

Jet-streams (as Carrier of Radioactive Fall-out)

www.stormsurfing.com

USA Radiation Levels — Citizens Radiation Network

www.radiationnetwork.com

USA Aerosols (monitored by Navy Satellite)

www.nrlmry.navy.mil

“No Safe Dosage” (for non-urgent reading)

www.ratical.com

2.0 Limiting Exposure

2.1 Using all available information and your gut instincts, estimate the region, path, intensity and length of exposure of harmful fallout. Consider whether a series of additional fallout-releasing events are likely to occur that will increase or extend the exposure.

2.2 Identify the people and animals in your care and their needs and abilities in weighing the options to stay or go: evacuate/vacate; go to a community shelter; make/stay in your own shelter; seal the home as much as possible (it is possible to make ad-hoc shelters of books, furniture, etc). The stay-or-go decision might be made for you by government and law enforcement in the emergency situation.

2.3 If evacuating or going to a community shelter, take money and emergency provisions (such as a “bug-out” bag) since plans and means of transportation may be altered unexpectedly. Notify trusted friends and family of your plans, location and means of contact before you set out and periodically en route.

2.4 If staying, optimize your shelter to limit exposure both from contact with radioactive particles and from penetrating radiation (gamma rays). Make-shift shelters are possible if you do not have a shelter pre-built. For information and advice for sealing and strengthening a home against radiation, preparing supplies for refuge, planning for sleeping, bathing, toilet, heat, light, ventilation, and other logistics, what you can do for animals, etc, see this excellent guide: www.ki4u.com

2.5 Start gathering supplies and assigning tasks as soon as possible, even before your stay-or-go decision is made. Do not wait for confirmation since key emergency supplies will rapidly disappear and official processes are reactive and tend to lag behind necessity. Another comprehensive supply list: www.sfgate.com

2.6 Begin preparing your body to minimize the effects of radiation right away (below).

3.0 Limiting Effects

3.1 Do not wait; begin to strengthen your body to resist the effects of radiation. It takes time for levels of key elements in the body to adjust. To optimize the process, drink plenty of pure water, avoid sugar, consume food and drink of high nutritive value — especially those high in natural iodine — and eliminate those that impede metabolism. The body needs the right resources internally to protect itself.

3.2 Give special attention to iodine and maximize the daily body level (do not exceed the limit as it is toxic in excess). Iodine is quickly concentrated in the thyroid gland making it very susceptible to radiation as radio-iodine in radioactive fall-out will lodge in the thyroid if it is not already “topped up” to optimum levels of natural iodine. Iodine levels can be optimized by taking potassium iodide supplement/pills and by ingesting foods rich in iodine such as seafood/seaweed and certain fruits and vegetables…

3.3 Guidelines for type and quantity of iodine supplementation must be followed as it is toxic in excess and taken in the wrong form (i.e. potassium iodide can be ingested but iodine cannot, though it may be safely absorbed through the skin less efficiently). The form of potassium iodide KIO3 is safer for children than the more common KI, but either will aid. Be careful of the difference in taking preliminary doses to optimize body levels of iodine ahead of exposure versus emergency levels to treat radiation exposure. Beware people with iodide allergy. For supplementation info see:

FAQs from KI4U: www.ki4u.com

Comprehensive Summary: www.pyradyne.com

3.4 Potassium iodide will rapidly become unavailable. Natural sources of iodine are also effective and safer, as the body will absorb only what it needs. Iodine-rich foods include: sea-salt, iodized salt, garlic, asparagus, dulse, kelp, seaweed, seafood, lima beans, mushrooms, sesame seeds, soy beans, spinach, chard, turnip greens, summer squash.

3.5 Radioactive boron is another element of radioactive dust that can be absorbed by the body. While not as large a concern as iodine, it can be similarly safe-guarded by optimizing natural body levels of boron through supplements (follow supplementation guidelines; 3mg/day average; 10mg/day limit) or boron-rich foods such as: prunes, raisins, dates, dried fruits and nuts, peanuts, grapes, wine, beer, banana, broccolli, beans, asparagus, red apples, dried apricots, wheat bran, carrots, celery, dates, honey, lentils, olive, onion.

3.6 Eat foods known to inhibit and repair the effects of radiation poisoning so that levels of the beneficial constituents are high enough to be both effective and preventative. Some of the most helpful are:

Rosemary has powerful inhibitors to mutagens generated by radiation. See:

www.naturalnews.com

Cilantro, Parsley help chelate minerals to pass them more rapidly out of the body

Yarrow flower (tincture, tea, supplement) helps recovery from radiation exposure.

Garlic stimulates the immune system.

Chaparral protects against radiation, but take no longer than one week.

Apples are a source of pectin which binds with radioactive particles to prevent absorption by the body.

Buckwheat is high in rutin, a bioflavinoid that protects against radiation

Avocadoes, Lemons, Oive Oil supply essential fatty acids.

Miso soup made with Konbu/seaweed.

3.7 Other supplements that can greatly assist the body in resisting and repairing the effects of radiation exposure/poisoning as listed in the leading guide to natural health include (guideliness given but follow instructions on labels or from your doctor):

Calcium (1500mg/day) and Magnesium (750mg/day) to prevent the absorption of other radioactive fall-out.

Coenzyme Q10 plus Coenzyme A (100mg/day) to boost the immune system and detoxify

Glutathione plus L-cysteine and L-methionine (500mg ea/day with 50mg vitamin B6 and 100mg vitamin C to improve absorption) to detoxify and reduce harmful effects.

Kelp (1000-1500 mg/day) to protect thyroid

Grape Seed Extract (as labelled) is a powerful anti-oxidant.

Pantothenic Acid (vitamin B5) (200mg before and after xray exposure; 50mg/day thereafter) to protect against harmful effects of radiation.

Selenium (200mcg/day unless pregnant 40mcg/day) scavenges free radicals that can cause cancer.

Vitamin C with bioflavonoids including rutin (5000-20000 mg/day in divided doses) as a powerful free-radical scavenger to protect against cancers.
Lecithin (1tbsp/3times/day) protects cell membranes

Vitamin A with carotenoids including beta-carotene (25000 IU/day unless pregnant 10000/day) strengthens immune system especially taken with vitamin E.

Vitamin B complex plus inositol (50mg/each/3times/day) protects against harmful effects of radiation

Vitamin E (400IU/day increasing every 4 days to 1200IU/day) protects immune system in combination with vitamin A
Zinc (50-80 mg/day; limit 100mg from all sources) helps increase immunity.

3.8 If you can bathe, using baking soda helps neutralize radiation and revive the body.

Thank you Tish!!!

This next section was sent to us by a group on skype that is working with people around the world also to give us great information. A special thank you to Bryan who stayed up for days …. to get this out to us. thank you to all of you!!!

Bare in mind that chemtrails will affect the water we have because if from outside source ie rainfall, city water, etc.
it will have barium in it which can absorb radiation

With the terrible earthquake in Japan, let’s send thoughts, prayers as well as assistance to the Japanese.

I have had inquiries about the use of iodine to prevent problems secondary to the nuclear fallout that will occur.
As the Japanese nuclear reactors release radiation into the air, the jet streams will push this radiation to the Western U.S. and Canada.
There are estimates that the radiation fallout will reach the Western side of N. American in six to ten days. Furthermore, I have seen
estimates that it is expected that 750 RADS may contaminate these areas.
How much is 750 RADS? One chest x-ray is approximately 3/100 RADS. One CT scan is 1 RAD.

Folks, potentially this is a lot of radiation. Fortunately, is an item that can prevent this fallout from damaging us: iodine.
If there is enough inorganic, non-radioactive iodine in our bodies, the radioactive fallout has nowhere to bind in our bodies. IT will pass through, unharmed.

It is important to ensure that we have adequate iodine levels BEFORE this fallout hits. How much iodine is recommended?

The CDC recommends using iodine to prevent injury form radioactive fallout. Adults and women who are breastfeeding should take 130mg
of potassium iodide. Children who are between 3 and 18 years of age should take 65mg of potassium iodide. Children who are adult size
should take the adult dose. Infants and children between 1 month and 3 years of age should take 32mg of potassium iodide. Newborns
from birth to one month of age should be given 16mg of potassium iodide.

When should you take iodine? For an acute exposure, you want to take iodine just before the exposure hits. Iodine is cleared out of the
body within 24 to 72 hours after taking it. However, If you have been using ortho-iodosupplementation (taking from 6-50mg/day of iodine and iodide),
you should be covered. Remember, the goal is to not let the radioactive iodine bind in the body.

Potassium iodide can be found in many health food stores. Combination’s of iodine/iodine can be obtained from holistic physicians.
Iodoral, Iodozyme HP, and Lugol’s solution are examples of this form of iodine.

I do not recommend starting the first dose of iodine right now. It is important to follow the news reports and supplement accordingly.
I would suggest starting iodine supplements within one to two days of the expected fallout. If the fallout is expected to continue,
you may need to take more than one dose.

FOLLOW WATERMANFILES.COM AND GET MORE UPDATES

More from the Group on Skype…. thank you!!

IODINE
For practical purposes, the terms iodide (one molecule) and iodine (two iodide molecules)
can be used interchangeably. Iodate is a compound that contains an Oxygen molecule.

There are components in soy, flax seeds, and raw cruciferous vegetables.
(Broccoli, brussels sprouts, cauliflower, and cabbage) that counteract iodine.
North American vegans should take a modest iodine supplement; 75-150 mcg every day
or every other day should be enough.

You can also get the extra 75 mcg of iodine from 1/4 teaspoon of iodized salt
(in the United States; other countries may not iodize their salt at the same levels).
If you are already eating 1/4 teaspoon of salt per day on your foods, make sure it is iodized.

Iodine Factoids

A goitre (enlarged thyroid gland) can be caused by eating both too little or too much iodine.
The symptoms of either can also be the same: hypothyroidism, in which metabolism slows and weight and cholesterol increases; or hyperthyroidism where metabolism increases resulting in weight loss.

An iodine deficiency can inhibit brain development in a fetus, so vegan women should ensure
a reliable source of iodine. Iodized salt has iodine added to it. The package will state that it is iodized.

In the U.S., iodine is added to iodized salt at a rate of 76 mcg per 1/4 teaspoon (1 gram) of salt.
This amount of salt also provides 500 mg of sodium. The salt found in packaged foods is usually not iodized. Sea salt, which does not necessarily contain iodine, has the same effects on blood pressure and calcium as table salt.

POTASSIUM IODIDE
Potassium iodide is an inorganic compound with formula KI. This white salt is the most commercially significant iodide compound formally derived from potassium hydroxide and hydriodic acid, used as an analytical reagent, in organic synthesis, and in the preparation of photosensitive emulsions and as a radioprotector to protect the thyroid.

Potassium iodide may protect just the thyroid gland against exposure to radioactive iodine that occurs when radiation levels increase. KI will probably not help with radiation damage in other parts of the body.

MORE INFO

http://en.wikipedia.org/wiki/Potassium_iodide

http://www.medicinenet.com/potassium_iodide-oral/article.htm

SAFETY DATA SHEET

http://www.mallbaker.com/americas/msds/english/p5906_msds_us_default.pdf

http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidance/UCM080542.pdf

SHELF LIFE EXTENSION

http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm080549.pdf

DOSES

The FDA has approved two different forms of KI—tablets and liquid—that people can take by mouth after a nuclear radiation emergency.
Tablets come in two strengths, 130 milligram (mg) and 65 mg. The tablets are scored so they may be cut into smaller pieces for lower doses. Each milliliter (mL) of the oral liquid solution contains 65 mg of KI.

According to the FDA, the following doses are appropriate to take after internal contamination with (or likely internal contamination with) radioactive iodine:

Adults should take 130 mg (one 130 mg tablet OR two 65 mg tablets OR two mL of solution).

Women who are breastfeeding should take the adult dose of 130 mg.

Children between 3 and 18 years of age should take 65 mg (one 65 mg tablet OR 1 mL of solution). Children who are adult size (greater than or equal to 150 pounds) should take the full adult dose, regardless of their age.

Infants and children between 1 month and 3 years of age should take 32 mg (½ of a 65 mg tablet OR ½ mL of solution). This dose is for both nursing and non-nursing infants and children.

Newborns from birth to 1 month of age should be given 16 mg (¼ of a 65 mg tablet or ¼ mL of solution). This dose is for both nursing and non-nursing newborn infants.

The protective effects of a dose of KI is about 24 hours. KI is available without a prescription, and a pharmacist can sell you KI brands that have been approved by the FDA

POTASSIUM IODATE
In other countries, potassium iodate is used as source for iodine. It is also an ingredient in baby formula milk. Potassium iodate (KiO3) is a superior form of KI. Potassium iodate will shield (or block) the Thyroid and prevent it form absorbing radiation.

MORE INFO

http://www.jtbaker.com/msds/englishhtml/p5895.htm

http://www.mallbaker.com/Americas/catalog/ProdPage.asp?sku=3156&brd=B&searchdata=potassium%20iodate&searchbrd=B&startnum=1&pnum=1&totalItems=2&language=E&bsnss=

http://en.wikipedia.org/wiki/Potassium_iodate

SAFETY DATA SHEET

http://www.mallbaker.com/americas/msds/english/P5895_msds_us_Default.pdf

http://www.reagent.co.uk/uploads/msds/POTASSIUM%20IODATE%200.05M.pdf

SHELF LIFE EXTENSION
Polypropylene containers – 30 months
PVC/PVDC/AI Blisters – 30 months
Al/Al blisters – 30 months
Al/Al strips – 30 months

DOSES
For oral administration.
Administration should take place within 3 hours of a nuclear accident, or up to 10 hours after an accident, however, this is less effective. A single daily dose should be administered. This will protect against exposure lasting up to 24 hours. (see Section 4.4).

Tablets:
Iodine equivalent

Adults & Elderly 2 tablets 100 mg

Adolescents over 12 years 100 mg

Children (3-12 years) 1 tablet 50 mg

Children (1 month – 3 years) ½ tablet 25 mg

Neonates ¼ tablet 12.5mg

Birth – 1 month 12.5mg iodine equivalent as standard solution

For neonates living at home a dosage of ¼ tablet is satisfactory. The dosage can be crushed and mixed with milk or water

For neonates in hospital a dosage of 12.5 mg iodine equivalent can be given as a standard solution freshly prepared from KI crystals. It is recommended that maternity wards store KI crystals.
For babies the dose may be crushed and mixed with milk or juice before administration. For children the dose may be crushed and mixed with eg. Jam, honey or yoghurt.

Dietary Reference Intake (DRI) for Iodine
Age (yrs) DRI (mcg) a Upper Limit b (mcg)
00 – 06 mons 110
07 – 12 mons 130
01 – 03 90 200
04 – 08 90 300
09 – 13 120 600
14 – 18 150 900
> 18 150 1100

Pregnant

= 18 220 900
> 18 220 1100

Lactating

= 18 290 900
> 18 290 1100

Amcg = Microgram = µ. | bDo not exceed the upper limit.

IONIZING RADIATION UNITS

ACTIVITY OF AN ISOTOPE OR MATERIAL

conventional unit: 1 curie = 37 billion disintegrations per second.

SI unit: 1 becquerel = 1 disintegration per second

conversions

1 curie (Ci) = 37 gigabecquerel (GBq)

1 gigabecquerel (GBq) = 27 millicurie (mCi)

Radiation absorbed dose (rad)

Conventional units: A dose of 1 rad means the absorption of 100 ergs of radiation energy per gram of absorbing material

SI units: A dose of 1 gray means the absorption of 1 joule of radiation energy per kilogram of absorbing material

conversion

1 Gy = 100 rad

1 rad = 0.01 Gy

1 roentgen (R) = 258 microcoulomb/kg (µC/kg)

1 millicoulomb/kg mC/kg = 3876 milliroentgen (mR)

Dose equivalent

The dose equivalent is a measure of biological effect for whole body irradiation. The dose equivalent is equal to the product of the absorbed dose and the Quality Factor.

The Quality Factor (Q) depends on the type of radiation:

X-ray, Gamma ray, or beta radiation: Q = 1

alpha particles: Q = 20

neutrons of unknown energy: Q = 10 (If the neutron energy is known, see more specific Q values at 10 CFR 20.1004 [1])

conventional units: dose equivalent (rems) is the product of dose (rads) and Q

SI units: dose equivalent (sieverts) is the product of dose (grays) and Q

Conversion

1 Sievert (Sv) = 100 rem

1 rem = 0.01 Sievert (Sv)

Counts per minute (CPM)

Used for alpha particles, beta particles or mixed gamma/beta, gamma/alpha, alpha/beta actual counts per minute. Counts per minute can also be useful when detector efficiency is in question. For example, when a scintillator is designed to detect the 0.013 Mev photons from Uranium 238 and one is measuring the 1.146 Mev photons from Potassium 40, the units cannot be easily converted to roentgens; CPM is a more appropriate unit under these conditions.

Roentgen equivalent physical (rep)

Roentgen equivalent physical (rep) is an obsolete unit of absorbed dose of any ionizing radiation with a magnitude of 93 ergs per gram. It has been superseded by the rad.

Guidance
Potassium Iodide as a Thyroid Blocking Agent in Radiation
Emergencies
U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER)
December 2001 Procedural
Guidance
Potassium Iodide as a Thyroid Blocking Agent in Radiation
Emergencies
Additional copies are available from:
Office of Training and Communications Division of Communications Management Drug Information Branch, HFD-210 5600 Fishers Lane Rockville, MD 20857 (Tel) 301-827-4573 (Internet) http://www.fda.gov/cder/guidance/index.htm
U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER)
December 2001 Procedural
I. II. III.
A.
B. IV.
A. B.
TABLE OF CONTENTS
INTRODUCTION………………………………………………………………………………………………….. 1 BACKGROUND ……………………………………………………………………………………………………. 1 DA T A SOURCES…………………………………………………………………………………………………… 2
Reliance on Data from Chernobyl……………………………………………………………………………..2
Thyroid Cancers in the Aftermath of Chernobyl …………………………………………………………4 CONCLUSIONS AND RECOMMENDA TIONS …………………………………………………….. 5 Use of KI in Radiation Emergencies: Rationale, Effectiveness, Safety…………………………….5 KI Use in Radiation Emergencies: Treatment Recommendations………………………………….6
ADDITIONAL CONSIDERATIONS IN PROPHYLAXIS AGAINST THYROID
V. RADIOIODINE EXPOSURE………………………………………………………………………………………… 8
VI. SUMMARY……………………………………………………………………………………………………………. 8 ACKNOWLEDGEMENTS……………………………………………………………………………………………. 9 BIBLIOGRAPHY ……………………………………………………………………………………………………….. 10
Guidance Potassium Iodide as a Thyroid Blocking
Agent in Radiation Emergencies
I. INTRODUCTION
The objective of this document is to provide guidance to other Federal agencies, including the Environmental Protection Agency (EPA) and the Nuclear Regulatory Commission (NRC), and to state and local governments regarding the safe and effective use of potassium iodide (KI) as an adjunct to other public health protective measures in the event that radioactive iodine is released into the environment. The adoption and implementation of these recommendations are at the discretion of the state and local governments responsible for developing regional emergency- response plans related to radiation emergencies.
This guidance updates the Food and Drug Administration (FDA) 1982 recommendations for the use of KI to reduce the risk of thyroid cancer in radiation emergencies involving the release of radioactive iodine. The recommendations in this guidance address KI dosage and the projected radiation exposure at which the drug should be used.
These recommendations were prepared by the Potassium Iodide Working Group, comprising scientists from the FDA’s Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiological Health (CDRH) in collaboration with experts in the field from the National Institutes of Health (NIH). Although they differ in two respects (as discussed in Section IV.B), these revised recommendations are in general accordance with those of the World Health Organization (WHO), as expressed in its Guidelines for Iodine Prophylaxis Following Nuclear Accidents: Update 1999 (WHO 1999).
II. BACKGROUND
Under 44 CFR 351, the Federal Emergency Management Agency (FEMA) has established roles and responsibilities for Federal agencies in assisting state and local governments in their radiological emergency planning and preparedness activities. The Federal agencies, including the Department of Health and Human Services (HHS), are to carry out these roles and responsibilities as members of the Federal Radiological Preparedness Coordinating Committee
This guidance represents the Food and Drug Administration’s (FDA’s) current thinking on this topic. It does not create or confer any rights for or on any person and does not operate to bind FDA or the public. An alternative approach may be used if such approach satisfies the requirements of the applicable statutes and regulations.
1
(FRPCC). Under 44 CFR 351.23(f), HHS is directed to provide guidance to state and local governments on the use of radioprotective substances and the prophylactic use of drugs (e.g., KI) to reduce the radiation dose to specific organs. This guidance includes information about dosage and projected radiation exposures at which such drugs should be used.
The FDA has provided guidance previously on the use of KI as a thyroid blocking agent. In the Federal Register of December 15, 1978, FDA announced its conclusion that KI is a safe and effective means by which to block uptake of radioiodines by the thyroid gland in a radiation emergency under certain specified conditions of use. In the Federal Register of June 29, 1982, FDA announced final recommendations on the administration of KI to the general public in a radiation emergency. Those recommendations were formulated after reviewing studies relating radiation dose to thyroid disease risk that relied on estimates of external thyroid irradiation after the nuclear detonations at Hiroshima and Nagasaki and analogous studies among children who received therapeutic radiation to the head and neck. Those recommendations concluded that at a projected dose to the thyroid gland of 25 cGy or greater from ingested or inhaled radioiodines, the risks of short-term use of small quantities of KI were outweighed by the benefits of suppressing radioiodine-induced thyroid cancer.1 The amount of KI recommended at that time was 130 mg per day for adults and children above 1 year of age and 65 mg per day for children below 1 year of age. The guidance that follows revises our 1982 recommendations on the use of KI for thyroid cancer prophylaxis based on a comprehensive review of the data relating radioioidine exposure to thyroid cancer risk accumulated in the aftermath of the 1986 Chernobyl reactor accident.
III. DATA SOURCES
A. Reliance on Data from Chernobyl
In epidemiological studies investigating the relationship between thyroidal radioiodine exposure and risk of thyroid cancer, the estimation of thyroid radiation doses is a critical and complex aspect of the analyses. Estimates of exposure, both for individuals and across populations, have been reached in different studies by the variable combination of (1) direct thyroid measurements in a segment of the exposed population; (2) measurements of 131I (iodine isotope) concentrations in the milk consumed by different groups (e.g., communities) and of the quantity of milk consumed; (3) inference from ground deposition of long-lived radioisotopes released coincidentally and presumably in fixed ratios with radioiodines; and (4) reconstruction of the nature and extent of the actual radiation release.
All estimates of individual and population exposure contain some degree of uncertainty. The uncertainty is least for estimates of individual exposure based on direct thyroid measurements.
1 For the radiation emitted by 131 I (electrons and photons), the radiation-weighting factor is equal to one, so that the absorbed dose to the thyroid gland expressed in centigrays (cGy) is numerically equal to the thyroid equivalent dose expressed in rem (1 cGy = 1 rem).
2
Uncertainty increases with reliance on milk consumption estimates; is still greater with estimates derived from ground deposition of long-lived radioisotopes, and is highest for estimates that rely heavily on release reconstruction.
Direct measurements of thyroid radioactivity are unavailable from the Hanford, Nevada Test Site, and Marshall Islands exposures. Indeed, the estimates of thyroid radiation doses related to these releases rely heavily on release reconstructions and, in the former two cases, on recall of the extent of milk consumption 40 to 50 years after the fact. In the Marshall Islands cohort, urinary radioiodine excretion data were obtained and used in calculating exposure estimates.
Because of the great uncertainty in the dose estimates from the Hanford and Nevada Test Site exposures and due to the small numbers of thyroid cancers occurring in the populations potentially exposed, the epidemiological studies of the excess thyroid cancer risk related to these radioiodine releases are, at best, inconclusive. As explained below, the dosimetric data derived in the studies of individual and population exposures following the Chernobyl accident, although not perfect, are unquestionably superior to data from previous releases. In addition, the results of the earlier studies are inadequate to refute cogent case control study evidence from Chernobyl of a cause-effect relationship between thyroid radioiodine deposition and thyroid cancer risk.2
The Chernobyl reactor accident of April 1986 provides the best-documented example of a massive radionuclide release in which large numbers of people across a broad geographical area were exposed acutely to radioiodines released into the atmosphere. Therefore, the recommendations contained in this guidance are derived from our review of the Chernobyl data as they pertain to the large number of thyroid cancers that occurred. These are the most comprehensive and reliable data available describing the relationship between thyroid radiation dose and risk for thyroid cancer following an environmental release of 131I. In contrast, the exposures resulting from radiation releases at the Hanford Site in Washington State in the mid- 1940s and in association with the nuclear detonations at the Nevada Test Site in the 1950s were extended over years, rather than days to weeks, contributing to the difficulty in estimating radioactive dose in those potentially exposed (Davis et al., 1999; Gilbert et al., 1998). The exposure of Marshall Islanders to fallout from the nuclear detonation on Bikini in 1954 involved relatively few people, and although the high rate of subsequent thyroid nodules and cancers in the exposed population was likely caused in large part by radioiodines, the Marshall Islands data provide little insight into the dose-response relationship between radioactive iodine exposure and thyroid cancer risk (Robbins and Adams 1989).
Beginning within a week after the Chernobyl accident, direct measurements of thyroid exposure were made in hundreds of thousands of individuals, across three republics of the former Soviet Union (Robbins and Schneider 2000, Gavrilin et al., 1999, Likhtarev et al., 1993, Zvonova and Balonov 1993). These thyroid measurements were used to derive, in a direct manner, the thyroid doses received by the individuals from whom the measurements were taken. The thyroid measurements were also used as a guide to estimate the thyroid doses received by other people, taking into account differences in age, milk consumption rates, and ground deposition densities, among other things. The thyroid doses derived from thyroid measurements have a large degree
2 We have included in this guidance an extensive bibliography of the sources used in developing these revised recommendations.
3
of uncertainty, especially in Belarus, where most of the measurements were made by inexperienced people with detectors that were not ideally suited to the task at hand (Gavrilin et al., 1999 and UNSCEAR 2000). However, as indicated above, the uncertainties attached to thyroid dose estimates derived from thyroid measurements are, as a rule, lower than those obtained without recourse to those measurements.
It is also notable that the thyroid radiation exposures after Chernobyl were virtually all internal, from radioiodines. Despite some degree of uncertainty in the doses received, it is reasonable to conclude that the contribution of external radiation was negligible for most individuals. This distinguishes the Chernobyl exposures from those of the Marshall Islanders. Thus, the increase in thyroid cancer seen after Chernobyl is attributable to ingested or inhaled radioiodines. A comparable burden of excess thyroid cancers could conceivably accrue should U.S. populations be similarly exposed in the event of a nuclear accident. This potential hazard highlights the value of averting such risk by using KI as an adjunct to evacuation, sheltering, and control of contaminated foodstuffs.
B. Thyroid Cancers in the Aftermath of Chernobyl
The Chernobyl reactor accident resulted in massive releases of 131I and other radioiodines. Beginning approximately 4 years after the accident, a sharp increase in the incidence of thyroid cancer among children and adolescents in Belarus and Ukraine (areas covered by the radioactive plume) was observed. In some regions, for the first 4 years of this striking increase, observed cases of thyroid cancer among children aged 0 through 4 years at the time of the accident exceeded expected number of cases by 30- to 60-fold. During the ensuing years, in the most heavily affected areas, incidence is as much as 100-fold compared to pre-Chernobyl rates (Robbins and Schneider 2000; Gavrilin et al., 1999; Likhtarev et al., 1993; Zvonova and Balonov 1993). The majority of cases occurred in children who apparently received less than 30 cGy to the thyroid (Astakhova et al., 1998). A few cases occurred in children exposed to estimated doses of < 1 cGy; however, the uncertainty of these estimates confounded by medical radiation exposures leaves doubt as to the causal role of these doses of radioiodine (Souchkevitch and Tsyb 1996).
The evidence, though indirect, that the increased incidence of thyroid cancer observed among persons exposed during childhood in the most heavily contaminated regions in Belarus, Ukraine, and the Russian Federation is related to exposure to iodine isotopes is, nevertheless, very strong (IARC 2001). We have concluded that the best dose-response information from Chernobyl shows a marked increase in risk of thyroid cancer in children with exposures of 5 cGy or greater (Astakhova et. al., 1998; Ivanov et al., 1999; Kazakov et al., 1992). Among children born more than nine months after the accident in areas traversed by the radioactive plume, the incidence of thyroid cancer has not exceeded preaccident rates, consistent with the short half-life of 131I.
The use of KI in Poland after the Chernobyl accident provides us with useful information regarding its safety and tolerability in the general population. Approximately 10.5 million children under age 16 and 7 million adults received at least one dose of KI. Of note, among newborns receiving single doses of 15 mg KI, 0.37 percent (12 of 3214) showed transient increases in TSH (thyroid stimulating hormone) and decreases in FT4 (free thyroxine). The side
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effects among adults and children were generally mild and not clinically significant. Side effects included gastrointestinal distress, which was reported more frequently in children (up to 2 percent, felt to be due to bad taste of SSKI solution) and rash (~1 percent in children and adults). Two allergic reactions were observed in adults with known iodine sensitivity (Nauman and Wolff 1993).
Thus, the studies following the Chernobyl accident support the etiologic role of relatively small doses of radioiodine in the dramatic increase in thyroid cancer among exposed children. Furthermore, it appears that the increased risk occurs with a relatively short latency. Finally, the Polish experience supports the use of KI as a safe and effective means by which to protect against thyroid cancer caused by internal thyroid irradiation from inhalation of contaminated air or ingestion of contaminated food and drink when exposure cannot be prevented by evacuation, sheltering, or food and milk control.
IV. CONCLUSIONS AND RECOMMENDATIONS
A. Use of KI in Radiation Emergencies: Rationale, Effectiveness, Safety
For the reasons discussed above, the Chernobyl data provide the most reliable information available to date on the relationship between internal thyroid radioactive dose and cancer risk. They suggest that the risk of thyroid cancer is inversely related to age, and that, especially in young children, it may accrue at very low levels of radioiodine exposure. We have relied on the Chernobyl data to formulate our specific recommendations below.
The effectiveness of KI as a specific blocker of thyroid radioiodine uptake is well established (Il’in LA, et al., 1972) as are the doses necessary for blocking uptake. As such, it is reasonable to conclude that KI will likewise be effective in reducing the risk of thyroid cancer in individuals or populations at risk for inhalation or ingestion of radioiodines.
Short-term administration of KI at thyroid blocking doses is safe and, in general, more so in children than adults. The risks of stable iodine administration include sialadenitis (an inflammation of the salivary gland, of which no cases were reported in Poland among users after the Chernobyl accident), gastrointestinal disturbances, allergic reactions and minor rashes. In addition, persons with known iodine sensitivity should avoid KI, as should individuals with dermatitis herpetiformis and hypocomplementemic vasculitis, extremely rare conditions associated with an increased risk of iodine hypersensitivity.
Thyroidal side effects of stable iodine include iodine-induced thyrotoxicosis, which is more common in older people and in iodine deficient areas but usually requires repeated doses of stable iodine. In addition, iodide goiter and hypothyroidism are potential side effects more common in iodine sufficient areas, but they require chronic high doses of stable iodine (Rubery 1990). In light of the preceding, individuals with multinodular goiter, Graves’ disease, and autoimmune thyroiditis should be treated with caution, especially if dosing extends beyond a few days. The vast majority of such individuals will be adults.
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The transient hypothyroidism observed in 0.37 percent (12 of 3214) of neonates treated with KI in Poland after Chernobyl has been without reported sequelae to date. There is no question that the benefits of KI treatment to reduce the risk of thyroid cancer outweigh the risks of such treatment in neonates. Nevertheless, in light of the potential consequences of even transient hypothyroidism for intellectual development, we recommend that neonates (within the first month of life) treated with KI be monitored for this effect by measurement of TSH (and FT4, if indicated) and that thyroid hormone therapy be instituted in cases in which hypothyroidism develops (Bongers-Schokking 2000; Fisher 2000; Calaciura 1995).
B. KI Use in Radiation Emergencies: Treatment Recommendations
After careful review of the data from Chernobyl relating estimated thyroid radiation dose and cancer risk in exposed children, FDA is revising its recommendation for administration of KI based on age, predicted thyroid exposure, and pregnancy and lactation status (see Table).
*Adolescents approaching adult size (> 70 kg) should receive the full adult dose (130 mg).
The protective effect of KI lasts approximately 24 hours. For optimal prophylaxis, KI should therefore be dosed daily, until a risk of significant exposure to radioiodines by either inhalation or ingestion no longer exists. Individuals intolerant of KI at protective doses, and neonates, pregnant and lactating women (in whom repeat administration of KI raises particular safety issues, see below) should be given priority with regard to other protective measures (i.e., sheltering, evacuation, and control of the food supply).
Note that adults over 40 need take KI only in the case of a projected large internal radiation dose to the thyroid (>500 cGy) to prevent hypothyroidism.
These recommendations are meant to provide states and local authorities as well as other agencies with the best current guidance on safe and effective use of KI to reduce thyroidal radioiodine exposure and thus the risk of thyroid cancer. FDA recognizes that, in the event of an emergency, some or all of the specific dosing recommendations may be very difficult to carry
Threshold Thyroid Radioactive Exposures and Recommended Doses of KI for Different Risk Groups
Predicted Thyroid exposure(cGy)
KI dose (mg)
# of 130 mg tablets
# of 65 mg tablets
Adults over 40 yrs
>500
130
1
2
Adults over 18 through 40 yrs
>10
Pregnant or lactating women
>5
Adoles. over 12 through 18 yrs*
65
1/2
1
Children over 3 through 12 yrs
Over 1 month through 3 years
32
1/4
1/2
Birth through 1 month
16
1/8
1/4
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out given their complexity and the logistics of implementation of a program of KI distribution. The recommendations should therefore be interpreted with flexibility as necessary to allow optimally effective and safe dosing given the exigencies of any particular emergency situation. In this context, we offer the following critical general guidance: across populations at risk for radioiodine exposure, the overall benefits of KI far exceed the risks of overdosing, especially in children, though we continue to emphasize particular attention to dose in infants.
These FDA recommendations differ from those put forward in the World Health Organization (WHO) 1999 guidelines for iodine prophylaxis in two ways. WHO recommends a 130-mg dose of KI for adults and adolescents (over 12 years). For the sake of logistical simplicity in the dispensing and administration of KI to children, FDA recommends a 65-mg dose as standard for all school-age children while allowing for the adult dose (130 mg, 2 X 65 mg tablets) in adolescents approaching adult size. The other difference lies in the threshold for predicted exposure of those up to 18 years of age and of pregnant or lactating women that should trigger KI prophylaxis. WHO recommends a threshold of 1 cGy for these two groups. As stated earlier, FDA has concluded from the Chernobyl data that the most reliable evidence supports a significant increase in the risk of childhood thyroid cancer at exposures of 5 cGy or greater.
The downward KI dose adjustment by age group, based on body size considerations, adheres to the principle of minimum effective dose. The recommended standard dose of KI for all school- age children is the same (65 mg). However, adolescents approaching adult size (i.e., >70 kg) should receive the full adult dose (130 mg) for maximal block of thyroid radioiodine uptake. Neonates ideally should receive the lowest dose (16 mg) of KI. Repeat dosing of KI should be avoided in the neonate to minimize the risk of hypothyroidism during that critical phase of brain development (Bongers-Schokking 2000; Calaciura et al., 1995). KI from tablets (either whole or fractions) or as fresh saturated KI solution may be diluted in milk, formula, or water and the appropriate volume administered to babies. As stated above, we recommend that neonates (within the first month of life) treated with KI be monitored for the potential development of hypothyroidism by measurement of TSH (and FT4, if indicated) and that thyroid hormone therapy be instituted in cases in which hypothyroidism develops (Bongers-Schokking 2000; Fisher 2000; Calaciura et al., 1995).
Pregnant women should be given KI for their own protection and for that of the fetus, as iodine (whether stable or radioactive) readily crosses the placenta. However, because of the risk of blocking fetal thyroid function with excess stable iodine, repeat dosing with KI of pregnant women should be avoided. Lactating females should be administered KI for their own protection, as for other young adults, and potentially to reduce the radioiodine content of the breast milk, but not as a means to deliver KI to infants, who should get their KI directly. As for direct administration of KI, stable iodine as a component of breast milk may also pose a risk of hypothyroidism in nursing neonates. Therefore, repeat dosing with KI should be avoided in the lactating mother, except during continuing severe contamination. If repeat dosing of the mother is necessary, the nursing neonate should be monitored as recommended above.
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V. ADDITIONAL CONSIDERATIONS IN PROPHYLAXIS AGAINST THYROID RADIOIODINE EXPOSURE
Certain principles should guide emergency planning and implementation of KI prophylaxis in the event of a radiation emergency. After the Chernobyl accident, across the affected populations, thyroid radiation exposures occurred largely due to consumption of contaminated fresh cow’s milk (this contamination was the result of milk cows grazing on fields affected by radioactive fallout) and to a much lesser extent by consumption of contaminated vegetables. In this or similar accidents, for those residing in the immediate area of the accident or otherwise directly exposed to the radioactive plume, inhalation of radioiodines may be a significant contributor to individual and population exposures. As a practical matter, it may not be possible to assess the risk of thyroid exposure from inhaled radioiodines at the time of the emergency. The risk depends on factors such as the magnitude and rate of the radioiodine release, wind direction and other atmospheric conditions, and thus may affect people both near to and far from the accident site.
For optimal protection against inhaled radioiodines, KI should be administered before or immediately coincident with passage of the radioactive cloud, though KI may still have a substantial protective effect even if taken 3 or 4 hours after exposure. Furthermore, if the release of radioiodines into the atmosphere is protracted, then, of course, even delayed administration may reap benefits by reducing, if incompletely, the total radiation dose to the thyroid.
Prevention of thyroid uptake of ingested radioiodines, once the plume has passed and radiation protection measures (including KI) are in place, is best accomplished by food control measures and not by repeated administration of KI. Because of radioactive decay, grain products and canned milk or vegetables from sources affected by radioactive fallout, if stored for weeks to months after production, pose no radiation risk. Thus, late KI prophylaxis at the time of consumption is not required.
As time is of the essence in optimal prophylaxis with KI, timely administration to the public is a critical consideration in planning the emergency response to a radiation accident and requires a readysupplyofKI. StateandlocalgovernmentschoosingtoincorporateKIintotheir emergency response plans may consider the option of predistribution of KI to those individuals who do not have a medical condition precluding its use.
VI. SUMMARY
FDA maintains that KI is a safe and effective means by which to prevent radioiodine uptake by the thyroid gland, under certain specified conditions of use, and thereby obviate the risk of thyroid cancer in the event of a radiation emergency. Based upon review of the literature, we have proposed lower radioactive exposure thresholds for KI prophylaxis as well as lower doses of KI for neonates, infants, and children than we recommended in 1982. As in our 1982 notice in the Federal Register, FDA continues to recommend that radiation emergency response plans include provisions, in the event of a radiation emergency, for informing the public about the magnitude of the radiation hazard, about the manner of use of KI and its potential benefits and
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risks, and for medical contact, reporting, and assistance systems. FDA also emphasizes that emergency response plans and any systems for ensuring availability of KI to the public should recognize the critical importance of KI administration in advance of exposure to radioiodine. As in the past, FDA continues to work in an ongoing fashion with manufacturers of KI to ensure that high-quality, safe, and effective KI products are available for purchase by consumers as well as by state and local governments wishing to establish stores for emergency distribution.
KI provides protection only for the thyroid from radioiodines. It has no impact on the uptake by the body of other radioactive materials and provides no protection against external irradiation of any kind. FDA emphasizes that the use of KI should be as an adjunct to evacuation (itself not always feasible), sheltering, and control of foodstuffs.
ACKNOWLEDGEMENTS
The KI Taskforce would like to extend special thanks to our members from the NIH: Jacob Robbins, M.D., and Jan Wolff, Ph.D., M.D., of the National Institute of Diabetes, Digestive, and Kidney Diseases and Andre Bouville, Ph.D., of the National Cancer Institute. In addition, we would like to thank Dr. David V. Becker of the Department of Radiology, Weill Medical College (WMC) of Cornell University and The New York Presbyterian Hospital-WMC Cornell Campus, for his valuable comments on the draft

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