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      Review of the PRIODAC project on thyroid protection from radioactive iodine by repeated iodide intake in individuals aged 12+

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          Abstract

          Background

          Intake of potassium iodide (KI) reduces the accumulation of radioactive iodine in the thyroid gland in the event of possible contamination by radioactive iodine released from a nuclear facility. The World Health Organization (WHO) has stated the need for research for optimal timing, appropriate dosing regimen, and safety for repetitive iodine thyroid blocking (ITB). The French PRIODAC project, addressed all these issues, involving prolonged or repeated releases of radioactive iodine. Preclinical studies established an effective dose through pharmacokinetic modeling, demonstrating the safety of repetitive KI treatment without toxicity.

          Summary

          Recent preclinical studies have determined an optimal effective dose for repetitive administration, associated with pharmacokinetic modeling. The results show the safety and absence of toxicity of repetitive treatment with KI. Good laboratory practice level preclinical studies corresponding to individuals >12 years have shown a safety margin established between animal doses without toxic effect. After approval from the French health authorities, the market authorization of the two tablets of KI, 65 mg/day, was defined with a new dosing scheme of a daily repetitive intake of the treatment up to 7 days unless otherwise instructed by the competent authorities for all categories of population except pregnant women and children under the age of 12 years.

          Conclusion

          This new marketed authorization resulting from scientific-based evidence obtained as part of the PRIODAC project may serve as an example to further harmonize the application of KI for repetitive ITB in situations of prolonged radioactive release at the European and international levels, under the umbrella of the WHO .

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          Most cited references53

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          Dose translation from animal to human studies revisited.

          As new drugs are developed, it is essential to appropriately translate the drug dosage from one animal species to another. A misunderstanding appears to exist regarding the appropriate method for allometric dose translations, especially when starting new animal or clinical studies. The need for education regarding appropriate translation is evident from the media response regarding some recent studies where authors have shown that resveratrol, a compound found in grapes and red wine, improves the health and life span of mice. Immediately after the online publication of these papers, the scientific community and popular press voiced concerns regarding the relevance of the dose of resveratrol used by the authors. The animal dose should not be extrapolated to a human equivalent dose (HED) by a simple conversion based on body weight, as was reported. For the more appropriate conversion of drug doses from animal studies to human studies, we suggest using the body surface area (BSA) normalization method. BSA correlates well across several mammalian species with several parameters of biology, including oxygen utilization, caloric expenditure, basal metabolism, blood volume, circulating plasma proteins, and renal function. We advocate the use of BSA as a factor when converting a dose for translation from animals to humans, especially for phase I and phase II clinical trials.
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            Consequences of excess iodine.

            Iodine is a micronutrient that is essential for the production of thyroid hormones. The primary source of iodine is the diet via consumption of foods that have been fortified with iodine, including salt, dairy products and bread, or that are naturally abundant in the micronutrient, such as seafood. Recommended daily iodine intake is 150 µg in adults who are not pregnant or lactating. Ingestion of iodine or exposure above this threshold is generally well-tolerated. However, in certain susceptible individuals, including those with pre-existing thyroid disease, the elderly, fetuses and neonates, or patients with other risk factors, the risk of developing iodine-induced thyroid dysfunction might be increased. Hypothyroidism or hyperthyroidism as a result of supraphysiologic iodine exposure might be either subclinical or overt, and the source of the excess iodine might not be readily apparent.
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              Plasma inorganic iodide as a homeostatic regulator of thyroid function.

                Author and article information

                Journal
                Eur Thyroid J
                Eur Thyroid J
                ETJ
                European Thyroid Journal
                Bioscientifica Ltd (Bristol )
                2235-0640
                2235-0802
                14 February 2024
                19 January 2024
                01 February 2024
                : 13
                : 1
                : e230139
                Affiliations
                [1 ]Centre de recherche en CardioVasculaire et Nutrition (C2VN) , Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Institut National pour la Santé Et la Recherche Médicale (INSERM), Aix Marseille Université (AMU), Marseille, France
                [2 ]Transporter in Imaging and Radiotherapy in Oncology Laboratory (TIRO) , Direction de la Recherche Fondamentale (DRF), Institut des sciences du vivant Frederic Joliot, Commissariat à l’Energie Atomique et aux Energies alternatives (CEA), Université Côte d’Azur (UCA), School of Medicine, Nice, France
                [3 ]Institut de Radioprotection et de Sûreté Nucléaire (IRSN) , PSE-Santé, Fontenay-aux-Roses, France
                [4 ]Pharmacie Centrale des Armées (PCA) , Direction des Approvisionnements en produits de Santé des Armées, Fleury-les-Aubrais, France
                Author notes
                Correspondence should be addressed to M Souidi: maamar.souidi@ 123456irsn.fr
                Author information
                http://orcid.org/0000-0002-2870-0012
                http://orcid.org/0000-0001-6397-0627
                Article
                ETJ-23-0139
                10.1530/ETJ-23-0139
                10895330
                38241789
                9becd77f-672f-44af-b991-22e9adb1686e
                © the author(s)

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 19 July 2023
                : 19 January 2024
                Categories
                Review

                iodine thyroid blocking,nuclear emergency,population over 12 years,potassium iodide,radioactive iodine contamination,repetitive prophylaxis

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