title: Association between Perchlorate and Indirect Indicators of Thyroid Dysfunction in NHANES 2001-2002, a Cross-Sectional, Hypothesis-Generating Study.
abstract: BACKGROUND
  A previous study based on NHANES 2001-2002 observed that increased levels of urinary perchlorate were associated with increased levels of thyroid stimulating hormone among all women, and with decreased levels of thyroxine among women with low urinary iodine. No associations were observed for men.
  
  
  METHODS
  Using the same NHANES 2001-2002 data, associations of urinary perchlorate with indirect biomarkers of thyroid hormone disruption were investigated. Decreased levels of hemoglobin (HGB), hematocrit (HCT), and high density lipoprotein (HDL) have been observed among subjects with subclinical hypothyroidism. To investigate the suitability of these indicators for use in observational studies, subjects were divided into six groups: boys, age 6-19; men, age 20-85; girls, age 6-14; non-pregnant women, age 15-49; women, age 50-85; and pregnant women. Use of perchlorate quintiles (Q1-Q5) and continuous log-transformed perchlorate in the regression models allowed investigation of both non-linear and linear associations. Adjustments were made for age, urinary creatinine, race/ethnicity, body mass index, cotinine, poverty index, hours of fasting, thiocyanate, nitrate, daily kcal intake, C-reactive protein. Adjustment for alcohol consumption depended on availability. Adjustment for prescription drugs (beta-blockers, sex hormones, antihyperlipidemic and antidiabetic drugs) was made if it changed the perchlorate estimate by ≥10%.
  
  
  RESULTS
  Statistically significant decreases were observed for HGB and HCT among boys, men, women age 15-49, and pregnant women, and for HDL among men.
  
  
  CONCLUSIONS
  Although the mean response biomarkers were within normal range, their association with urinary perchlorate is of interest. HGB and HCT among pregnant women showed a stronger association with urinary perchlorate than non-pregnant women age 15-49. Statistically significant associations were observed for individual perchlorate quintiles. Assumption of linearity of log-transformed perchlorate may result in underestimation of some associations.
authors.affiliation: Epidemiology Branch, Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, Office of Research and Development, US Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA.
authors.forename: Dina M
authors.initials: DM
authors.lastname: Schreinemachers