{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T04:57:00Z","timestamp":1783573020056,"version":"3.55.0"},"reference-count":30,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/501100000145","name":"Alberta Innovates - Health Solutions","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000145","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000036","name":"Institute of Population and Public Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000036","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2017,7,8]]},"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There are concerns that altered thyroid functioning could be the result of ingesting too much fluoride. Community water fluoridation (CWF) is an important source of fluoride exposure. Our objectives were to examine the association between fluoride exposure and (1) diagnosis of a thyroid condition and (2) indicators of thyroid functioning among a national population-based sample of Canadians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analysed data from Cycles 2 and 3 of the Canadian Health Measures Survey (CHMS). Logistic regression was used to assess associations between fluoride from urine and tap water samples and the diagnosis of a thyroid condition. Multinomial logistic regression was used to examine the relationship between fluoride exposure and thyroid-stimulating hormone (TSH) level (low\/normal\/high). Other available variables permitted additional exploratory analyses among the subset of participants for whom we could discern some fluoride exposure from drinking water and\/or dental products.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There was no evidence of a relationship between fluoride exposure (from urine and tap water) and the diagnosis of a thyroid condition. There was no statistically significant association between fluoride exposure and abnormal (low or high) TSH levels relative to normal TSH levels. Rerunning the models with the sample constrained to the subset of participants for whom we could discern some source(s) of fluoride exposure from drinking water and\/or dental products revealed no significant associations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>These analyses suggest that, at the population level, fluoride exposure is not associated with impaired thyroid functioning in a time and place where multiple sources of fluoride exposure, including CWF, exist.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2017-209129","type":"journal-article","created":{"date-parts":[[2017,8,24]],"date-time":"2017-08-24T20:40:23Z","timestamp":1503607223000},"page":"1019-1025","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Fluoride exposure and indicators of thyroid functioning in the Canadian population: implications for community water fluoridation"],"prefix":"10.1136","volume":"71","author":[{"given":"Amanda M","family":"Barberio","sequence":"first","affiliation":[{"name":"Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada"},{"name":"Department of Community Health Sciences and O\u2019Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F Shaun","family":"Hosein","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Queensland, Herston, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Qui\u00f1onez","sequence":"additional","affiliation":[{"name":"Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"McLaren","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences and O\u2019Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,8,24]]},"reference":[{"key":"2025100702445439000_71.10.1019.1","unstructured":"Hall JE . Guyton and hall textbook of medical physiology: Elsevier Health Sciences, 2015."},{"key":"2025100702445439000_71.10.1019.2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006-1402"},{"key":"2025100702445439000_71.10.1019.3","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-0798"},{"key":"2025100702445439000_71.10.1019.4","unstructured":"National Research Council. Fluoride in drinking water: a scientific review of EPA\u2019s standards. Washington DC, USA: The National Academies Press, 2006."},{"key":"2025100702445439000_71.10.1019.5","first-page":"63","article-title":"Investigations of soft tissue functions in fluorotic individuals of North Gujarat","volume":"29","author":"Michael","year":"1996","journal-title":"Fluoride"},{"key":"2025100702445439000_71.10.1019.6","first-page":"98","article-title":"Excess fluoride ingestion and thyroid hormone derangements in children living in Delhi","volume":"38","author":"Susheela","year":"2005","journal-title":"India Fluoride"},{"key":"2025100702445439000_71.10.1019.7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/2193-1801-3-7","article-title":"A comparative study of fluoride ingestion levels, serum thyroid hormone & TSH level derangements, dental fluorosis status among school children from endemic and non-endemic fluorosis areas","volume":"3","author":"Singh","year":"2014","journal-title":"Springerplus"},{"key":"2025100702445439000_71.10.1019.8","first-page":"24","article-title":"The relationship of a low iodine and high-fluoride environment to subclinical cretinism in Xinjiang","volume":"7","author":"Lin","year":"1991","journal-title":"IDD Newsletter"},{"key":"2025100702445439000_71.10.1019.9","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1055\/s-0039-1698949","article-title":"Study of thyroid hormones free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) in subjects with dental fluorosis","volume":"6","author":"Hosur","year":"2012","journal-title":"Eur J Dent"},{"key":"2025100702445439000_71.10.1019.10","unstructured":"Sutton M , Kiersey R , Farragher L , et al . Health effects of water fluoridation. Dublin, Ireland: Health Research Board, 2015."},{"key":"2025100702445439000_71.10.1019.11","unstructured":"Health Canada. Findings and recommendations of the fluoride expert panel, 2008."},{"key":"2025100702445439000_71.10.1019.12","doi-asserted-by":"crossref","first-page":"e413","DOI":"10.17269\/CJPH.106.5031","article-title":"Public perceptions and scientific evidence for perceived harms\/risks of community water fluoridation: an examination of online comments pertaining to fluoridation cessation in Calgary in 2011","volume":"106","author":"Podgorny","year":"2015","journal-title":"Can J Public Health"},{"key":"2025100702445439000_71.10.1019.13","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2014-204971"},{"key":"2025100702445439000_71.10.1019.14","unstructured":"Statistics Canada. Canadian Health Measures Survey (CHMS).\u00a0Data user guide: Cycle 2, 2013."},{"key":"2025100702445439000_71.10.1019.15","unstructured":"Statistics Canada. Canadian Health Measures Survey (CHMS). Data user guide: Cycle 3, 2015."},{"key":"2025100702445439000_71.10.1019.16","unstructured":"Institut National de Sant\u00e9 Publique du Qu\u00e9bec (INSPQ): Centre de toxicology. Analytic Method for the Determination of Fluoride in Urine (M-186)-Condensed Version for CHMS. 2009."},{"key":"2025100702445439000_71.10.1019.17","unstructured":"Health Canada. Second Report on Human Biomonitoring of Environmental Chemicals in Canada: Results of the Canadian Health Measures Survey Cycle 2 (2009-2011). Ottawa, ON: Health Canada. 2013."},{"key":"2025100702445439000_71.10.1019.18","first-page":"679","article-title":"Monitoring salt fluoridation programs through urinary excretion studies","volume":"115","author":"Marthaler","year":"2005","journal-title":"Schweiz Monatsschr Zahnmed"},{"key":"2025100702445439000_71.10.1019.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijd.2013.05.002"},{"key":"2025100702445439000_71.10.1019.20","unstructured":"Health Canada. Analytic procedure manual: Third Generation Ultra THYROID STIMULATING HORMONE (TSH3-UL) on ADVIA Centaur XP: Division. CRLNR, 2012."},{"key":"2025100702445439000_71.10.1019.21","unstructured":"Health Canada. Analytic procedure manual: free\u00a0thyroxine (FT4) on ADVIA Centaur XP: CHMS Reference Laboratory: Nutrition Research Division, 2012."},{"key":"2025100702445439000_71.10.1019.22","unstructured":"American Thyroid Association website. Thyroid disease and pregnancy, 2016. http:\/\/www.thyroid.org\/thyroid-disease-pregnancy\/ (accessed Jul 2016)."},{"key":"2025100702445439000_71.10.1019.23","first-page":"1","article-title":"Fluoridation exposure status based on location of data collection in the Canadian health measures survey: is it valid?","volume":"82","author":"McLaren","year":"2016","journal-title":"J Can Dent Assoc"},{"key":"2025100702445439000_71.10.1019.24","unstructured":"StataCorp. Stata Statistical Software: release 14.1. College Station TX, USA: StataCorpLP. 2015."},{"key":"2025100702445439000_71.10.1019.25","doi-asserted-by":"publisher","DOI":"10.1177\/096228029900800102"},{"key":"2025100702445439000_71.10.1019.26","doi-asserted-by":"publisher","DOI":"10.1136\/ewjm.172.2.102"},{"key":"2025100702445439000_71.10.1019.27","unstructured":"Iodine Global Network. http:\/\/www.ign.org\/ (accessed Jun 2017)."},{"key":"2025100702445439000_71.10.1019.28","unstructured":"Canadian Public Health Association. Food fortification with vitamins and minerals. http:\/\/www.cpha.ca\/en\/programs\/history\/achievements\/09-shf\/fortification.aspx (accessed Jun 2017)."},{"key":"2025100702445439000_71.10.1019.29","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980012005496"},{"key":"2025100702445439000_71.10.1019.30","unstructured":"Federal-Provincial-Territorial Committee on Drinking Water. \u00a0Guidelines for Canadian drinking water quality: guideline technical document \u2013\u00a0fluoride. Ottawa, ON Health Canada, 2010."}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2017-209129","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T09:45:10Z","timestamp":1759830310000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2017-209129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,24]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2017,9,7]]},"published-print":{"date-parts":[[2017,10]]}},"alternative-id":["10.1136\/jech-2017-209129"],"URL":"https:\/\/doi.org\/10.1136\/jech-2017-209129","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,24]]}}}