{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:52:58Z","timestamp":1790189578634,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T00:00:00Z","timestamp":1737072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: With technological development, ionizing radiation has found applications in numerous occupations. However, the determination and quantification of the damage resulting from exposure to it remains rather unclear, along with the damage to particular organs. The aim of this systematic review was to investigate the relationship between low-dose ionizing radiation (LDIR) in exposed workers and possible functional changes and cancer development in the thyroid gland. Methods: We included observational studies evidencing the correlation under study. Data extraction and analysis was conducted on all included studies. The research strategy included three electronic databases (PubMed, Scopus, and Web of Science). The systematic review followed PRISMA guidelines, and the research protocol was submitted to PROSPERO (CRD:42023425839). Results: The search initially yielded 166 articles and, once duplicates and irrelevant articles were removed, a total of 15 useful articles were reviewed. Qualitative analysis of the studies showed that the TSH value does not change following exposure, while a reduction in fT3 and an increase or reduction in fT4 can be observed. Furthermore, the correlation between thyroid cancer and occupational exposure to radiation was not shown with certainty, but there was some evidence of increased gland volume and nodule formation. Conclusions: Even at low doses, ionizing radiation adversely affects thyroid activity. In this regard, new studies should be carried out in order to further investigate and define this issue and, consequently, outline useful measures to ensure the protection of workers in contact with this particular physical agent.<\/jats:p>","DOI":"10.3390\/jcm14020588","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T11:24:56Z","timestamp":1737113096000},"page":"588","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Low-Dose Ionizing Radiation and Thyroid Diseases and Functional Modifications in Exposed Workers: A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Corrado","family":"Colaprico","sequence":"first","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Lomartire","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0191-981X","authenticated-orcid":false,"given":"Ivana","family":"Raccio","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7475-3038","authenticated-orcid":false,"given":"Giorgia","family":"Mantione","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Ammirati","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"La Torre","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1016\/j.dnarep.2008.07.009","article-title":"Suppressed expression of non-DSB repair genes inhibits gammaradiation-induced cytogenetic repair and cell cycle arrest","volume":"7","author":"Zhang","year":"2008","journal-title":"DNA Repair"},{"key":"ref_2","unstructured":"(2024, July 13). AIRC-Radiazioni Ionizzanti e Cancro. Available online: https:\/\/www.airc.it\/cancro\/informazioni-tumori\/cose-il-cancro\/radiazioni-ionizzanti-cancro#:~:text=Le%20radiazioni%20ionizzanti%20possono%20danneggiare,allo%20sviluppo%20di%20un%20tumore.&text=Le%20radiazioni%20ionizzanti%20sono%20un,per%20l'insorgenza%20del%20cancro."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/HP.0b013e31820a83ae","article-title":"Biological consequences and health risks of low-level exposure to ionizing radiation: Commentary on the workshop","volume":"100","author":"Feinendegen","year":"2011","journal-title":"Health Phys."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"160","DOI":"10.4103\/rpe.RPE_72_18","article-title":"Excerpts of UNSCEAR white paper on \u201cevaluation of data on thyroid cancer in regions affected by the Chernobyl accident\u201d","volume":"41","author":"Rao","year":"2018","journal-title":"Radiat. Prot. Environ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2575","DOI":"10.1210\/jc.2016-3529","article-title":"Thyroid Cancer Following Childhood Low-Dose Radiation Exposure: A Pooled Analysis of Nine Cohorts","volume":"102","author":"Lubin","year":"2017","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1093\/ije\/dyv122","article-title":"Cohort Profile: The International Nuclear Workers Study (INWORKS)","volume":"45","author":"Hamra","year":"2016","journal-title":"Int. J. Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e074520","DOI":"10.1136\/bmj-2022-074520","article-title":"Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): Cohort study","volume":"382","author":"Richardson","year":"2023","journal-title":"Br. Med. J."},{"key":"ref_8","unstructured":"National Research Council (2006). Committee on the Biological Effects of Ionizing Radiation. Health Risks from Exposure to Low Levels of Ionizing Radiation. BEIR: VII Report, Phase 2, The National Academic Press."},{"key":"ref_9","unstructured":"(2024, July 13). Dipartimento Della Protezione Civile, Presidenza del Consiglio dei Ministri-Decreto Legislativo n.101 del 31 Luglio 2020, Available online: https:\/\/www.protezionecivile.gov.it\/it\/normativa\/decreto-legislativo-n101-del-31-luglio-2020-0\/."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., and Brennan, S.E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372.","DOI":"10.1136\/bmj.n71"},{"key":"ref_11","first-page":"29","article-title":"Radiaciones ionizantes en trabajadores sanitarios: Funci\u00f3n tiroidea y niveles de riesgo de exposici\u00f3n laboral [Ionizing radiation in healthcare workers: Thyroid function and risk levels of occupational exposure]","volume":"31","author":"Mahillo","year":"2022","journal-title":"Rev. Asoc. Esp. Espec. Med. Trab."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"El-Benhawy, S.A., Fahmy, E.I., Mahdy, S.M., Khedr, G.H., Sarhan, A.S., Nafady, M.H., Yousef Selim, Y.A., Salem, T.M., Abu-Samra, N., and El Khadry, H.A. (2022). Assessment of thyroid gland hormones and ultrasonographic abnormalities in medical staff occupationally exposed to ionizing radiation. BMC Endocr. Disord., 22.","DOI":"10.1186\/s12902-022-01196-z"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Cioffi, D.L., Fontana, L., Leso, V., Dolce, P., Vitale, R., Vetrani, I., Galdi, A., and Iavicoli, I. (2022). Low dose ionizing radiation exposure and risk of thyroid functional alterations in healthcare workers. Eur. J. Radiol., 132.","DOI":"10.1016\/j.ejrad.2020.109279"},{"key":"ref_14","first-page":"434","article-title":"The relationship between occupational radiation exposure and thyroid nodules","volume":"17","author":"Adibi","year":"2012","journal-title":"J. Res. Med. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s10654-021-00822-9","article-title":"Risk of thyroid cancer in Ukrainian cleanup workers following the Chornobyl accident","volume":"37","author":"Gudzenko","year":"2022","journal-title":"Eur. J. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1097\/JOM.0b013e318167751d","article-title":"Cancer admission and mortality in workers exposed to ionizing radiation in Korea","volume":"50","author":"Ahn","year":"2008","journal-title":"J. Occup. Environ. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"225","DOI":"10.2307\/3579424","article-title":"Thyroid nodularity and cancer among Chernobyl cleanup workers from Estonia","volume":"147","author":"Inskip","year":"1997","journal-title":"Radiat. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1038\/sj.bjc.6604825","article-title":"Mortality and cancer incidence following occupational radiation exposure: Third analysis of the National Registry for Radiation Workers","volume":"100","author":"Muirhead","year":"2009","journal-title":"Br. J. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1667\/RR2975.1","article-title":"Risk of thyroid cancer among chernobyl liquidators","volume":"178","author":"Kesminiene","year":"2012","journal-title":"Radiat. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s12020-021-02972-y","article-title":"Molecular profiling of papillary thyroid carcinomas in healthcare workers exposed to low dose radiation at the workplace","volume":"76","author":"Duque","year":"2022","journal-title":"Endocrine"},{"key":"ref_21","first-page":"338","article-title":"Thyroid parameters variations in healthcare workers and students exposed to low-dose ionizing radiations","volume":"44","author":"Sernia","year":"2022","journal-title":"G. Ital. Med. Lav. Ergon."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1097\/EDE.0000000000001004","article-title":"The Relationship Between Occupational Exposure to Low-dose Ionizing Radiation and Changes in Thyroid Hormones in Hospital Workers","volume":"30","author":"Wong","year":"2019","journal-title":"Epidemiology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1136\/oemed-2021-107452","article-title":"Occupational radiation exposure and cancer incidence in a cohort of diagnostic medical radiation workers in South Korea","volume":"78","author":"Lee","year":"2021","journal-title":"Occup. Environ. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1002\/ijc.31270","article-title":"Occupational radiation exposure and thyroid cancer incidence in a cohort of U.S. radiologic technologists, 1983\u20132013","volume":"143","author":"Kitahara","year":"2018","journal-title":"Int. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1667\/RR0553.1","article-title":"The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: Estimates of radiation-related cancer risks","volume":"167","author":"Cardis","year":"2007","journal-title":"Radiat. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/0959-8049(92)90442-5","article-title":"Low-dose radiation carcinogenesis","volume":"28 Pt A","author":"Modan","year":"1992","journal-title":"Eur. J. Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"McLean, A.R., Adlen, E.K., Cardis, E., Elliott, A., Goodhead, D.T., Harms-Ringdahl, M., Hendry, J.H., Hoskin, P., Jeggo, P.A., and Mackay, D.J.C. (2017). A restatement of the natural science evidence base concerning the health effects of low-level ionizing radiation. Proc. Biol. Sci., 284.","DOI":"10.1098\/rspb.2017.1070"},{"key":"ref_28","first-page":"S263","article-title":"Thyroid nodules: Pathophysiological insight on oncogenesis and novel diagnostic techniques","volume":"63","author":"Jiskra","year":"2014","journal-title":"Physiol. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"36","DOI":"10.21514\/1998-426X-2022-15-1-36-46","article-title":"Relation between the thyroid diseases prevalence and doses of radiation exposure in the individuals relocated from radioactively contaminated areas in South Urals","volume":"15","author":"Rabinovich","year":"2022","journal-title":"Radiatsionnaya Gygiena"},{"key":"ref_30","first-page":"323","article-title":"Thyroid abnormalities and influencing factors in medical radiology workers in Guangdong Province","volume":"40","author":"Liu","year":"2023","journal-title":"J. Environ. Occup. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/588\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:30:58Z","timestamp":1759919458000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/588"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,17]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020588"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020588","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,17]]}}}