Perfluoroalkyl substances and thyroid stimulating hormone levels in a highly exposed population in the Veneto Region

Elisa Gallo, Claudio Barbiellini Amidei, Giulia Barbieri, Aline S.C. Fabricio, Massimo Gion, Gisella Pitter, Francesca Daprà, Francesca Russo, Dario Gregori, Tony Fletcher, Cristina Canova*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Per- and poly-fluoroalkyl substances (PFAS) are persistent and widespread environmental pollutants. People living in Veneto Region (Italy) have been exposed from the late 1970s to 2013 to elevated concentrations of PFAS through drinking water. The effect of PFAS on thyroid function is still controversial and studies focusing on thyroid stimulating hormone (TSH) have shown inconsistent results. The aim of this study was to evaluate the association between serum PFAS and TSH levels and its dose-response relationship in a large population of highly exposed individuals. Methods: A cross-sectional study was conducted on 21,424 individuals aged 14–39 living in the contaminated area. In the main analysis, participants with prevalent thyroid disease and pregnant women were excluded. Serum levels of perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) were measured. Generalized Additive Models were used to evaluate the association between TSH levels and serum PFAS, using thin plate spline smooth terms to model the potential non-linear relationship. Models were stratified by sex and age group and adjusted for potential confounders. A secondary analysis was conducted to evaluate the association between PFAS with prevalent self-reported thyroid disorders. Results: We found no association between TSH and any type of PFAS among adolescents or women. A decrease in TSH concentration was observed in association with an IQR increase in PFHxS and a mild decrease in TSH at low levels of PFOA, PFOS and PFHxS among male adults. Self-reported thyroid disease was more common among women with higher levels of PFNA concentrations, whereas all other PFAS were not associated with thyroid diseases regardless of sex or age. Conclusions: Overall there is no evidence of an association between TSH and PFAS. However, some results are suggestive of a possible inverse association of TSH with PFOA, PFOS and PFHxS among adult males.

Original languageEnglish
Article number111794
JournalEnvironmental Research
Publication statusPublished - Jan 2022
Externally publishedYes

Bibliographical note

Funding Information:
This research was funded by CORIS/REGIONE VENETO (IT) with a grant to Cristina Canova. Award Number: CANO_ALFREVE18_01 (CONVENZIONE CORIS PER REALIZZAZIONE PROGETTI DI RICERCA INNOVATIVI SUI PFAS 2017-18).

Publisher Copyright:
© 2021


  • Biomonitoring
  • Contaminated water
  • Cross-sectional study
  • Perfluoroalkyl substances
  • Thyroid stimulating hormone


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