Friday, August 23, 2013

Twelfth Prefectural Oversight Committee Meeting: Thyroid Ultrasound Examination Results

The Proceedings of the Twelfth Prefectural Oversight Committee Meeting for Fukushima Health Management Survey were released on August 20, 2013.  Below is the translation of the thyroid ultrasound examination.

Original Japanese document can be found here: http://www.pref.fukushima.jp/imu/kenkoukanri/250820siryou2.pdf

For a summary of the thyroid examination results, please refer to this post.

Note: Errata released on November 13, 2013 can be viewed here with an explanation here

1. Implementation status of the initial examination (in-prefecture)
   FY2013 examination began on April 22, 2013.  The examination will be conducted in approximately 158,783 subjects in 34 municipalities by the end of March 2014.
   Currently the examination is being conducted in the municipalities shown below, according to the original plan.

【Implementation status table for thyroid examination (initial examination): in-prefecture】(as of July 31, 2013)

FY2013 target municipalities (only five municipalities where the examination is currently conducted are listed). 
(Note: the top line in column "a" shows the current number of eligible subjects, whereas the bottom line shows an overall number of eligible subjects).



FY2012 target municipalities (Iwaki-city only includes Hisanohama District)

FY2011 target municipalities (13 municipalities designated by the national government as the evacuation zone)
※1 The top row shows the number of subjects who actually underwent the initial thyroid ultrasound examination.  The middle row shows the rate of eligible subjects who were examined in each age group.  The bottom row shows the proportion of subjects in each age group who actually underwent the initial thyroid ultrasound examination.
※2   The number of subjects, originally Fukushima residents, now residing outside Fukushima Prefecture, who came back to Fukushima Prefecture to undergo thyroid ultrasound examination.
● Proportions shown to the first decimal point might not add up to 100% due to rounding off.
● Age shown is the age as of March 11, 2011.

2. Implementation status of the initial examination (out-of-prefecture)
   Thyroid examination has been conducted, since November 1, 2012, at examination facilities outside Fukushima Prefecture which singed an an agreement with Fukushima Medical University.
   Currently, notices for out-of-prefecture examinations are being sent to subjects from municipalities where the examination was implemented up to FY2012.  Examinations are conducted in order.  Breakdown by municipalities are shown below.

Implementation status table for thyroid examination (initial examination): out-of-prefecture   

FY2012 target municipalities (as of June 30, 2013)

FY2011 target municipalities (as of June 30, 2013)
※1 The number of notices sent to the eligible subjects who have not undergone examinations at their respective municipalities. (Including out-of-prefecture residents)
Proportions shown to the first decimal point might not add up to 100% due to rounding off.
● Those who have not undergone the examination may be examined either inside or outside Fukushima Prefecture.
● Age shown is the age as of March 11, 2011.

3. Initial examination results summary for FY 2011, 2012 and 2013
The results confirmed up to the June 7, 2013 examination date, are shown below. For results summary by municipalities, refer to the attachments.

【Summary sheet by assessment categories for thyroid examination (initial examination)  

Results confirmed up to the June 7, 2013, examination date.          (Unit: upper row-persons, bottom row-%)
※1 The number of results confirmed, "b," denotes the number of subjects examined at examination facilities either inside or outside Fukushima Prefecture, whose results were confirmed.
 ① Explanation of the assessment categories
   (i)   Assessment A: (A1) No nodules or cysts.
                                   (A2) Nodules 5.0 mm or smaller, or cysts 20.0 mm or smaller.
   (ii)  Assessment B: Nodules 5.1 mm or larger, or cysts 20.1 mm or larger.
   (iii) Assessment C: The condition of the thyroid gland warrants an immediate secondary examination.
② Explanation of assessment results
(i) A1 and A2 will be under observation until the next round of examination beginning in FY2015.
(ii) B and C will undergo secondary examination.
(iii) Some A2 cases might be considered B if the condition of the thyroid gland warrants secondary examination.
Proportions shown to the first decimal point might not add up to 100% due to rounding off.
4. Secondary examination
(1) Implementation status
When lumps (nodular lesions) etc. have been found in the initial thyroid ultrasound examination, secondary examinations will be conducted at Fukushima Medical University, including detailed ultrasound, blood and urine tests, and biopsy if needed).
As of June 2013, the secondary examination is being conducted by three physicians per day instead of two.
Also, in addition to Fukushima Medical University, Hoshi General Hospital in Koriyama City and Fukushima Rousai Hospital in Iwaki City began secondary examination on July 24 and July 26, 2013, respectively.

Implementation status table for thyroid examination (secondary examination)

FY2013 target municipalities

FY2012 target municipalities


FY2011 target municipalities

FY2011-2013 municipalities grand total
※1   "a" denotes a total number of subjects who were examined by July 31, 2013, at examination facilities either inside or outside Fukushima Prefecture.
※2   "h" does not include the subjects who have not received the examination results for blood and urine tests and biopsy.
※3   "i" and "j" will be followed up in the full-scale examination beginning in April 2014.
※4   "k" denotes subjects who will be followed up in approximately 6 months to one year using regular health insurance.
● FY2013 results are not shown by municipalities as only a few subjects underwent the secondary examination.
Proportions shown to the first decimal point might not add up to 100% due to rounding off.
● Secondary examination requires multiple visits, as blood and urine tests are conducted first and the results reported at a later date.

   (2) Number of new patients per month
Trend of the number of new patients for secondary examination which began in March 2012 is shown below.

(3) Summary of results
 ① Results of cytological examination

② Age and gender distribution of 44 cases confirmed or suspected of cancer by cytological examination. (As of July 31, 2013)




※1  FT4: thyroid hormone with four iodine atoms; high in Basedow's (Graves') disease and low in Hashimoto's disease.
※2  FT3: thyroid hormone with three iodine atoms; high in Basedow's (Graves') disease and low in Hashimoto's disease.
※3  TSH: hormone secreted by the pituitary gland, which orders the thyroid gland to release thyroid hormones; high in Hashimoto's disease and low in Basedow's (Graves')  disease.
※4  Tg (thyroglobulin): substance used by the thyroid gland to produce thyroid hormones.  Present in the thyroid gland in a large quantity.  High levels indicate destruction of the thyroid gland or overproduction by tumor.
※5  TgAb (anti-thyroglobulin antibody): autoantibody against thyroglobulin; high in Hashimoto's disease or Basedow's (Graves') disease.
※6  TPOAb: autoantibody against an enzyme called peroxidase; high in Hashimoto's disease or Basedow's (Graves') disease.

④ Secondary examination results by municipalities, for in-prefecture examination (as of July 31, 2013)

FY2012 secondary examination results by municipalities for in-prefecture examination
※1  Initial examination subjects include both in-prefecture and out-of-prefecture examinees.
Those who require urgent clinical assessments will be given priorities for secondary examinations.  

FY2011 secondary examination results by municipalities for in-prefecture examination
※1  Initial examination subjects include both in-prefecture and out-of-prefecture examinees.
※2  Does not include the case that was suspected of cancer after biopsy, which turned out to be a benign nodule after surgery.
※3  Other includes subjects from outside the municipalities designated as the evacuation zone by the government but underwent thyroid ultrasound examination at schools.


(Attachment)

FY2013 thyroid examination results summary for five municipalities (as of July 31, 2013)

FY2012 thyroid examination results summary (as of July 31, 2013)

FY2011 thyroid examination results summary (as of July 31, 2013)
































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