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Thirteenth Prefectural Oversight Committee Meeting: Fukushima Thyroid Ultrasound Examination Results

The Proceedings of the Thirteenth Prefectural Oversight Committee Meeting for Fukushima Health Management Survey were released on November 12, 2013.  Below is the complete translation of the thyroid ultrasound examination.

Please refer to this post for the short summary.


Original Japanese document can be found here.

The official English translation is here.

Page 1

Implementation status of the "thyroid examination" in Fukushima Health Management Survey

1   Progress status and summary of the results

   (1) The primary examination
   The Fiscal Year 2013 examinations have been conducted, in approximately 158,000 participants from 34 municipalities, since April 22, 2013. In addition, participants from the previously targeted municipalities who have not been examined were encouraged to participate in the following ways: Letters have been sent to them, explaining the examination implementation outside Fukushima Prefecture or in other municipalities; and information about the examination has also been available on the website. As a result, more participants have been examined even after the end of the target year for their municipalities, and 82.4% of overall participants have been examined. ※1
   Moreover, thyroid examinations have been conducted in facilities outside Fukushima Prefecture since November 1, 2012. ※2
   Also, 94.5% of the 238,785 participants had their examination results confirmed and had them mailed. ※3,4

Progress status (as of September 30, 2013: Results have been confirmed for those examined up to August 23)


Number and proportion of nodules and cysts (as of September 30, 2013: Results have been confirmed for those examined up to August 23)
※1 Implementation status by municipality is shown in Supplement 1.
※2 Implementation status in prefectures other than Fukushima Prefecture is shown in Supplement 2.
※3 Results by municipality are shown in Supplement 3.
※4 Age and gender distribution of participants whose results have been confirmed is shown in Supplement 4.
● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down.

Page 2

   (2) The secondary examination
    Fukushima Medical University has been expanding the examination system, in an attempt to accelerate the implementation of the secondary examination. As a result, 73.6% of the 1,559 participants eligible for the secondary examination actually went through it, and 78.1% of them have completed it. ※5
    Also, in addition to Fukushima Medical University, two other medical facilities in Koriyama City and Iwaki City have been conducting the secondary examination since late July.
    Furthermore, out-of-prefecture facilities plan on conducting the secondary examination beginning in November 2013.

Progress status (as of September 30, 2013)

※5 Implementation status by municipalities is shown in Supplement 5.
● Priorities are given to those with urgent clinical needs.
● Regular follow-up examination, beginning April 2014, applies to those who were confirmed to be within the normal range (A1,A2) of the primary examination.
● Regular medical care applies to those who would need a close monitoring in about 6 months to 1 year (using national health insurance) and those who are confirmed to be beyond the normal range of A2.



Page 3
2  Summary of the fine-needle aspiration biopsy results
   (1) Results of biopsy (as of September 30, 2013)



Addendum dated November 14, found here, states, "As for one of the 26 papillary cancer cases, its histologic type is currently under close investigation."

   (2) Age and gender distribution of the 59 cases confirmed or suspected of malignancy by biopsy (as of September 30, 2013; including the case post-surgically confirmed to be benign).



Page 4

   (3) Results of the basic survey for the 59 cases confirmed or suspected of malignancy by biopsy, etc.
   21 (35.6%) of them submitted the basic survey questionnaire, and 12 (57.1%) of them were in the dose range below 1 mSv. The meaning and importance of the questionnaire will be explained to the rest of them in order to encourage them to turn it in.

Breakdown of the effective dose estimates by age and gender for those who submitted the basic survey


   (4) Blood tests and urinary iodine (as of September 30, 2013)

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

Page 5

   (5) Results of the secondary examination by municipality (as of September 30, 2013)

FY 2011 secondary examination results by municipality (13 municipalities nationally designated as the evacuation zones) 

※1 Does not include the case that was suspected of malignancy after biopsy but turned out to be benign after surgery.
※2 Includes subjects from outside the 13 municipalities nationally designated as the evacuation zones but underwent thyroid ultrasound examinations at schools and other locations.

FY 2012 secondary examination results by municipality (Iwaki City includes only some districts such as Hisanohama)


FY 2013 secondary examination results by municipality


Page 6
3   Implementation of the full-scale examination
   The thyroid examination conducted from October 2011 through March 2014, considered the "preliminary examination," will continue as the "full-scale examination" beginning April 2014.
   Summary of the current "preliminary examination" and the improved features in the "full-scale examination" are described below.
   From now on, in order to engage in the maintenance and promotion of participants' health, implementation plans will be established to ensure the smooth and reliable examination with cooperation from the examination facilities inside and outside Fukushima Prefecture, the concerned academic societies and the related organizations.

(1) Summary of the thyroid examination

A. Summary of the preliminary examination

Targeted subjects

Fukushima Prefecture residents who were generally 18 or under at the time of the Great East Earthquake, specifically including those who were born between April 2, 1982 and April 1, 2011.

The primary examination

The examination to assess the current status of thyroid gland (mainly the presence or absence as well as the size of cysts and nodules) using the ultrasound diagnostic equipment.

Assessment results

Assessment A: (A1) No nodules or cysts.
                          (A2) Nodules 5.0 mm or smaller or cysts 20.0 mm or smaller. 
Assessment B: Nodules 5.1 mm or larger or cysts 20.1 mm or larger.
                            Moreover, A2 will be upgraded to Assessment B if the condition of thyroid gland warrants the secondary examination.
Assessment C: The thyroid gland condition warranting the immediate secondary examination.

The secondary examination

The examination conducted on those in need of more detailed tests as a result of the primary examination. It consists of ultrasound examination, blood and urine tests, and fine-needle aspiration biopsy when needed.

(For information)

The regular follow-up examination
Beginning April 2014, the regular follow-up examination (full-scale examination) will continue every 2 years up to age 20 and every 5 years after age 20.
Regular medical care
・A re-examination is conducted, as close monitoring, generally in 6 months to 1 year.
・Consists of examinations and/or medical procedures (such as surgery).

B. Improved features for the full-scale examination

(a) Targeted subjects
   In addition to the targets subjects in the preliminary examination, those born between April 2, 2011 and April 1, 2012 are to be included, giving rise to a total targeted subjects of approximately 385,000.
(b) The implementation period
   All targeted subjects are to be examined in two years from April 2014 to March 2016.
After that, the examination is to be conducted, on a long term, every 2 years up to age 20 and every 5 years after age 20.
(c) The implementation facilities
   The primary and secondary examinations are to be conducted by the examination facilities inside and outside Fukushima Prefecture as well as Fukushima Medical University.
(d) The primary examination implementation system
   Non-school age children, college students and adults will be examined mostly at the examination facilities within Fukushima Prefecture (examinations at public facilities to be concurrently carried out until the examination system is fully established), and elementary, junior high and high school students will be examined at the traveling examinations at schools. Non-Fukushima residents are to be examined at the out-of-prefecture examination facilities.
(e) The secondary examination implementation system
   In order to facilitate the secondary examination and improve the convenience for the participants, efforts will be made towards appropriate examinations at the examination facilities within and outside Fukushima Prefecture as well as Fukushima Medical University.

Page 7 

(2) FY 2015 and FY 2016 examination schedule, proposed

4.   Simplification of the information disclosure procedure for detailed information about the thyroid examination

   In regards to the self request for information disclosure relating to the thyroid examination, 
an easier process has been established. From now on, it will be conducted as below.

   (1) For the identity confirmation, submission of an extract of the family register is no longer required. As a rule, a copy of the examination notification sent tom Fukushima Medical University or the examination result notification is to be used for identity confirmation.

   (2) Multiple steps previously carried out by the person requesting information disclosure will be, as a rule, completed in one step.
   (3) No fee will be charged for the information disclosed.

Details are to be posted on the home page of Radiation Medical Science Center for the Fukushima Health Management Survey at Fukushima Medical University , http://fukushima-mimamori.jp/.


Page 8

Supplement 1
Implementation status of the primary examination by municipality

FY 2011 target municipalities (The 13 municipalities nationally designated as evacuation zones) (as of September 30, 2013)


※1 The top row shows the number of examined participants, the middle row the progress rate in each age group, and the bottom row the proportion of the examined participants in each age group.
※2 The number of the out-of-prefecture residents who were examined during the in-prefecture examination, at the out-of-prefecture examination facilities or or the out-of-prefecture traveling examinations.
※3 The number of examinees who underwent thyroid examination at schools and other facilities outside the 13 municipalities nationally designated as evacuation zones.
● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down of individual number.
● Age shown is as of March 11, 2011.

Page 9

FY 2012 target municipalities (Iwaki City includes only some districts such as Hisanohama) (as of September 30, 2013)
● Participants examined at their current schools are categorized in municipalities where schools are located. At the completion of the preliminary examination, they will be recategorized in their municipalities of residence at the time of the accident.

FY2013 target municipalities (as of September 30, 2013)


Page 10

Supplement 2
Implementation status of the primary examination by prefecture
● The number of subjects examined includes those examined at out-of-prefecture examination facilities as well as the traveling examinations by Fukushima Medical University.
● The traveling examinations by Fukushima Medical University were conducted in Niigata Prefecture (twice), Yamagata Prefecture (twice) and Kanagawa Prefecture (once).

Page 11

Supplement 3
The results of the primary examination by municipality

FY 2011 target municipalities (The 13 municipalities nationally designated as evacuation zones) (as of September 30, 2013)

※1 The number of examinees who underwent the thyroid examination at schools and other facilities outside the 13 municipalities nationally designated as evacuation zones.
● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down of individual number.

Page 12

FY 2012 target municipalities (Iwaki City includes only some districts such as Hisanohama) (as of September 30, 2013)
● Participants examined at their current schools are categorized in municipalities where schools are located. At the completion of the preliminary examination, they will be recategorized in their municipalities of residence at the time of the accident.

Page 13

FY 2013 target municipalities (as of September 30, 2013)

Page 14

Supplement 4
1    Age and gender of participants whose examination results have been confirmed



● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down of individual number.
● Age shown is as of March 11, 2011.

Page 15

2   The presence/absence and the size of nodules

(as of September 30, 2013: Results have been confirmed for those examined up to August 23)






Page 16
3   The presence/absence and the size of cysts

(as of September 30, 2013: Results have been confirmed for those examined up to August 23)






Page 17
Supplement 5
Implementation status of the secondary examination by municipality

Progress rate (as of September 30, 2013)

FY 2011 target municipalities (The 13 municipalities nationally designated as evacuation zones)

FY 2012 target municipalities (Iwaki City includes only some districts such as Hisanohama)


FY 2013 target municipalities


※1 The number of examinees who underwent the thyroid examination at schools and other facilities outside the 13 municipalities nationally designated as evacuation zones.

● Proportions shown up to the first decimal point may not add up to 100% due to rounding up/down of individual number.
● Age shown is as of March 11, 2011.
● Participants examined at their current schools are categorized in the municipalities where schools are located. At the completion of the preliminary examination, they will be recategorized in their municipalities of residence at the time of the accident.

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