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Environmental Medicine Integrating a Missing Element into Medical Education (1995) / Chapter Skim
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Case Study 18: Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis
Pages 402-409

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From page 402...
... We suggest that increased bone turnover accompanying thyrotoxicosis led to clinically significant lead poisoning in this patient, due to mobilization of accumulated bone lead stores acquired many years earlier. This phenomenon raises the general issue of more subtle forms of lead exposure from increased bone turnover states (e.g., osteoporosis)
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From page 403...
... We describe the presentation, evaluation, and treatment of a patient with lead poisoning, no identifiable ongoing lead exposure, high skeletal lead as noted by K-X-ray fluorescence (K-XRF, an in vivo method of accurately quantitating bone stores) , and marked hyperthyroidism.
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From page 404...
... DISCUSSION This case is important because it demonstrates lead poisoning in the absence of an ongoing source of external lead exposure in a hyperthyroid patient, detects elevated bone lead stores through K-X-ray fluorescence, demonstrates increased bone turnover through elevated serum osteocalcin levels, and documents a decline in blood lead without the use of chelating agents as hyperthyroidism and bone turnover come under control. This patient's bone lead levels were very high.
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From page 405...
... The Centers for Disease Control has established 0.48 ,umol/1 (10 ,ug/dl) as the tolerable upper limit for lead in a child's blood, whereas the Occupational Safety and Health Administration does not allow a worker to return to work until his/her blood lead level is below 1.93 ,umol/1 (40 ~g/dl)
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From page 406...
... We believe that the patient's high blood lead levels resulted from increased bone turnover and mobilization of her bone lead stores due to hyperthyroidism. Thyroxine and triiodothyronine stimulate osteoclastic activity and bone resorption, although their precise mode of action is unknown [Mundy, 1990~.
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From page 407...
... Given the toxic potential of bone lead stores demonstrated by this case study, the continued lowering of the amount of lead exposure that has been associated with significant health effects in recent research, and the continued widespread nature of lead exposure in the U.S.
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From page 408...
... Burger DE (1990) : X-ray fluorescence measurements of lead burden in subjects with low-level community lead exposures.
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From page 409...
... (1992) : Residual cognitive deficits 50 years after lead poisoning during childhood.
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Key Terms

  • bone lead
  • lead exposure
  • lead poisoning
  • bone turnover
  • lead levels

  • increased bone
  • lead stores
  • serum osteocalcin
  • lead level
  • bone mineral

  • bone stores
  • manual motor
  • chelating agents
  • patella bone
  • environmental medicine

  • childhood lead
  • neuropsychological symptoms
  • elevated blood
  • markedly elevated
  • deficits seen

  • cognitive tracking
  • visuospatial tasks
  • motor deficits
  • osteocalcin level
  • ongoing lead

  • lead burden
  • occupational safety
  • elevated bone
  • occupational health
  • harvard school


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