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Modeled nitrate levels in well water supplies and prevalence of abnormal thyroid conditions among the Old Order Amish in Pennsylvania

Briseis Aschebrook-Kilfoy129, Sonya L Heltshe3, John R Nuckols4, Mona M Sabra5, Alan R Shuldiner67, Braxton D Mitchell6, Matt Airola8, Theodore R Holford2, Yawei Zhang2 and Mary H Ward1*

Author Affiliations

1 Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA

2 Yale School of Public Health, Yale University, New Haven, Connecticut, USA

3 Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA

4 Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA

5 Endocrine Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

6 Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

7 Geriatrics Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, MD, USA

8 Westat, Rockville, MD, USA

9 Department of Health Studies, University of Chicago, Chicago, IL, USA

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Environmental Health 2012, 11:6  doi:10.1186/1476-069X-11-6

Published: 17 February 2012



Nitrate is a widespread contaminant of drinking water supplies, especially in agricultural areas. Nitrate intake from drinking water and dietary sources can interfere with the uptake of iodide by the thyroid, thus potentially impacting thyroid function.


We assessed the relation of estimated nitrate levels in well water supplies with thyroid health in a cohort of 2,543 Old Order Amish residing in Lancaster, Chester, and Lebanon counties in Pennsylvania for whom thyroid stimulating hormone (TSH) levels were measured during 1995-2008. Nitrate measurement data (1976-2006) for 3,613 wells in the study area were obtained from the U.S. Geological Survey and we used these data to estimate concentrations at study participants' residences using a standard linear mixed effects model that included hydrogeological covariates and kriging of the wells' residuals. Nitrate levels estimated by the model ranged from 0.35 mg/L to 16.4 mg/L N-NO3-, with a median value of 6.5 mg/L, which was used as the cutpoint to define high and low nitrate exposure. In a validation analysis of the model, we calculated that the sensitivity of the model was 67% and the specificity was 93%. TSH levels were used to define the following outcomes: clinical hyperthyroidism (n = 10), clinical hypothyroidism (n = 56), subclinical hyperthyroidism (n = 25), and subclinical hypothyroidism (n = 228).


In women, high nitrate exposure was significantly associated with subclinical hypothyroidism (OR = 1.60; 95% CI: 1.11-2.32). Nitrate was not associated with subclinical thyroid disease in men or with clinical thyroid disease in men or women.


Although these data do not provide strong support for an association between nitrate in drinking water and thyroid health, our results do suggest that further exploration of this hypothesis is warranted using studies that incorporate individual measures of both dietary and drinking water nitrate intake.

Nitrate; Thyroid Conditions; TSH; Old Order Amish; Water pollution; Drinking water