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UVa-Wise junior researches thyroid disorders in Appalachia


Maddison Couch, a junior at The University of Virginia’s College at Wise, spent last summer researching thyroid disorders in the Central Appalachia after both her grandmother and mother were diagnosed with thyroid-related syndromes. 

What her research revealed was that the region is a “hotspot” for many thyroid disorders, and it appears a naturally occurring compound could be the cause. Couch, under the guidance of Professor Wally Smith, has found that a compound that is naturally found in coal deposits could seep into water sources, especially private wells, and could trigger the thyroid disorders. 

According to Couch, the region has a higher than average rate for hypo- and hyperthyroidism, thyroid cancer, and goiter (enlarged thyroid). She said the high incidence of goiter in Appalachia is of particular interest since the region has a sufficient level of iodine and presently lacks any known environmental cause. 

“My mother and grandmother had the same pathologist, and I asked her about it,” Couch said. “It turns out that that no real research had been done in this area. I was very curious about what was causing it.” 

Couch, encouraged and assisted by Professor Smith, studied a report that touched on the high level of thyroid disorders in the region, but it failed to mention any soil testing. 

“Over the summer, I went to 45 sites in the region,” she said. “I checked 15 from disturbed land and 15 from undisturbed land, and I tested 15 sites from outside the coalfield region.” 

Couch was specifically looking to determine the potential role of chemical compounds present in the environment as goitrogens, or compounds that can act to induce abnormalities in thyroid tissue that may lead to thyroid disorders. She said one class of compounds, phenols, has been shown to exhibit goitrogenic. Phenols contain a hydroxyl group bonded directly to an aromatic hydrocarbon group. Phenolic compounds may be widely substituted and vary in function in natural systems, yet a wide variety of goitrogenic phenols have been extracted from coal-bearing strata, such as those found in central Appalachia. 

According to Couch, this information has led researchers to hypothesize that goitrogenic phenols may be present in Appalachian surface and groundwater and therefore serve as an environmental cause of Appalachia’s goiter hotspot, particularly for those residents who rely on private water supplies such as wells, cisterns, or piped springs. 

Couch’s testing revealed a high level of the compound in both disturbed and undisturbed land in the coalfield region. She found smaller amounts in the land outside of the region. 

“It was what we expected to find,” she said. 

In order to get more information for her research, Couch worked with the Cytopathology in Johnson City on a survey of thyroid disorder patients who live in the region. She asked the participants about their water sources, family history of thyroid problems, and a variety of related questions. 

“My next step is to research both well water and public water to find out is there is a pattern,” she said. “There is something that is keeping it in our area. Hopefully, we can find it.” 

Couch, a Healthy Appalachia Fellow, recently presented her research on campus. She is also planning to present her work at other conferences in the region. She hopes her research will lead to more intensive research into the status and/or role of phenolic compounds in private water supplies as a source of Appalachia’s thyroid disorder hotspot. She also credited Smith guidance as vital to her research. 

The Wise resident has plans to attend medical school after she graduates from UVa-Wise.