Mykola Tronko, director of the Endocrinology and Metabolism Institute of Ukraine’s National Academy of Sciences, was recently decorated in Japan with the international peace memorial medal named after Dr. Nagai, who suffered from the 1945 nuclear apocalypse in Hiroshima and Nagasaki, and a commemorative award statue. An independent expert commission chose the Kyiv academic as winner from among six contenders. He is the first Ukrainian researcher to be granted one of Japan’s highest awards in radiation medicine for a major contribution to studying the effect of the Chornobyl disaster on the thyroid gland.
Whoever does things fast doubles the result – it is the work style of Mykola TRONKO, Corresponding Member of Ukraine’s National Academy of Sciences, Full Member of Ukraine’s Academy of Medical Sciences, winner of the State Prize in Science and Technology and Oleksandr Bohomolets and Vasyl Komisarenko academic prizes. As one of the leading and highly experienced associates at the institute, Tronko was chosen to head it in March 1986, just on the eve of a reactor explosion at the Chornobyl Nuclear Power Plant. It is Vasyl Komisarenko, the founder and first director of the Kyiv-based vanguard of endocrinology, after whom the institute was named later, who put forward the candidature of him, his brilliant pupil, to this responsible post. And he was not mistaken. They worked shoulder to shoulder for another seven years or so, but it is Tronko who was destined to organize the repulsion of radioactive attacks on the thyroid gland in thousands of people.
“The thyroid gland, which weighs 40-50 g, is an endocrinal organ of paramount biological importance,” Prof. Tronko says. “It is an iodine laboratory for the body: the two hormones that comprise this element and coordinate a number of physiological and biochemical cascades in body are produced in its tissue. But it is also the absorbent of iodine and its radioactive varieties which represent an oncologic danger, and there was such an enormous emission of them and other radionuclides from the reactor that they rushed to the critical little island of viability regulation. This posed a tremendous threat for children and teenagers. Their thyroid is extremely active and vulnerable to radioactive iodine.”
On the outside, at a distance from what happened in Prypiat, all looked calm, the spring was in full swing, but you, Mr. Tronko, were clearly aware of the fast-growing risks. What was done?
“To begin with, the institute had also dealt – quite naturally – with some cases of thyroid cancer before, and their number was gradually on the rise,” my interlocutor reflected, “but the new situation did not rule out an abrupt growth of such attacks. I must say that the institute enjoyed high prestige, so it was immediately chosen as No.1 establishment for the post-Chornobyl problems of thyroid lesions in Ukraine, Belarus, and the affected areas of Russia. We also intensified international contacts. Yet the situation required a go-ahead tactic. The institute’s traveling teams surveyed the most affected areas of Kyiv, Chernihiv, Zhytomyr, Rivne, and Cherkasy oblast, putting emphasis on children. More than 500 toddlers were examined at the institute’s clinic – we thought it would thus be a children’s facility. But, looking into the future, we understood that we needed comparative data for thyroid behavior – before and after Chornobyl. This caused the institute to open – still before 1992 – a unique register of children and teenagers with oncological lesions of the thyroid gland. There are 4,065 people on the list now. The main conclusion, in medical terms, was that cases of radio-induced thyroid cancer in this age group were occurring more and more often. Their incidence has increased more than three- to fivefold in comparison with the previous, pre-Chornobyl, level. This means there was also a need in a well-echeloned counterattack: a diagnostic plan, surgeries, and post-operation treatment. What is more, the children who had been fewer than four years old by the moment of the disaster accounted for the bulk – about 70 percent – of all the diagnostic and healing efforts. This was sort of a peak of research. In a word, it looked like there was a war. Meanwhile, the first wave of radiation in fact rebounded among the individuals who were children and teenagers at the moment of the disaster and ran the highest risk of contracting thyroid cancer.”
But let us switch to the decisive medical steps which also touched, naturally, these involuntary victims of Chornobyl.
“It was clear that it was necessary to radically change and expand ultrasonic diagnosing of the thyroid gland. The institute began to receive new state-of-the-art equipment, which conducive to a higher skill of specialists in this field. But screening and purposeful elimination was also impossible without another fundamental point – cytological specification of the tumor’s properties and tendencies towards malignity. So the departments that dealt with these diagnostics learned in a short period of time to do fine-needle biopsy of the gland’s tissue and carry out a high-skilled examination of the biological material because these conclusions prompt the further tactic of treating patients. The institute became the leading line, if you like, in this case, too.”
The full cycle of the radical care of these patients comprises mandatory surgery and a subsequent radioiodine course. What about these stages?
“I’d like to emphasize that our institute is perhaps Ukraine’s only facility with a closed diagnosis-cum-treatment cycle from the pre-surgery diagnosing of thyroid cancer to radiotherapy. The institute’s surgery clinics on Shevchenko Square have performed operations on 1,544 patients with this diagnosis of tumors. The efficacy – with five-year survivability and practical recovery – exceeds 98 percent. Naturally, everything is rather complicated in each concrete case. The globally recognized scientific goal is as full excision of the thyroid gland as possible, which prevents metastasizing. But one must not catch on parathyroid glands. Naturally, this involves intricate virtuoso-style surgery in an area full of vessels and nerves. The art of surgeons and new surgical approaches have allowed reducing such complications as paresis of the larynx and hypothyroidism by several times. This ensures a proper quality of life for patients against the backdrop of a further radioiodine therapy course.”
The institute’s innovations arouse great interest in the scientific world. Tellingly, you twice delivered reports on post-Chornobyl thyroid problems in 2006 and 2007 at international conferences held in the UN headquarters in New York. Far from all academics and institutions are honored with invitations like this.
“Indeed, our scientific achievements are much in demand. We cooperate purposefully and actively with the leading research institutions of the US, Japan, the UK, and Germany, as well as with such international organizations as the WHO and UNICEF. On the whole, the incidence of the abovementioned diseases gradually wanes with age. So we were not late. But improving the criteria of early diagnosis by means of molecular-level markers remains a topical problem. We continue joint work with a number of high-profile institutes. I also work eagerly on these aspects because this, in conjunction with other duties and projects, is the basic field of activities for me as an endocrinologist.”
I think this heroic symphony contains some absolutely striking achievements: 158 young women from what was recently a small town of Mavky Polissia, who had a thyroid oncological problem, became mothers contrary to all predictions and have one or two kids. The institute has in fact gifted them happiness by pulling them out of a major woe by means of purposeful diagnosis and treatment.
“Well, this is clear and I would say inspiring proof that what we have done was not in vain. But, at the same time, intensive work continues: the institute annually carries out about 10,000 ultrasonic examinations of the thyroid gland and 2,000 fine-needle biopsies, performs more than 1,000 operations on endocrinal glands. Diagnosing thyroid pathology and, first of all, thyroid cancer is on a high scientific level.”
I step out of the institute’s building and look again at the commemorative plaque to see the kind face of Vasyl Komisarenko who laid the groundwork for this establishment. This scientific school was up to the mark in the hard times of salvation from radiation arrows. Mykola Tronko and the staff of the institute he runs have put up an incomparable shield of life to protect people, first of all, children and youngsters of Ukraine, when their little endocrinal organ suddenly turned into a cutting sword.
