Introduction Episode 2: It's the Fall of Rome all over again. If they had only had a Community-Based Research Group and access to blood and water testing... The globe has become polluted to such an extent that industrial contaminants can be found in the air, soil, water and food supplies. Many contaminants can be inhaled or absorbed through the skin. Polyfluoroalkyl Substances (PFAS) represent 15,000 different variation of chemical compounds with known health effects including abnormal laboratory tests (liver enzymes and cholesterol) and cancers. The fear-mongering media has dubbed these "forever chemicals" because the original PFOS (with 8 carbons) took over 27 years to eliminate from the body. Current versions may take over 8 years be eliminated from the body. The region surrounding Springfield, MO contains PFAS in the water supply due to ongoing industrial contamination. A trend was noticed at a busy psychiatric urgent care in Springfield, MO whereby it seemed to staff that healthy people had low Vitamin D, thyroid dysfunction, and abnormal lipids. In the majority of cases, these were the only medical problems these people had. The rates of abnormal labs and medications/supplements for Vitamin D, thyroid dysfunction and dyslipidemia in this vulnerable population are reported here. Methods Chart reviews were conducted for patients attending a psychiatric urgent care in Springfield, MO in July 2024. Inclusion criteria was having had a full panel of laboratory studies within the previous 18 months. Labs had to include a Vitamin D level, full lipid panel and full thyroid panel with at least TSH, T4 (conjucated/unconjucated), and T3 . Exclusion criteria were patients missing laboratory studies for either Vitamin D, lipid panel or thyroid panel. Age, gender, number of medical diagnoses, vitamin D supplement usage, TSH, T4 (or free T4), T3, total cholesterol, triglycerides, HDL, calculated VLDL, calculated HDL, and statin use were studied. Results Twenty-six patients were included in this study (n=26). Ages ranged from 8-68. Thirty-eight percent were male and 62% were female which is typical in outpatient psychiatric practice. Out of nine total lab tests, seven labs were above the expected 5% outliers of the reference range (Table 1). Over 73% of patients had elevated calculated LDL, 46.2% had abnormal total cholesterol, 38.5% had low Vitamin D, 30.8% had abnormal TSH values, 19.2% had low HDL, 15.4% had elevated triglycerides, and 7.7% had abnormal T3 triiodothyronine values. Thyroxine (T4) and calculated VLDL were the only tests that had less than the 5% of patients with abnormal results. Table 1: Number of patients with and without abnormal labs. Ratios and percentages are calculated. Percentages of patients with abnormal labs over the expected 5% are highlighted in green. Discussion Bioaccumulation of pollutants is known to cause endocrine disruption. Early detection of bioaccumulation is important for medical surveillance efforts to understand the scope of the problem, further identify at-risk populations, and contribute to reducing the current cancer epidemic. This study demonstrated the need for further research in epidemiologic studies, hazard identification, mitigation of pollutants, education for the public and researching detoxification outcomes. Limitations of this study include low sample size, lack of controls for medical problems and medications (except for Vitamin D supplementation which was studied). REFERENCES Guidance on PFAS Exposure, Testing and Clinical Follow-Up, Consensus Study Report, National Academies Press. 2022. Nationalacademies.org Toxicants in Food Packaging and Household Plastics: Exposure and Health Risks to Consumers, Suzanne M. Snedeker, Editor, Humana Press 2014. Tittlemier, S. A., et al. (2007). "Dietary Exposure of Canadians to Perfluorinated Carboxylates and Perfluorooctane Sulfonate via Consumption of Meat, Fish, Fast Foods,
