（五）铅
人体可以通过呼吸系统或消化系统摄取环境和食物中的铅。在美国和其他发达国家，摄入铅漆芯片仍然是儿童暴露的主要来源。在许多行业的工人，包括采矿、冶炼、精炼、电池制造、焊接、电气布线和陶瓷玻璃存在高铅水平的职业暴露[39]。
职业研究表明在中度至高度铅作业工人存在外周T4水平下降伴有血清TSH浓度不适当的降低，提示可能导致继发性甲状腺功能减退症。对54名高铅暴露的黄铜铸造工人研究显示，血清T4和FT4水平偏低，TSH浓度正常。研究表明，长期低水平铅暴露的男性青少年血铅水平和FT4呈负相关，血清TSH、T3、甲状腺体积较对照组均没有显著差异[40]。在一项针对58名男性加油站的服务员（平均血铅水平52μg/dL）的研究显示，血清TSH水平明显高于对照组，但T3、T4水平没有差异。一项长达10年的针对151名男性铅冶炼厂工人的研究证明，中度铅暴露对甲状腺没有任何影响。
国内一项针对以铅作业人员为样本的研究显示，当血铅高于2.88μmol/L时，血T3、FT3的含量均低于中、低浓度血铅者，表明血铅达到一定的浓度时会损害甲状腺细胞，抑制其分泌功能。高血铅浓度抑制了T4的脱碘，导致血T3浓度较低，同时，高血铅浓度也可抑制T4的合成，从而降低血中T4浓度。由于T3、T4浓度下降，反馈抑制HPT的作用减弱，导致血清TSH增高[41]。
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