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The cause of itai-itai disease was determined to be cadmium poisoning in the drinking water from the Jinzugawa River basin. The source of cadmium was discovered to be from Mitsui Mining and Smelting Company. Mitsui Mining began to discharge cadmium into the Jinzugawa River in 1910.
Fluoride added to water and dental products is another trigger for AITD. Furthermore, like chloride and lithium, fluoride is able to displace iodine, contributing to hypothyroidism. Mercury and nickel have been found to trigger autoimmune thyroid disorders and other autoimmune disorders such as systemic lupus.