In addition, several exexposed individuals had T, increments of <1.5 ug/dl.
posed individuals with intact thyroid glands have periodically shown modest
TSH elevations. These observations stimulated attempts to evaluate residual
thyroid function in all exposed individuals (1,36).
B.

Methods
1.

Thyroid Examinations

Examinations included inspection, palpation, and auscultation of the

neck and thyroid gland; notation of any clinical signs of thyroid dysfunction;
quantitative assays of serum iodine, thyroid hormones, and iodoproteins; and

special studies of thyroid function as described below.
Suspected nodules
were examined by other team physicians for confirmation and were recorded by
description and full-scale drawings.
Some nodules were so indistinct on ini-

tial examination that they were not evaluated further at the time but received
special attention on subsequent surveys, often by the same physicians utiliz-

ing the medical records and annotated drawings as a basis for comparison.
Since, in most cases, a diagnosis could not be firmly established without histopathologic evaluation, surgical exploration was usually recommended
for patients with clinically suspicious findings.
Age and general health sta-

tus of these patients were important considerations in view of travel require-

ments.
Surgery was sometimes deferred because of poor health and/or old age,
favorable response of thyroid nodules to thyroxine therapy, or unavailability
of the individual for close followup examinations.
Those consenting to surgery were generally admitted to hospitals in the United States after initial
evaluation at Brookhaven National Laboratory Medical Research Center.
Preoperative thyroid studies included iodine uptake, scans, and determination of thy-

roid hormone and autoantibody levels.

Aside from a few cases at Tripler Army

Hospital in Honolulu, surgical procedures during the past decade were performed exclusively at Cleveland Metropolitan General Hospital.

2.

Pathologic Evaluation

All excised tissues were examined by the pathologists associated with
each hospital where surgery was performed.
In the past these have also included U.S. Naval Hospital, Guam; Ishoda Memorial Hospital, Majuro; and New
England Deaconness Hospital, Boston.
In addition to gross and microscopic
pathologic evaluations, selected slides from each specimen were referred for

review to a number of pathologists who had special expertise in diseases of
the thyroid.* Working diagnoses for individual patients were assigned on the

basis of evaluations obtained from all these sources at the time.

*Drs. S. Warren (deceased), W.A. Meissner, and M. Legg (New England Deaconness
Hospital, Boston, MA); J.D.

Reid and M.

Petrelli (Cleveland Metropolitan Gen-

eral Hospital); J. Oertel (Armed Forces Institute of Pathology, Walter Reed

Army Medical Center, Washington, DC); L.B. Woolner (Mayo Clinic, Rochester,
MN); A.L. Vickery (Massachusetts General Hospital, Boston); L.V. Ackerman

(S.U.N.Y. Stony Brook, NY); W. Hawk (Cleveland Clinic, Cleveland, OH); and

D.

Slatkin

(BNL).

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