PATIENT No. 21 (continued) We plan on discharging her on this regimen, with the recommendation that she be readmitted in January, 1965, for another attempt to wean her from medications, or at least reduce the amounts of medications necessary. Regarding the microscopic studies of the removed thyroid gland, here is a summary. Our pathologist considered the slides positive for malignancy, but desired confirmation from the AFIP. The report from AFIP, however, though acknowledging the presence of some "bizarre fields on high power examination," concluded that the diagnosis was "nodular, adenomatoid goiter, thyroid gland." The report was signed by G. H. Klinck. Follow-Up: Following discharge the patient was careless about her treatment regimen and had an episode of tetany a few months later. She then began seriously taking her medication and remained asymptomatic until March, 1965, when she developed swelling of the right knee suggestive of rheumatic fever. She was hospitalized for several days and responded well to salicylates. She has since remained asymptomatic. In March, 1966, the Trousseau was negative, but the Chvostek was positive. At that time she was taken off thyroid hormone for several weeks (temporarily for test purposes),and her TSH was quite high (440 mug/ml) and an 327 uptake study showed no uptake, both results proof of completeness of thyroid- “a ectomy. She has maintained euthyroid and euparathyroid states on levothyroxine 3 mg daily and vitamin D 50,000 units daily. thyroid nodules. PATIENT NO. 69 AGE SEX 14 F She has shown no recurrence of HOSPITAL U.S. Naval Hospital, Guam DATE October, 1964 This 14 year old Micronesian female received radioactive fallout on the Island of Rongelap Atoll in 1954. After recovery from the beta burns and the blood element depression, all of which required several months, the child was well until examination in 1964 revealed several nodules in the thyroid gland. The patient was referred here as had two other girls with similar problems in recent months. These other two girls had undergone total thyroidectomy for what appeared at operation to be diffuse thyroid carcinomatous degeneration, but final pathologic studies by the AFIP yielded a diagnosis of benign multinodular goiter in each case, The child's preoperative work-up was within the limits of normal except for the nodules in each lobe of the thyroid and acutely inflamed tonsils. The child was therefore placed on warm saline gargles, procaine, penicillin and forced fluids from 10-12-64 until she was ready for thyroid surgery on 10-20-64. Thyroidectomy was performed on 10-20-64, with removal of the entire right lobe, the isthmus, and the medial one-half of the left lobe. The portion of the left lobe and superior pole that were left were relatively uninvolved with the nodular process that permeated the rest of the thyroid. It is of interest that a nodule overlying the trachea in the region of the so-called sentinal nodule was removed as a separate specimen prior to the thyroidectomy and sent to the laboratory for examination. The nodule was thyroid tissue; yet there was absolutely no connection between this nodule and the rest of the thyroid, The patient's postoperative course was completely benign, with removal of sutures on the second postoperative =e 98