ne 23.
48g"
Vol. 274
PRIVACY ACT MATERIAL REMOVED
No. 25
RADIOACTIVE FALLOUE-CONARD RE AL.
a
\
.
thyroid autoantibodies were present in a ter under 1:16, A
thyroid scan showed a large “cold” nodule replacing the
lower pale of the right lobe of the gland. X-ray examination
af the chest aid bones wave no evidence of metastatic le-
AREER
sions. A ostudy of thyroid uptake with [' showed a G-hour
vue of 22.3) per cent, with urinary excretion of 33> per
RET NEG
to RO
cent. After Weatment with TSH, 10 units daily for 3 days,
53.8
60.0
0.0
0.0
7,7
tvreid: uptake had increased to 33 per cent, and the proieil- sound tedine was 8.00 intcrogm. per LOU mil. Hematologic studies were not contributory,
inmnation and
within normal
‘A subtotal thyroidectomy, leaving a small portion of the
left lobe, wis carried owt, Tt was reported that 2 nodules,
cach approximately To cm, m diameter, were present, and the
pathological cliugnosis was “mixed papillary and follicudar
aarcinema of right lobe, with bload-vessel invasion and mestasis too fo dymph node and normal right’ parathyroid
diagnosis was
gland: (the left lobe of the thyroid gland shows no significant
changes).
.
Recovery from the operation was uneventful. Fhe patient
vas hen given JO units of TSH daily for 3 days, and on the
in September,
ed,
issuc. Phe subsequent course has been uneventful, and
reatment with devothyroxine was started in August, 1965,
moved ut the
tiple nodules
Wits ex.
cery from: the
ly good health,
protein-bound
mired with unhid shown a
int hropametric
dismeter, was
eowits taken to
ad later to the
iwraicl work-up
tion of serum
oprotein of L4
rogm. per 100
the cholesterol
1 the esterified
cent: a thyroid
wer right lobe:
Wouptake in 6
moat dual time.
the uptake at 6
cretion of 184
Lime was about
if the chest and
mic stuctics were
tirining multiple
in size up (oe
and pulpy and
soitler,
WOKE,
Was ex
covery: Prom i
health, wih
y children, 4 of
hus apparendy
xline in
March.
the Marshallese)
my. per 100 ml.
t not tender, *#
db planed. No lym
nto Brookhaven
the New Fugla
qth
fay, 300 me. of Po ta destroy the remaining thyroid
Gross Appearance of the Thyroid Glands
In all 5 children operated upon (Cases 1-5) the
multinodular character of the glands was notable at
surgery although on prior clinical examination, the
nodules had appeared to be solitary. The nodules
varied in size from 1 mm. to several centimeters, in
con stence from fluctuant to relatively hard and in
colo; from pale gray to pink to red; cyst formation
was present in many, and some had hemorrhagic
aeas. Figure | shows the gross appearance at operation in Case 1. In the patient with carcinoma (Case
6} the gland cid not show the same degree of nodu-
larity, except for the presence of 2 firm, yellow nodWes about 1 em. in diameter (Fig. 2).
Wicroscopical Appearance
Tle microscopical appearance of all the benign
modular glands
ver LOG mi. t
(in the csteruk”
vas S27 per cent
was characteristic of adenomatoid
gcoiter and varied mainly in the degree of change.
The architecture of the gland was disrupted by the
Wdules of widely varying sizes, some: containing
microfoHicular elements with and without colloid:
thers were atrophic, some contained large cysts
sith colloid, some with hemorrhage, andstill others
howed extensive proliferation of the epithelial lay‘Ss with marked infolding, giving an “arboreal”
Spe trance. Figure 1 indicates some of the changes.
The tumor in Case 6 showing papillary andfollicar carcinoma, with invasion of bloed vessels and
‘lymph node, is demonstrated in Figure 2.
Thyroid Abnormality In Boys Showing Retarded Growth
Two twelve-year-old boys (.
_*, who
‘ad been exposed at fifteen andeighteen months of
%e respectively, have had the greatest retardation
up revealed t
mation dhe (ol "growth
bow in no
fraction 1.5 mt
Abomicrognn, 4
Adoeee ae
eee
t ineluctec!
boy,
1395
and development. |
(Fig. 3) has
change in bone maturation since 1961
ad ut present has a bone age of that of a threefa-old child. The bone age of A.B. has showed
Atinuing slow growth and in 1965 was five and a
Froure 1. Benign ddenamatondThyroid Nadules ina Fourteen-YearOld Gal ;
The gross specimen af the sectioned gland (A) tidicates the nodular
character, The microscopical section (BY shows wide variations in follicle sizes (original magatpeation X {4}: sowie are vmall and atraphic,
end athers are large and cystic, The nodule at the upper right shows
Ayperplasia, with pajallary tnfoldarz of epithelium,
half vears. Both these boys in 1965 have the height
of normal seven-vear-old) Marshallese bovs. Their
dwarfism has been particularly marked in) comparison with younger siblings who noware taller than
they are (Fig. 3).2 During the past vear in both
cases the levels of protein-bound todine have
dropped below 2 microgm. per 100 ml. Before that
time they had levels in the normal range, and they
had heen considered to be euthyroid. They now
have definite signs of hypothyroidism, with nonpalpable thyroid glands, and Achilles reflexes with the
typical slugvish return, These boys do not appear to
show mental retardation. TSH levels (in March,
1965) were elevated in both bovs (more than 120
and 119 millimicrogm. per milliliter), corroborating
the impression of primary hypothyroidism.* Other
exposed ‘male children in the fetarded group (but
“We are indebted to Dr, William Odetf*at ‘the Natiogal Institutes
of Heafth, for carrving out the TSH determinations.
:
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i,
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