2 a ‘cl from scretion lations based Inv fron, OF deto. ntent of vcurics) cent) of | in the rads te am oral sotopes, cnergy evration thy raid vis then msidera: id) size? he main its being med that as adults of raciothe beta Iv harcer. dine isois. witha r of 1400 175 rads se calcus un ‘und was belie. ed this asea > most of . No, 2h & RADIOACTIVE t the exposed as compared with the unexposed papu- | The first G patients have been hospitalized and Jation. Determinations of basal metabolic rate were not done owing to difficulties of carrving ont the procedures under field) conditions. Dietary iodine has apparently been adequate. In 28 cases the mean have undergone surgery. These cases are briefly sumoriuized below. Their response to the radiation was similar to that outhned above, ind only specific differences-aire noted here. geASE REPORTS microgm. (ange, 19.5 to 279 microgin.). Cvsr | cil Fve:areola) Miushallese girl, was 0 vcus old when exposed to radioactive Callout, Her response to thts gwenty-four-hour urinary iodine excretion was LS In 1963, nine vears after the accident, a twelveyear-old) girl in the exposed) group was found to have a nodule of the thyroid gland. In 1964, 2 ad- ditional cases with thyroid nocdwes were found in exposed girls thirteen and fourteen vears old. In March, 1965, 3 additional cases in exposed people were noted in bevs thirteen and cighteen years of age and the ins first a adult, forty-one-year-old woman, In September, 1965, a further examination wa carried out, and 5 additional exposed people with nodules varving in size from 2 to & min. were found. One of these was a forty-five-vear-old womin in the vroup that received only an estimated 69 rads. In addition, there were 5 people in whom the thyroid gland appeared to be roughened or minima! nodularity was considered likely. These cases are not included in Table 1 because of the minimal nature of the physical findings. Table I tists the cases with thyroid abnormalities. Table 2 shows the ino -dence of thyroid .disease in the more heavily exposed group of 55 living Rongelap people as a hadiation was typical of the group. Chnically, she has re- manned, cuthyroid dhroughowt the period of observation: (in 1057 the cholesterol was P35 mg... and in 964 the proteinbound iadinge was 6.8 microgm. per Hh mb). In Mirch, 2963, she was found to tave a 2-cm. norten- der, firm nodule of the deft lobe of the thyroid gland. In August, PU64. a0 totd thyroidectonn was performed, with dissechion al the anterior compartment of the neck. Cit wits ato first thought fram the frozen section that the nodules wore mahynant.) Grossly, the glands showed multiple nodies with exstic and hemorrhagic areas (Fig. The vland weighed Tem. The pathalogical ditgnosis was adenomiutoid SORECT. The microscopical appearance was reported as folJers: 2. there ive adeneAmong the nodular fornimations . matoid nodules, with and without regeneration and lem. orrhage. and adenomas, some consisting of very pale. almost clear cells. Numerous papillary formattons present are somewhat alarming. However, no evidence, of muliznant change as found. Ino seme phices the intranedutar Hivroid tisste is arranged in lozenge-shaped masses issociated with somewhat acy prod cetts. [he recovery from the operation was aneventiul except function of age. The 1 case in the Jess exposed group of 16 is not included. Not including the’ 5 fora transitory episode of lvpoparathyrord tetany, and: the patient is being treated with devathyroxime, (4 my. per day. thyroid abnormalities (nodules in addition to hypothyvroidism) was highest in the children exposed to fallout an 3S years of age and showed a typical course. She was upparenth cuthyroid during repeated examinations (he recent cases with minimal changes, the incidence of at less than ten vears of ave (55 per cent of this group). The greater incidence in females (8 of 16) than in males (5 of 13) exposed is in line with the greater in- cicence of thyroid abnormalities usually noted in the female. ermies to Coase 2. ao dd-vear-old) Marshallese girl, wis ox poscd proteim-bound iadine being 74 microgme. ino L058 and 8.1 microg, per LO ml in 1964, and the cholesterol being 128 mg. per LOG mb in Fag), In March, TPQ, a firm, nontender nodile, 1 em. in diameter, was discovered tn the left lobe of the thyroid gland. Jn Atgust, 1004, a total thyroidectomy wis per: TABLE 1. Taprotd Abnormalities in Exposed Afarshallese.* PATIENT AND led care exposed PRESENT AUE AGE aT Expose Re Jr. vr. 14 3 15 18 12 4 7 I 14 addition, id iodine <d out at ons. Until in either 1, except enlarge: average found to mparison cial charlue to an f serum ween the levels in PAL TOU P-CONARD EE OAL. . 3 - Sex PDatr ABNORMALITY Noten F 3/63 Adcnomatoid thyroid nodules F M Mt 3/64 3/65 3/65 Adenomatoid thyroid nodules “Adecnomataid thyroid nocdutes Adenommatoid thyroid noduies F F 3/64 41 30 3/65 17 14 19 40 45 12 6 3 8 29 34 1 F F F M F M 9/65 9/65 9/65 9/65 9/65 3/65 12 1 M 3/65 ~~ Disanosts Adenomatoid thyraid nodules Papillary & follicular thyroid carcinoma 3-mm. nodule of left lobe 2-mm. nodule of right lower lobe 6-8-mm., smooth nodule of left lower pole 2-mm. nodule of right lower pole 5-mm. nodule ac midline Hypothyroidism protein-bound iodine < 2 microgm./100 ml. (Mar. 1965); marked retardation of growth. Hypothyroidism protein-bound iodine < 2 microgm./100 ml. (Mar. 1965};: marked retardation of growth. * ‘TREATMENT Complete thyroidectomy (1964) Complete thivroidectomy & parathsyroidectomy (1964) Partial thyroidectomy (1964) Partial thyroidectomy (1965) Partial thyroidectomy (1965) Thyroidectomy—surgical & with radioiodine (1965) Levothvroxine, 1.3 Levothyroxine, 0.3 Levothyroxine, 4.3 Levothyroxine, 0.3 Levothyroxine, 0.3 Levothyroxine, 0.3 mg. dav my. dav my.-dav my. dav my. das my. dav Levothyroxine, (ha my. das owes g J. “Does now include 5 patients believed to have minimal thyroid irregularities (2 were [2-ve. old girls, Va 2u-yr.-old woman, n, eg fnen 31 &° 347 vr. of awed: nm thyroid nodules detected in 200 unexposed Rongclap people. a . 1 . tExposed to only 69 ¢ of whole-body radiation (see text). BEST AVAILABLE COPY os be tak eee Te i clireet bidirect vol. 274 thee ee outta es 2501 8g “PRIVACY ACT MATERIAL REMOVED A