: SLE COPY BEST AVAILAG PRIVACY ACT MATERIAL REMOVED V3te THE NEW ENGLAND JOURNAL OF MEDICINE June 23, 1966 thyrote rh OH TABLE 2. Thyroid Abnormalities in the More Heavily Exposed Marshallese Group.* * Expesune No. Exrosen Hiypotinygeainiss NODULES NOP GF GASES PERCENTAGE MUL GH @ USES Total ABNORMALITIES mae a eK pS AGE S40 GPP GASES VRMC RNG AGE feb dice 13 5 5 6 > 20 3 3 0 0 26 2 38.5 60.0 0.0 0.0 7.7 1 O-5 10 11-15 16-20 53.8 60.0 0.0 0.0 77 woDM 4 teed ae "S cases with minimal thyraid abnormalities nat included, | 45-vr.-old-woman in less exposed group in when thyroid nodule developed also not included. formed. The gland was moltinodafar, with nodules up to about Poem. in diameter, and weighed about T2 gm. The histopatholovical diagnosis was adenomatotd goiter. The fustologic description was as follows: The thyroid sections show multiple adenomatoid nodules of widely varying pattern. Most of them contain level of protein-bound jodine. Hematologic examination and x-ray study of the chest were considered to be within normal lirnits. The right lobe of the thyroid: gland was removed at the New Enyland Baptist: Hospital and showed multiple nodules upto b2 em. a diameter. The pathological diagnosis was papillary fornnitions that make it necessary to consider the possibility of carcinoma. Although ao few microscopical adenomatous Borer, . Recovery from surgery was uneventful, and in September, leved that the overall picture does not justify a diagnosis of neoplastic disease. posed to fullout at the aye of 7. Since recovery from the fields on high-power examination appear bizarre it is) be- A state of persistent: hypoparathyroidism followed the operation. necessitating the use of vitamin D, as well as thyroid-replacement therapy. Clank 3 a )d-vear-oldb girl, was exposed to fallout at the age of Po owith signs and symptoms typical of the group. fo March, PoG4, aa 1-4 vears of ave, she was found to have a sna, nentender thyroid nodide (2 or 3 mine in size) in thé iInffmus. Vhe right lobe, isthmas and medial half of the left lohe were romeved. Miuy nodules were present, varying: in siveoup to 3 mm in diameter. Phe following was reported: The pormal thyrokd architecture is efTaced bv sonal nodules showing varying degrees of atrophy and hyperplasia, Some nodules consist of microfollicular tissue, ancl some show luxuriant papillary growth, whereas others are colloid evsts with flattened epithelium. Uhere are foot of hemorrhage and cileification. Dense fibrous septums scparate nodutes., Vhe chagnosis was adenomatord goiter. Recovers was uneventful, and the patient ts being treared with levothyroxine, 0.3 mg. per day. Clase ch. a T2-vear-olcl boy, was exposed to fallout at Tosearof age. During the ten-vear period after exposure, he was found to show a dag in growth, based on anthropometric studies and radiographic determination of bone age, so chat he has continued J ote 1/2 years behind inexposed children of his ave. He hus had no obvious evidence of thyroid matluncheon. During the past several years 2 determinations of protamebound iodine and | of cholesterol have been within the normal range. He has remained in’ generally ewood 1965, treatment with levothyroxine was instituted. Clash 5. a, oan PS-yeur-oll Marshallese boy, was) ex- acute effects of radiation he has been in generally good healtia, and: thought to be cuthyroid (in P58 the protein-bound iodine was 7.0 microgm. per PQQ ink). Compared with unexposed bovs of the same age, however, he had shown a inhi dexree of returdanen in growth based on anthropometric and bone-age studies. In March, 1965, a firm nodule, 1.9 cm. in) diameter, was neted inthe lower right: pole of the gland. He was taken to Brookhaven National Laboratory for study and later to the New England Baptist Hospital for surgery. Thyroid work-up showed the following data: iodine fractionation of serum indicated! a total iodine of 6.5 microum., iocdoprotent of lower of ihe sions. value cent. thyrois tein-l« logic st A st left. lo each a pathol: carciti tastasts glanct: change Rece was th 4th di tissue. trearm Gross In ‘multi: surge: nodul variex consis color was j ares. ation 6) the microgm. and thyronine CF, +71) of 2 microgm., per 1Go mL: thyrotd amoantibedies were ander 1:16. the cholesterol was P70 ine. per LOO mb, with EEE me. in the esterified form: the basal metabolic rate was 12 per cent: a thyroid scan (Ue!) showed a “coldnodule in the lower right lobe: studies of IP! uptake revealed 10 per cent uptake in 6 larity, ules ; Afier TSH, 10 CSP? units daily for 3 days, the uptake at 6 hours was 33.7 per centy with a urinary excretion of 18.5 per cent. The protem-bound iodine it that time was about nodul hours, with 32.5) per cent urinary excretion at that dime. Micro: The the same as before TSH stimulation. Films of the chest and an clectrocardiogram were normal. Hematologic studies were not remarkable. goites nodules was removed. The nodules varied in size tp tol others senticyslic. Phe diagnosis was adenomatous goiter, with « The right lobe of the thyroid gland containing multiple cm. and were pale grav to deep red, firni and pulpy and Clash o. _t Hleveat-old Marshallese worn, wis ex- posed to fallout at 300 vears of ave. Since recovery front ra- The ;. nodul micro shows ers w health, dition she has reniined in redatively good diealth, with no appea bit frrim. dieely movable nodule in the right Jobe of the serious ilnesses or injuries. She has had O children, - of them born since the fallout exposure. She tris apparendy ular t roid-lonction tests showed Uhe following results: serum io- 1965, was POO microm. (high nermal lor the Marshallese) and the seruny cholesterol in P9S8 was 24 meg. per LOO wl In March, 165, he was found to lave a 2-cm., nontender thyreand elind. Noo lymphadenopathy was palpated. He was tken te Brookbaven National Laboratory in’ June. “Phydine tractionaion (by column chromatography’) was 7.1 microgn toned, 2.0 microgm., iodoprotein and f.2 microgm per TOO mE thyromne fraction (1, +78: the cholesterol was P67 ome. per LOO mi, with TS me. in the esterified form Hhvred autoantibedies (the tanped red-cell techmie was used reall these cetermimitions) indicated a ater under btG: the haesal metabelie rite was 723 per cents thyroid scan (Pet) showed possible nodularity of the right lobe: studies of 1'# Uplike aisclosed a level of 39 per cent at 6 hours. Miter PSI} stunaiiien with EO) O87? unis dail for 3 days the uptake slrowed aoslivht decrease, with noo inerease ip the reinained: cathivroid, “Vhe protein-bound iodine an March, In March, F065, a d-cm. nodule, hard bert aot tender, wis found ta othe rehbe lower pole of the divrord ahind. Ne lyme phadenopathy was detectuble. She was luken to Brookhaven National Laboratory for study and liter to the New England — Harpist Hospital lor surgery, Thyroid work-“Ipreve: dled the, following vadites: On seria iodine Pragions Won the cou” iodine was S23 micrewni. the lodeproven fraction 5 mi croun, the thyronine Praction (EP, + PA) 3. fucrogur, wn the protein-bound iodine 7.5 microgm. per’ L000 mb; the serum cholesterol wis 230 me. per 100 dnl. (irr the “esterified forma, T&S aie: the basal mictabolic made wis 27 per cers The a Ih rH Thyroi Tw had hb 2 age rn. q ofang show; and ; Y@i.- -y Con: