ceived thyroid irradiation in 1954 seems to conform in vw general way to the concepts outlined above. Radiation appears to have been the cause of the thyroid abnormalities seen, since 200 natives of the same ethnic background and living under identical conditions showed no thyroid disease. Furthermore, there is no evidence that these people have been exposed to other factors that might cause pathologie changes in the gland: urinalyses indicate that the iodine intake is adequate, and no dietary goitro- venic factors have been implicated. In addition, the dati in the present study show a much greater incidence of thyroid disease in children than in adults in accord with the findings cited above. This greater sensitivity of infants may also be related to the rel- ative magnitudes of the dose of radiation received, the infant ghind probably receiving five to ten times the radiation dose that an average adult's) gland received. Fhe dose range of from 700 to 1400 rads delivered to the children’s thyroid glands is similar to the doses received during thymic irradiation. The apparently yreater incidence of pathologie chanves in the glands of the Marshallese is not clear. It may dose in these people is subject, as noted above, to due to the radiation, but the mechanism has not been known. With the recent development of frank hypothyroidism in 2 of the most retarded boys in the exposed group hypothyroidism: seems the most likely cause. In 2 other retarded boys ( thyroid nodules have developed. However, it is’ in- teresting that the exposed girls have shown verylittle retardation of growth and development although the nodules are more prevalent among them. Except for the 2 boys with hypothyroidism. the rest of Ghe children with growth retardation have showin normal protein-bound iodine and cholesterol values. Minimal “hypothyroidism may bave been missed and may be enough to account forthe growth retardation seen. The fincliny of high VTSIE levels in the 2 most retarded bows with lwpothyroidisn and slight elevation in 2 other retarded children strongly indicates primary hypothy- roidism. The growth response of these children after thyroid feeding will offer an interesting therapeutic. test of the hypothyroid etiology of the growth retar- dation, j brits some er study est stuiclics wi Surgery on ¢ RA Broadcle fam). andl on Mghey Clinic). A Klinck (Ari Rod 2, by Dr. aren Nationa Messner (New mrough 6. ‘We are inde! shock, CG. b. SUMMARY AND CONCLUSIONS in Bhi, J. b. Je ficking. for cor indsav, Hi. A. the thyroid gland were found in a number of Marshallese people of Ronge- the more heavily exposed population (55 living of These people were exposed to varying doses of external radiation to the thyroid) gland but not. to internal exposure from radioiodine. The growth retardation previously noted in some of the exposed children has been assumed to be - ared in) cir Bewth rate in ; explosions. The numbers are small, however, comalmost 15,000 individuals, as compared to 2 cases in shehthy less than 5000 unexposed individuals. were 31 Ate incredse ' mone (rect fect of the | \ dap Iskuxl who were accidentally exposed to racdio- prising 19 causes ino a combined exposed group of ech, 1166, si 7 yzecl. and deliver 300 to [400 rads to the gland makes caution in changes X% Ackerman active fallout in 1954. Definite thyroid nodules were noted in Ll people, minimal changes in 5 others, gher thyroid gondence ane assion tuid t] priment of | and hypothyroidism in 2. Al but 1 case occurred in Marshallese sun the original 64 persons), who received about 175 rads of whole-body giumma radiation, burns of the skin from fallout products and internal absorption of fission products. One case with a nodule was noted inoun adult woman in the smaller Rongelap group (16 of the IS are still alive) that had received less than half the exposure of the other group. In 200 individuals of a control group not exposed no such thyroid abnormalities were found. In the Pl, Cronkite, B, exposedl 0 1955. 2 Conard, R. : D7 people expos JANA. 192: y Sutow, WoO of chitdren more heavily exposed ywroup, thyroid abnormalities developed in 55 per cent of children exposed at less than ten vears of age. Five children were found at Pediatics 36: 4 Harris, POU .3. Cohn, 8. 1h, ~beings ane surgery to have benign adenomatous goiters. The ! :7> sion, Some h "On the Metrshe fallout cud a adult patient had a mixed papillary-and_ follicular carcinomit, with localized metastasis. Two boys showed marked retarcation of growth, apparently owing to primary hypothyroidism. The radiation etiolous in these cases appears + by RP. Cro ation, DC. 2 THD 535K.) James, Ri, att » Mochizuki, * to be reasonably certain in view of the following facts: the thyroid ghinds received ao substantial dose of radiation from radioiodines and external gamm radiation (adults about 300 rads, and children about 700 to 1400 rads): and. the incidence of thyroid ail normalities was high in the exposed group and ab- sent in an unexposed control populagon living 0 the same ishund. Do . The present. findings suggest that the seriousneess of the internal hazard associated with fallout, parle ularly from radioiodine. must be revised upwair® PRIVACY ACT MATERIAL REMOVED mtu Ph resurvey + thyroidisin, of thyroid adenomatoid lésions and of a thyroid carcinoma after doses of radioiodine that Pathologic high ine Nijdren. and unpublished data by Godwin demonstrating a reduced incidence of [-induced adenomas in rts treated with thyroid hormone. This form of treat ment, therefore, seems reasonable in the Marshal: lese. The implications of the present findings are two. fold. In the first place, contrary to previous con. cepts, the quantity of radioisotopes of jodine in fallout of the close-in type associated with atomic. bomb detonations must be regarded as a major long. term hazard. Secondly, the development of hypo the use ofraclioiodine necessary No. hallese tiation favorable effects of thfroid treatment. of Patients with nodules of the thyroid gland. The only expert, mental evidence found directly applicable tg the Marshallese situation is a paper by Nichols et alas large uncertainties. There appears to be an increased incidence of thyroid carcinoma in inhabitants of Hiroshima and Navasaki exposed to radiation from the atomic-bomb te The treatment of the exposed group with levothy. roxine deserves some further comment, Bielschone, skyand Astwood and Cassidy™ have reviewed the be related to a greater dose of radiation received by the MarshaHese since the calculations for thyroid 974+ June 23, bagg PagteMotta tarde 6+ + THE NEW ENGLAND JOURNAL OF MEDICINE mona a 1398 PYAARRIEOPY Man thyraie 19833. 8 Rall yo Ba Modine level i} Press). ae % Axciracl, A... = + by Jow joshi | 2 ot ant, Cance Ld aa