43 Table 25 Thyroid Lesions in Marshallese, December 1974 Group Rongelap exposed (175 rads) Ailingnae exposed (69 rads) Age at exposure Est. thyroid dose,* rads “ Subjects® with thyroid lesions No. subjects with surgery “e Subjects® with malignant lesions < {0 10--18¢ >18 All 810-1150 333-810 335 356® 89.5 (17, 19} 16.6 (2/12) 9.1 (3 (3334 34.4 (22,64) 15 1 3 19 5.3 (1, 19) <10 275-450 33.3 (2 '6) 1734? 33.3 (1/3) 10-18 >18 All in utero exposed Utirik exposed (14 rads 69+? <10 10-18 >18 All Rongelap unexposed 190 135 217e 60-958 27-60 27 30¢ <10 10-18 1 0 3 4 1 0.0 (0/1) 0 0.0 (0/58) 4.8 (1/21) 0 1 6.4 (3/78) 3.8 (6/157) 1.6 (1/61) 7.7 (1/193) 3 4 5.8 (7/120) < 10 0.0 (0/3 1) 0 >10 4.7 (3/106) 0 All 4.6 (9/194) 3.6 (5/137) 4.8 (1/21) 0.6 (1-157) 0 | > 18 All Likiep unexposed 0.0(0/1) 36.3 (4/11) 33.3 (6. 18) 6.1 (2 33) 4.7 (3 64) 2 3 0 4 Dose from 1311, 132], 133], and 135] plus gamma; mean dose extrapolated from calculations?® for adults and 3-vear-olds (see Section IT). > Based on numberof people exposed, excluding those in utero (numberof cases/total numberin group). ¢The thyroid is considered to be fully developed by about age 18. 4QOne additional case of adenoma, found at autopsy, not included here. *Weighted mean dose. ' Pathologists differed as to whetherthis lesion was malignant; it was scored as benign. © The more energetic, shorter-lived isotopes of iodine contributedless to the total thyroid dose in the Utirik people because the fallout occurred later there. It might be surmised also that the biological effectiveness of the thyroid dose per rad would be less in the Utirik group. roid surgery has been carried out on 24 of the ex- woman(age 6 at exposure). A fourth case of cancer of the lesions (20 were subtotal and 4 total thyroid- exposure.23 Three of 196 unexposed Rongelap people have had surgery with removal of benign adenomas. All three were women. Hospital summariesof cases admitted at BNL are presented in Appendix 10. posed Rongelap people with removal of varying amounts of thyroid tissue depending on the extent ectomies with parathyroidectomy inadvertently in one of the latter who was thought to have cancer at the time of surgery). Of these cases, 3 were found to have carcinomaofthe thyroid and 21 to have benign lesions of the thyroid. The first case of carcinoma of the thyroid oc- curred in a 40-vear-old woman (29 at the time of exposure) in the heavily exposed group. Theinterval between exposure and diagnosis was 11 vears.°0.23 The second and third cases in this group occurred 15 years after exposure, in a 36-year-old woman (age 21 at exposure) and in a 22-year-old was found, 14 years after exposure,in a 36-year-old Utirik woman whohad received considerablyless 1. Gross Appearance Since the discovery of the first thyroid lesion 9 years after radiation exposure, clinicians particularly interested in the thyroid haveparticipated in the annual examinations. As a result, any slight irregularities discovered by palpation drew special attention. This high degree of scrutiny and suspicion led to the detection and removal of nodules