49 D, HORMONE TREATMENT In 1965, the seriousness of the developmentof thyroid lesions in the Rongelap people was recognized, and a panelof experts wascalled together to review the findings and make recommendations regarding the possibility of initiating preventive therapy.1%23 The concensus was that the more heavily exposed Rongelap group should be placed on replacementthyroxine forlife in order to block TSH secretion by the pituitary gland. It was hoped thatnullifying the stimulatingactivity of this hormone.on the thyroid would inhibit development of benign and malignant nodules, and that growth and development in the hormonedeficient children would be improved. The possibility of developmentof pituitary tumors, which has been noted in hypothyroid animals®5 and human beings,®6 might be prevented. Ethical considerations ruled out randomizedclinical trials of therapy. Synthetic L-thyroxine (Synthroid, Flint Drug Co.), which might be morestable than dessicated thyroid under tropical conditions, was recommended at a dose of 0.3 mg/day for people <50 years of age and 0.2 mg/dayfor those >50. Treatment was supervised by the health aide, but difficulties in maintaininga strictly regular treatment arEP att i ey Figure 37. Same comparison as in Figure 36. for subject No. 3 and his younger brother(No.83). regimen soon became apparent. In an effort to overcomethis problem it was found that giving the entire weekly dose at one time was effective andsafe, and resulted in maintenance of normal levels of thyroxine.8? Even on this simplified teatment schedule a few of the people, including some who had undergone thyroidectomy, showed low thyroxinelevels indicating that they were not con- sistently taking the medication. (This was one of the reasons for establishing the post of resident physician in the Islands in 1972 to monitor the treatment program as weil as offer health care.) For 4 people on this regimen who developed above- normal T, levels, associated with complaints of nervousness and palpitation, the dose was reduced. In view of the recent appearanceof thyroid nod- ules among the Ailingnae group andin a subject exposed i utero, all persons exposed on theatoil are now included in the treatment program. The hormone therapy has unquestionably en- — hanced growth and developmentin the growth- retarded Rongelap children (Figures 21, 36, and 37 show the improvementin the two most stunted boys). However, the benefit of such treatmentregarding developmentof nodularities in the thyroid is uncertain. Of the children exposed at age < 10 Figure 36. Left: Subject No. 5 (shorter) and his younger brother (No. 85) in 1963. Right: Same two boys in 1973 after No. 5 had been given thyroid hormonefor 8 years. TO00b1ub years in the more highly exposed Rongelap group, only two have not developedlesions. The less ex- posed Ailingnae group, in which developmentof PRIVACYACTMATERIAL REMOVED”