Of 60 known to have died, the post-mortem examination was available on k6. Two
thyroid neoplasms were described;. one was a carcinoma, the cther was an adehoma. It

as been noted that most of the patients on whom post-mortem examinations

were

erformed died within 5 years of the radiation therapy--a relatively limited] interval
n which to develop tumors.
Two patients who have very discrete masses continue to refuse exploratipbn. One
££ these who was recently seen and reluctantly submitted to examination has Heveloped
ersistent hoarseness and the mass has increased in size strongly suggesting] a malignant

esion.

This occurrence of 5 histologicaily identified carcinomas of the thyroi seems
ighiy significant in this small selected group of patients exposed to knowrg
amounts
0 radiation. A manuscript has been prepared for publication, but it has ndt been
submitted for publication because we have thought it preferable to await a ffinal diagnosi
n two patients being followed with suspicious lesions but as yet urwilling [to submit to
thyroidectomy.
The Life of the Normal Thyroid Cell and Its Potential for Replication as Compared to
the Radiated Thyroid Cell:

The long term follow-up of patients treated with 131] is showing that the
of patients if followed long encugh will ultimately suffer from hypothyroidism
tyxedema. Our figures show an incidence of only 12% hypothyroidism at the dnd
rear, but 4§ - 50% if patients are observed for fifteen years. Unfortunately,
woblem of hypothyroidism, if it does not occur promptly, anjses so long after

xreatnent that the patient has forgotten that he received

I or he became

majority
or
of one
the
the

Fareless

about taking prophylactic supplemental hormone earlier and found that he did not need
it. Since the patient has forgotten, subsequent physicians are not alerted jto the
»ssibility of hypothyroidism, a diagnosis that is difficult to make if
theyp is no
uistory to suggest its origin. As a result of vigorous follow-up efforts by a few
wedical centers,Asurprising number of patients with unrecognized myxedema have turned up.
[The symptoms are attributed to, or confused with, senility and considered tq be premature
aging. It may be that the life span of the "ideally irradiated" cells in diffuse
1yperplastic thyroid in man is not greatly different from the non-irradiated cells, the

mly difference being a failure of replication in the radiated cell.

In orcer to learn more about the long, latent thyroid failure after 135, it is

recessary first to learn mre about the survival and replacement of normal thyroid celts.

Initial studies were made in young, middle-aged and old rats quite some years ago in ar
Laboratory, using tritiated thymidine and radiocautography to identify the cq@lls that
vere undergoing mitosis. In the young growing rat, the occurrence of labeling was
fairly frequent. The incidence declined with age until, in the rats that ware 2% to
3 years of age, only rare muclei were found to contain the labeled thymiding. This pilot
2xperiment illustrated the normal replication rate at different points in
tHe life span.

Qur first experimental steps to try to determine the life history and wate of

‘placement of the normal thyroid cells were observations on the labeling off thyroid
quclei with tritiated thymidine. The objectives were to determine how rapidly the
labeling takes place, the duration of the stage of DNA duplication in prepagiation for
division and the duration of the total period required for mitosis to becom@ complete.

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