of laboratory test results with the doctor*s opinion is prepared for each individual and arrangements be made for one copy to be retained by the Government of Micronesia so that it can be referred to at any time as required by doctors or a person of similar qualifications. I recommend also that more highly trained health aids be stationed on the islands and have doctors visit the island 3-4 times a year for examination and consul- tation, and that both the doctors and health aids cooperate in maintaining the health of the residents. 2. a. I shall limit my report to thyroid diseases. Surgical Treatment: The operations for thyroid cancer that have been conducted are appropriate. It is usually the case with adenomatous goiter that operation is performed only after the tumor becomes enlarged causing disturbances. Therefore, for small adenomatous goiters as seen in many of the exposed, total thyroidectomy or similar operations are not required. It is enough to closely follow the course and perform an operation only when cancer is strongly suspected. However, for the following reasons, the treatment given in the past is considered to have been inevitable. (1) at = Under the present system where one examination is made per year, it is not possible to make detailed follow-up observations. Therefore, it is safer to perform such operations on cases with even the slightest suspicion. _4 (2) From the biopsy specimens prepared from surgical material, I received the impression that some parts showed severe cell abnormality. Considerations must be given to the possibility of such areas developing into cancer in the future. From the standpoint of preventing radiation induced cancer from occurring, it is safer to perform such operations. Medical Treatment: (1) Treatment with Synthyroid after operation of the thyroid is considered as having been properly administered in view of the fact that the patients failed to show symptoms considered as due to hypothyroidisa. (2) Administration of Synthyroid for prevention of thyroid diseases is also considered as being properly handled, though some patients were found not to be taking the medicine as instructed by the doctor. This is considered due to the reason stated in lec, and the necessity for a means to more effectively utilize the results of examinations as stated in 1-d was keenly felt. b. The above stated opinions are presented on the basis of my knowledge, experience and reference from medical literature. 3. Additional Comments Item 1. This is beyond the realm of my specialty. 209