31
13 and 18 years of age and in a 41-year-old
woman,thefirst adult case. Two cases of hypo-
thyroidism in growth-retarded boys were also
noted at this time. In September 1965 a further
examination wascarried out by two of us (R.A.C.
and J.E.R.}, and 5 more exposed people were
found with nodules varying in size from 2 to 8 mm.
One of these was a 45-year-old woman in the
group that received only an estimated 69 rads.
The cases up to this point were recently reviewed.**
In March 1966 nodules of the thyroid gland were
detected in 5 additional exposed children. Table
17 gives some pertinent data on all these cases.
Table 18 showsthe distribution of the thyroid abnormalities (nodules and hypothyroidism) by age.
decided that 5 such cases should be brought to the
United States. These cases had not shown reduction in nodule size, though presumably they had
been on the hormone therapy for the 6-month
period. Four children with thyroid nodules who
were not considered to have had an adequatetrial
therapy with thyroid hormone wereleft in the
Islands to be re-evaluatedlater. In one 40-year-old
man a nodule had disappeared, presumably as a
result of therapy.
Surgical Cases
Of the 16 cases with nodules, a total of 11 have
had surgery. In 1964, the first 3 cases in teen-age
age and only in the more heavily exposed group
(15 of 19 children, 78.9%). No cases with thygte
girls were operated upon* at the U.S. Naval Hospital, Guam.'*-?? In July 1965, 3 cases were brought
to the Medical Research Center at Brookhaven
National Laboratory (Figure 22) and later taken
to the New England Baptist Hospital, Boston, for
surgery.** In May 1966, 5 additional cases were
brought to Brookhavenfor further examinations
(Figure 23)
were latertaken:to theNew Eng-
lower exposure groupsof the same age range{6
At Brookhavert, detailed thyfoid studies wereCar-
In Table 19 results are presented on the various
populationsstudied along with the estimatedradiation dose to the thyroid gland. It is noteworthy
that the preponderance of thyroid abnormalities
have occurred in children exposed at < 10 years of
abnormalities were.detected in the children int
Ailingnaechildren, 40 Utirik children) ogin the
61 unexposed Rongelap children. Two adults wath
thyroid nodules were noted in the mé@feheavily
exposed Rongelap group andonein the Ailingnae
group.In the Utirik and unexposed populations a
low incidence of thyroid nodules was found, and
these occursed only in x Glider age group.
In view of the potefitiakseriousness of the thyroid abnormalities in the Marshallese, it was de-
é
nodules and sp oil
P
nodules. There
Mile should receive thyfee the remaénderof,
RE TSH secre@n
ffrther developmentof
land Deaé
24 Mospitalin®
for'ssurgery.**
- ried out, including "I and oof uptake studies
and scans before and after TSHadmitnistrationt
and measurergent afbasalmetabolismrate, serum
protein-bound iodipe,-serum thyroxine (7,) level,
and serum antifieyroglobptin aritibodytiter. Brief
hospital sufa#fary reports on aise cases are presented in apes 6.
°
Gross Ap
nce. In all 9 children operated
upon, the
were found at surgery to be
Meacrdeealinongin some cages the nodules
had appeaped@lipically to be solitary,Fhe nodules
varied in
i
er froma few. pith to several cm,
elatively hard,
Big regression ofexsting
ge red. Cyst
} gross ap-
ign Bodules at
<50 yeats: ofage and 0.2 mg toall people >50.
The new cases with thyroid nodules wereleft in
the Islands under hormonetreatment, with the
idea that,if at the time of the next survey (March
1966) the nodules had not regressed or further
nodules had developed, consideration would be
given to bringing them to the UnitedStates for
study andpossible surgery. In March 1966it was
Sere wda solitary
nodule, anggthe surround#Agrs Tt appeared norPt gland also
mal. In thother adult (Ne
did not s
multiple nedata easbut‘contained
two firm, yellow, malignan neadtites about 1 cm
in diameter(Figure 26).
*Surgery was performed by Captain C.A. Broaddus, MC,
USN.
**Surgery was performed by Dr. B.P. Colcock of the Lahey
Clinic.
+Weare grateful to Dr. H.-L. Atkinsfor these analvses.