33

cates some of the changes characteristic of these
benign nodules. In one case (No. 33), in addition
to adenomatoid nodules there also was present a
Hurthle’s cell adenoma. In anothercase (No.61),
one pathologist remarked that “some observers
might regard the large nodule as a follicular adenoma.” In subject No. 59, a 46-year-old woman
who hadreceivedless than half the radiation dose

of the other cases with nodules, there was a solitary
adenomatous nodule, well circumscribed, and the

surroundingthyroid tissue was normal in appearance. This was in contrast to the other cases in
whom the glands were almost entirely abnormal
in appearance. A 41-year-old woman (No. 64) had
a mixed papillary and follicular carcinomaof the
thyroid with localized metastasis to a blood vessel
and lymph node (Figure 26). Following complete
thyroidectomy by surgery and therapeutic '*'I
no recurrence or further metastasis has been noted.
In September1966, at Tripler General Hospital,
Hawaii, thyroid uptake studies following TSH
stimulation (10 units daily for 2 days), thyroid
scans, and skeletal surveys for metastasis showed

absence of the thyroid and no detectable metastasis. *

Thyroid Function Tests Related
to Thyroid Abnormalities and Growth Retardation

Figure 24. Benign thyroid nodules at surgery. Top: exposed thyroid with arrows pointing to nodules. Bottom:
sectioned gland from another case. Note multinodular,

cystic, and hemorrhagic nature of gland.

Microscopic Appecrance. ‘The microscopic appearanceofall the benign nodular glands in the
children was characteristic of adenomatous goiter
and varied mainly in the degree of change. The
architecture of the gland was disrupted by the
nodules of widely varying sizes. Some of the nodules contained microfollicular elements with and
withoutcolloid, others were atrophic, some con-

tained large cysts with colloid, some with hemorrhage, andstill others showed extensive proliferation of the epithelial layers with marked infolding,
giving an “arboreal” appearance. Figure 25 indi-

In Table 20 the cases with thyroid abnormalities are listed along with the growth status of children and results of thyroid function tests. The results of kinetic analysis of '*7I tests are given in
Table 21. Two 12-year-old boys (No. 5 and No. 3)
who had been exposed at 15 and 18 monthsof age
respectively have had the greatest retardation of
growth and development. Subject No. 3 had
shown no change in bone maturation since 1961
and until recently had the bone age of a 3-year
old child. The bone age of No. 5 has shown continuing slow growth and in 1965 was 5years.
Both these boys in 1965 had the height of normal
7-year old Marshallese boys. Their dwarfism was
particularly evident in comparison with younger
siblings who were taller than they. In 1965 it was
found that in both cases the levels of proteinbound iodine had dropped below 2 ug%. Before
that time, they had levels considered to be in the
normal range, and there was noreasonto relate
their dwarfism to hypothyroidism. With the developmentof the low PBIs they showed definite
*Weare grateful to Major Ronald Moore, MC, USA, for carrying out these examinations.

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