because thyroid-stimulating hormone levels have been performed annually on that population. (The Utirik population is currently tested every two years: no cases of nonsurgicalthyroid hypofunction have been detected.) It is not knownif the incidence of biochemically detectable thyroid hypofunction is increasing among the people of Rongelap, because 1) thyroid hor-monereplacement would haveto be temporarily discontinued for testing, and 2) treatment for hypofunction would be the same supplementation they are currently receiving. It is not clear, therefore, that they would derive any clinical benefit from the information that might be obtained. There is a continuing problem with noncompliance in taking Synthroid, even though the medical program provides and distributes the supplement. For 1980-1982 the average percent of elevated TSH values in the Rongelap group was 19% even though all persons in the group are advised to take suppressive doses of Synthroid. This is clearly a minimum estimate of noncompliance because manypersons who are to take thyroid supplementation are euthyroid. Their noncompliance would therefore not be reflected in the TSH level. In 1980, when 24% had elevated TSH levels, another 18% with normal TSH levels admitted to either irregular compliance or none atall. This adds up to a 42% minimum estimate for noncompliancein that year. “Complete failure” to take prescribed medication may occur in 25-50% of outpatients in the us. Findings. One thyroid nodule was detected in a 28-year-old womanof the comparison population in 1981. Surgery proved it to be an adenoma. This nodule, as well as those detected in 1980, were included in the statistics of the 26year report.’ Five persons underwent surgery in 1982 for suspected thyroid nodules. Significant pathology, however, was foundin only three. Two of these were exposed persons from Rongelap (Nos. 36 and 65). They had adenomatous nodules removed in 1969 and 1966, respectively. The nodules detected in 1982 were also adenomatous nodules. They are therefore not included as new casesin the updatedstatistics. The other patient (No. 942) was a 65-year-old womanin the comparison population; three of four pathology consultants felt she had occult papillary carcinoma, while the fourth felt the lesion to be follicular carcinoma. An updated listing of all surgically removedlesions in the four exposure groups through 1982 is presented in Table5. A reassessmentof absorbed radiation dose to the thyroid has now been completed and a summaryof the results is presented in Appendix I. Dr. Robert Conard and Mr. Edward Les- Table 5 Thyroid lesions diagnosed at surgery through 1982. Occult Papillary Adenomatous Nodules Adenomas Carcinomas Carcinomas Rongelap (67)* 17 2 4 —_ Ailingnae (19)* 4 — _ 1 10 2 3t 1 3 1 2 gtt Utirik (167)* Comparison (227)** ‘ NOT INCLUDED are the following unoperated (and therefore unconfirmed) nodules: Rongelap -1; Ailingnae-1; Utirik - 1; comparison -5. INCLUDED are all consensus diagnoses of a panel of consultant pathologists; two different lesions were detected in one person each from Rongelap, Ailingnae,and Utirik. * Number of persons (including those in utero) who were originally exposed. ** This number includes all persons who have been included in the comparison group since 1957. Some have not been seen for many years; others have been added as recently as 1979. Equally divided opinion in one case; follicular carcinoma vs atypical adenoma. Divided opinion in one case; occult papillary carcinoma vs follicular carcinoma. The same patient had a lymphocytic thyroiditis. ---3 Cl Co Cc cri 15