1774 PANEL DISCUSSION ON HYPERTHYROIDISM til we now have 18 cases of thyroid pathology. Seventy-nine per cent of these have occurred in children that were exposed at less than ten years of age. Eleven patients have been operated upon and, of the 11, Volume 27 3 particularly to late effects of radiation, as had been supposed previously. In view of this, it would seem that we must seriously consider the hazard associated with the use of radioiodines in the treatment of thyroid disease, particularly in children. nine were children, all showing benign adenomatous goiter histologically rather than the type one sees with iodine de- DR. WERNER: Dr. Lindsay, it is comficiency. However, there is no iodine de- mon knowledge that, if one operates on ficiency in the Marshall Islands where they enough patients with hyperthyroidism, a live, and no known goitrogenic foods exist fair number of them will have thyroid there. One case of cancer has developed in cancer instead of the seeming toxic diffuse one of the three adults with nodules. This goiter, or may have cancers within the was in a 41-year-old woman and wasof the hyperthyroid gland. Yet there has been a mixed follicular and papillary type with sharp decrease from the expected incidence localized metastases in lymph nodes and of thyroid cancer in patients treated with 137. I wonderif you would like to speculate blood vessels. Another interesting aspect of the study aboutthis. is the possible relationship of the thyroid pathology to the slight degree of retard- DR. STUART LINDSAY, Departmentof ation of growth and development that has Pathology, University of California Medibeen noted over the past years in the ex- cal Center, San Francisco: In any series 6 4 posed children (47). In the last three years, patients with Graves’ disease who aré@ 4 frank hypothyroidism has occurred in two operated upon, a certain number, probboys who have shown the greatest retard- ably something less than 1%, will be ation of growth. Their PBI values found to have microscopic carcinomas, dropped below 2 yug/100 ml, and they usually papillary in type. I have seen showed all the characteristics of hypo- several of these which were probably of thyroidism. In addition, several other multicentric origin. This finding always brings up this queschildren have had low PBI values. It thus appears that this growth retardation tion. If a thyroid carcinoma should appear may well berelated to the effects of radia- later in a patient with Graves’ disease who tion upon the thyroid gland. We had not had been irradiated with ''J, was the neosuspected the thyroid relationship in earlier plasm really an effect of radiation or wasit years, since PBI levels had appeared to be possibly a tumor that had been present normal. As a matter of interest, the before the I radiation? This is a point Marshallese have considerably higher PBI that is at present impossible to answer. levels than Americans. Dr. Rall and I, in studying this, have found that there was a DR. MALOOF: I would like to ask Dr. high level of iodoprotein which largely Conard to clarify the problem of ‘I accounted for the high PBI values (48). irradiation and cancer of the thyroid reTherefore, it seems likely that earlier ported to be found in children exposed to detection of thyroid hypofunction in these radiation in the Marshallese Islands (46). I would like to make one point about children may have been masked by the this. In the paper by Dr. E. M. Chapman finding of falsely normal PBI levels. Thus it appears, as a result of these and myself in 1955 (49), we reported that developments in the Marshallese and there was no greater incidence of thyroid other studies which -[ have referred to, cancer in our patients with hyperthyroid that the thyroid gland is not as resistant, ism who had been given ™I than in othe 9015110