sata beta bane Lee eof. W. H. ADAMS; LATE MEDICAL CONSEQUENCESOF EXPOSURE TO RADIOACTIVE Postsurgical Hypoparathyroidism Two women whohadthyroid surgery for benign nodules developed clinically significant low mtinues to be evidence of calcium levels due to parathyroid gland injury at the time of surgery. ig the exposed population. increase in frequencyof Laryngeal Nerve Injury One Rongelap man developed this complication of thyroid surgery. Pituitary Tumor Formation developed =r Two women exposed as young children have developed pituitary tumors. These tumors are usually benign, causing disease in part because of their expansion inside a rigid structure (the skull). There is no known direct association between radiation exposure and developmentofa pituitary Percent tumor, but there are reasons to suspectthat pituitary tumor formation may be a late consequence of thyroid injury (23). yroidism** In summary, hypothyroidism and subclinical thyroid hypofunction, benign thyroid nodule A formation, thyroid surgery with its attendant risks and complications, an excessive prevalence of thyroid hypofunction after thyroid surgery, and possibly pituitary tumors can be considered adverse 6l delayed consequencesof radiation injury in the exposed Marshallese. Thetally comes to 85 morbid 28 events in 253 persons. In contrast, the only evidence for what might be described as a “stochastic” effect of radiation exposure has been an increase in thyroid cancers in the Rongelap population, none of whom yet have evidence of residual disease. While several nonthyroidal cancers knownto be inducible in humans by ionizing radiation have been documented in the exposedpopulation, similar cancers have occurred in the unexposed population. Therefore, one may conclude thatin the Marshallese experience the delayed expression of morbidity from nonmalignant disease caused by wo determinations 6.0 uU/1. tadiation has indeed been great and far exceeds that of malignant disease. This is an important point, for much of the morbidity has occurred despite our best attempts at prevention. In addition, a death made premature as a consequence of nonmalignant morbidity is not likely to be listed as radiation-related, for its detrimental effects are subtle and blend easily into the spectrum of human S apparent, even though illness. Finally, a given malignant disease may be uncommon, but frequently fatal. Whereas ie data in Table 9 must nonmalignant radiation-related morbidity, while uncommonly lethal, may be highly significant by pofunction, for thyroxin virtue of the large population that can be affected. To conclude, the sequence of thyroid-related aintained normal serum morbidity provides a warning that biological misadventure does not occur in a vacuum. 1g satisfactorily to the aintly high frequency of References \yroid function prior to ‘serve in many exposed 1. P. CRONKITE, V. P. BOND, R. A. CONARD, N. R. SHULMAN, R. S. FARR, 5. H. COHN, C. L. DUNHAM, L. E, BROWNING, J. Amer. Med. Assoc., 159 (1955) 430. 2. M. .T TSUZUKI, Munchener Med. Wochenschr., 31 (1955) 988. g of hormone levels, it 289 -