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function which are described below. Occasionally, this instruction was not
followed. However, the nature of the tests performed was such that this
circumstance would result in an underestimation (rather than an overestimation)
of the frequency of abnormalities in thyroid function.
Plasma was separated by allowing the red cells to sediment and was frozen
within eight hours after obtaining the specimen. Serum Thyroid Stimulating
Hormone (TSH) and thyroxine (T4) were measured as previously described [8].
The normal range for serum TSH in ourlaboratory is from <0.05 to 3 wU/ml
in the United States population (mean 2.0 nU/ml). Thyrotropin Releasing
Hormone (TRH)stimulation tests were performed by infusion of 500 yg of
TRHintravenously, plasma samples were obtained at O and at 20 minutesafter
the infusion. TSH stimulation tests were performed by administration of ten
units of bovine TSH intramuscularly with plasma obtained for T, determinations
before injection and 24 hours later. The normal range for serum T, concentrations
is 5-10 yg/dl. Estimation of the free fraction of T, was obtained by aT;
charcoal uptake method developed in our laboratory (TBG Index). Twenty-five
ul of plasma are incubated in | ml of glycine acetate buffer, pH 8.6, containing

1251 T,. Dextran-coated charcoal is added at 4°C with subsequent centrifugation
to sediment the charcoal. The fraction of the total 1251 T, bound to charcoal

‘is determined andthis result is normalized to the results of simultaneously
assayed quality control samples containing normal quantities of T, and
thyroxine-binding globulin (TBG). The normalrange for the test is 0.85—1.10.
The TBG Index increases parallel to the free fraction of the serum T, and T;
and is therefore elevated in hyperthyroidism or TBG deficiency.

RESULTS
TSH stimulation tests

Somer

To determine whether or not there was impaired thyroid reserve in the
exposed subjects, TSH stimulation tests were carried out using an increase in
serum T, as the response endpoint. In normal subjects in the United States of
America, the mean increment in plasma T, was 4.7 + | yg/dl (mean + SD) in
13 subjects following injection of 10 U of TSH. In Table III are shown data
for the Marshall Islands population. The control subjects who had not been
exposed to radiation were given TSH, and the mean increment in T, was
4.2 + 1.3 (SD) not statistically different from the results in the United States
population. However, in 24 exposed Rongelap subjects, a mean increment of
only 2.4 + 1.2 ug/dl was obtained, which wassignificantly less (p < 0.001) than
in the control subjects.

goTE OGY

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