JAEA-SM-224/607

111

and the TSH response to TRH wasalso significantly increased, indicating the
presence of impaired thyroid function.
Characteristics of Marshallese with biochemical evidence of thyroid dysfunction
In Table VII are presented the results of other studies in the four individuals
with biochemical evidence of impaired thyroid function. At present, these are
the only individuals who have fulfilled the criteria described in Table V, though
several other subjects have shown at least one abnormal finding but have not
had the required numberof tests to meet the established criteria. The age at
exposure varied from 16 to 38 years and the estimated thyroid dose was thought
in three or four to be less than 400 rads. Serum T, concentrationsin all four
subjects are in the low normal range when considered in the light of their
estimated serum Thyroxine-Binding Globulin (TBG). Subjects 74 and 71 have
approximately normal serum TBG concentrations, whereas subjects 78 and 4
apparently have a modestly elevated serum TBG. In the last column of Table VII
are shownresults of the TSH stimulation tests of these subjects performed in
1974. In all three, the serum T, response to TSH was impaired, suggesting
decreased thyroid reserve.

DISCUSSION

rm

SO1e3

cr

An association of thyroid nodularity and cancer with prior radiation of the
thyroid gland, particularly in younger patients, is well recognized and the
association has recently been reviewed [11]. In addition, it has been recognized
that radiation to the thyroid delivered in the course of treatment of patients
with thyroid dysfunction is associated with hypothyroidism in a significant
fraction of the patients (as high as 50%) at the higher dosage levels [12]. The
lowest dosage considered in previousstudies of this type has been approximately
3400 rads estimated dose to the thyroid which was associated with a 6% probability
of hypothyroidism within one year and a 13% probability in 13 years [13].
There are few data available in the literature relative to the possibility of
hypothyroidism following '3I dosages ofless than 2500 rads. Preliminary results
of Hamilton and Thompkins indicated that eight of 443 subjects (1.8%) subsequently became hypothyroid after diagnostic }*"I tests at less than 16 years [13].
A summary of these preliminary data has been presented. None of 146 subjects
with an estimated thyroid absorbed dose of 30 rads developed hypothyroidism,
but three of 146 subjects receiving 31 to 80 rads estimated thyroid dose had this
condition [14]. Of 151 subjects with an estimated dose range of 81—1900 rads,
five hypothyroid patients were found with an incidence of hypothyroidism of
0.23% yearly.

Select target paragraph3