Tasre 2. Thyrotd Abnormalities in the More Heavily Exposed Marshallese Group.*
Exproapre
,
No.
Exprosep
;
rads
0-5
6-10
11-15
16-20
> 20
Hyrotnyvroiwns
Nopu es
SOL OP CLASES
» OF CASES
PERCENTAGE
z
x
=
t
.
Tora Aswoawacitizs
PEMCENTAILE
Nt, OF CASES
15.4
7
,
13
5
5
6
26
5
3
0
0
2
PERCENTAGE
OF GHOKUF
2
38.5
60.0
0.0
0.0
7.7
_
_—
—_
—
—
—
—
—
3
0
0
2
53.8
60.0
0.0
0.0
V7
*S cases with minimal thyroid abnormalities not included; 1 45-vr.-cld-woman in less exposed group in whom thyroid nodule developed also not included,
level of protein-bound iodine. Hematologic examination and
x-ray study of the chest were considered to be within normal
limits.
The right lobe of the thyroid gland was removed at the
New England Baptist Hospital and showed multiple nodules
up to 1.2 cm. in diameter. The pathological diagnosis was
adenomatous goiter. |
Recovery from surgery was uneventful, and in September,
1965, treatment with levothyroxine was instituted.
Case 5.
an 18-year-old Marshallese boy, was exposed to fallout at the age of 7. Since recovery from the
acute effects of radiation he has been in generally ood health, |
and thought to be euthyroid (in 1958 the protein-bound
iodine was 7.0 microgm. per 100) mil.). Compared with unexposed boys of the same age, however, he had shown a
slight degree of retardation in growth based on anthropometric
formed. The gland was multinodular, with nodules up to
about | cm. in diameter, and weighed about 12 gm. The
histopathological diagnosis was adenomatoid goiter. The
histologic description was as follows:
The thyroid sections . . ..show multiple adenomatoid
nodules of widely varying pattern. Most of them contain
papillary formations that make it necessary to consider the
possibility of carcinoma. Although a few microscopical
fields on high-power examination appear bizarre it is believed that the overall picture does not justify a diagnosis
of neoplastic disease.
A state of persistent hypoparathyroidism followed the operation, necessitating the use of vitamin D, as well as thyroid-replacement therapy.
Case 3.
. a 15-year-old yirl, was exposed to Fallout at
the age of 4 with signs and symptoms typical of the group.
In March, 1964, at 14 years of ape, she was Found to huve a
small, nontender thyroid nodule (2 or 3 mm. in size) in the
isthmus. The right lobe, isthmus and medial half of the left
lobe were removed. Many nodules were present, varying in
siz¢ up to 5 mm. in diameter. The following was reported:
and bone-age studies.
In March, 1965, a firm nodule, 1.5 cm. in diameter, was
noted in the lower right pole of the gland. He was taken to
Brookhaven National Laboratory for study and later to the
New England Baptist Hospital for surgery. Thyroid work-up
showed the following data: iodine fractionation of serum
indicated a total iodine of 6.5 microym., iodoprotein of 1.3
microgm. and thyronine (T, + T,) of 4.2 microgm. per 100
ml.; thyroid autoantibodies were under 1:16: the cholesterol
was 170 mg. per 100 ml., with 144 my. in the esterified
colloid cysts with Rattened epithelium. There are foci of
hemorrhage and calcification. Dense fibrous septums separate nodules. The diagnosis was adenomatoid goiter.
Recovery was uneventful, and the patient is being treated
with levothyroxine, 0.3 mg. per day.
Case 4,
, a 12-year-old boy, was exposed to fallout at
| year of age. During the ten-year period after exposure, he
was found to show a lag in growth, based on anthropometric
studies and radiographic determination of bone age, so that
he has continued | to [Ya years behind unexposed children
of his age. He has had no obvious evidence of thyroid malfunction. During the past several years 2 determinations of
protein-bound iodine and 1 of cholesterol have been within
the normal range. He has remained in generally good
health,
In March, 1965, he was found to have a 2-cm., nontender
but firm, freely movable nodule in the right lobe of the
thyroid gland. No lymphadenopathy was palpated. He was
taken to Brookhaven National Laboratory in June. Thyroid-function tests showed the following results: serum iodine fractionation (by column chromatography") was 7.1
microm. total, 2.0 microgm. iodoprotein and 4.2 microgm.
per 100 ml. thyronine fraction (T, + T,): the cholesterol was
167 mg. per 100 ml, with 145 my. in the esterified form:
thyroid autoantibodies (the tanned red-cell technic wus used
in all these determinations) indicated a uter under 1:16: the
basal metabolic rate was —23 per cent: a thyroid scan (Tc?)
showed possible nodularitv of the right lobe: studies of ['?
uptake disclosed a level of 39 per cent at 6 hours. After
TSH stimulation with 10 {SP unis daily For 3 days the
uptake showed a slight decrease, with no increase in the
5012958
form: the basal metabolic rate was —12 per cent: a thyroid
scan (Tc) showed a “cold” nodule in the lower right lobe:
‘studies of I? uptake revealed 40 per cent uptake in 6
hours, with 32.5 per cent urinary excretion at that time.
After TSH, 10 USP units daily for 3 days, the uptake at 6
hours was 33.7 per cent, with a urinary excretion of 18.5
per cent. The protein-bound iodine at that time was about
the same as before TSH stimulation. Films of the chest and
an electrocardiogram were normal. Hematologic studies were
not remarkable.
The right lobe of the thyroid gland containing multiple
nodules was removed. The nodules varied in size up to |
cm. and were pale gray to deep red, firm and pulpy and
semicystic. The diagnosis was adenomatous goiter.
Case 6.
. a 41-year-old Marshallese woman, was exposed to fallout at 30 years of age. Since recovery from radiation she has remained in relatively yood health, with no
serious illnesses or injuries. She has had 9 children, 4 of
them born since the fallout exposure. She has apparently
remained euthyroid. The protein-bound iodine in March,
1965, was 10.0 microgm. (high normal for the Marshallese),
and the serum cholesterol in 1958 was 249 my, per 100 mi.
In March, 1965, a l-cm. nodule, hard but not tender, was
found in the right lower pole of the thyroid gland. No lymphadenopathy was detectable. She was taken to Brookhaven
National Laboratory for study and later to the New England
Baptist Hospital for surgery. Thyroid work-up revealed the
following values: on serum iodine fractionation the total
iodine was 8.5 microgm., the iodoprotein fraction 4.5 microgm., the thyronine fraction (T, + T,) 3.4 microgm., and
the protein-bound iodine 7.5 microgm. per 100 ml.: the
serum cholesterol was 239 mg. per 100 ml. (in the esterified
form, 183 mg.): the basal metabolic rate was —27 per cent:
~ PRIVACY ACT MATERIAL REMOVED
oe ae ree +
‘
The normal thyroid architecture is effaced by small
nodules showing varying degrees of atrophy and hyperplasia. Some nodules consist of microfollicular ussue, and
some: show luxuriant
papillary . growth,
whereas others 3 are
*
‘