i p & e i: Pee left lobe, was carried out. It was reported that 2 nodules, each approximately | cm. in diameter, were present, and the pathological diagnosis was “mixed papillary and follicular carcinoma of right lobe, with blood-vessel invasion and metastasis to | lymph node and normal right parathyroid gland: (the left lobe of the thyroid gland shows no significant changes).” Recovery from the operation was uneventful. The patient was then given 10 units of TSH daily for 3 days, and on the 4th day, 30 mc. of I' to destroy the remaining thyroid tissue. The subsequent course has been uneventful, and treatment with levothyroxine was started in August, 1965. eenTE TT, ager ¥otthgtes pit at,alli . RM 1 a ao“Saget Bovey Apeace) fRS oe SEE7OSi TiteMEE «TEE IRR Shed ae oa : SEN REae aeeey re 2 aS ae BE SNE ae Aa Re ee a RS - ARI ey in ea CIN: ae ilaaa RS gO, t RNS, aesapere TEAL SAf : 2 �� thyroid autoantibodies were present in a titer under 1:16, A thyroid scan showed a large “cold” nodule replacing the lower pole of the right lobe of the giand. X-ray examination of the chest and bones pave no evidence of metastatic lesions. A study of thyroid uptake with 1"? ‘showed a 6-hour value of 22.3 per cent, with urinary excretion of 33° per cent. After treatment with TSH, 10 units daily for 3 days, thyroid uptake had increased to 33 per cent, and the protein-bound iodine was 8.0 microgm. per 100 ml. Hematologic studies were not contributory. A subtotal thyroidectomy, leaving a small portion of the Gross Appearance of the Thyroid Glands In all 5 children operated upon (Cases 1-5) the multinodular character of the glands was notable at surgery although on prior clinical examination, the nodules had appeared to be solitary. The nodules varied in size from 1 mm. to several centimeters, in consistence from fluctuant to relatively hard and in color from pale gray to pink to red; cyst formation was present in many, and some had hemorrhagic areas. Figure 1 shows the gross appearance at operation in Case 1. In the patient with carcinoma (Case 6) the gland did not show the same degree of nodu- larity, except for the presence of2 firm, yellow nodules about 1 cm. in diameter (Fig. 2). Microscopical Appearance The microscopical appearance of all the benign nodular glands was characteristic of adenomatoid goiter and varied mainly in the degree of change. The architecture of the gland was disrupted by the nodules of widely varying sizes, some containing microfollicular elements with and without colloid: others were atrophic, some contained large cysts with colloid, some with hemorrhage, andstil] others showed extensive proliferation of the epithelial lay- ers with marked infolding, giving an “arboreal” appearance. Figure | indicates some of the chanves. The tumor in Case 6 showing papillary and follicular carcinoma, with invasion of blood vessels and a lymph node, is demonstrated in Figure 2. Thyroid Abnormality in Boys Showing Retarded Growth Two twelve-year-old boys ( . and .), who had been exposed at fifteen and eighteen months of age respectively, have had the greatest retardation of vrowth and development. . (Fig. 3) has shown no change in bone maturation since 1961 and at present has a bone age of that of ‘a threevear-old child. The bone age of has showed continuing slow growth and in 1965 was five and a 90129549 Figure |. Benign Adenomatotd Thyroid Nodules in a Fourteen-YearOld Girl). The gross specimen ofthe sectioned gland (A) indicates the nodular character. The microscoptcal section (B) shows wide veriations in falhiele sizes (original magnification X14): some ave small and atroplie, aud others are large and cystic. The nodule at the upper right shows hyperplasia, unth papillary infolding of epithelium. half years. Both these boys in 1965 have the height of normal seven-year-old Marshallese boys. Their dwarfism has been particularly marked in comparison with younger siblings who now are taller than they are (Fig. 3).27 During the past year in both cases the levels of protein-bound iodine have dropped below 2 microgm. per 100 ml. Before that time they had levels in the normal range, and they had been considered to be euthyroid, They now have definite signs of hypothyroidism, with nonpalpable thyroid glands, and Achilles reflexes with the typical sluggish return. These boys do not appearto show mental retardation. TSH levels (in March, 1965) were elevated in both boys (more than 120 and 119 millimicrogm. per milliliter), corroborating the impression of primary hypothyroidism.* Other exposed male children in the retarded group (but “We are indebted to Dr. William: Odell. at the National Insturutes ol Health, for carrying out the TSH determinations. PRIVACY ACT MATERIAL REMOVED