ae Binge Oe eeelwate tame ah ee i. 5. Area of atypical proliferating cells in thyroid which had developed multiple discrete benign adenomas (hematoxylin-eosin stain, X70), et papillary and follicular type. All showed invasion of the thyroid capsule and in two patients localized metastases to lymph nodes were present and in two other patients blood vessel invasions were noted (Fig 6 and 7). Benign adenomatous changes accompanied malignant changes in the glands. Total thyroidectomies were performed in three patients with malignancy, and a left radical cervical lymph node dissection was carried out in one of these patients because spread to lymph nodes was seen. The fourth patient had a hemithyroidectomy. No metastases have been recognized beyond the cervical region in any - patients. 320 Thyroid Functions; Correlation With Retardation of Growth in Children In some children with thyroid lesions, deficiency in serum thyroxine has been correlated with retardation of growth. The moststriking instances of hypothyroidism were in two boys who showed marked retardation of statural growth and bone age. By 1964, they had developed obvious atrophy of the thyroid gland with almost complete loss of thyroid function as evidenced bya failure of the thyroid to take up much,if any, iodine even after thyroid-stimulating hormone (TSH) stimulation. By this time ‘ there were low thyroxine and very JAMA, Oct 12, 1970 © Vol 214, No 2 I01Zo10 6. Follicular carcinoma of thyroid showing capsular invasion in 35-year-old woman exposedto fallout. This represented discrete mass as shown in Fig 4. No lymph node metastasis (hematoxylin-eosin stain, X26). high TSH levels in the blood. The boys showed bony dysgenesis, sluggish Achilles tendon reflexes, puffy faces, and dry skin. The patients’ response to thyroid hormone supplement as evidenced by growth spurt, improved appearance,etc, has been dramatic (Fig 8 and 9). Several other children who displayed thyroid nodularity and whose statural growth was below average showed low or low-normal serum thyroxine values and poor radioactive iodine uptake after TSH stimulation which indicated that their thyroid glands were functionally impaired and were operating near their maximum capacity. Functional deficiency of the thyThyroid Neoplasia—Conard et al