PRIVACY ACT MATERIAL REMOVED TABLE 2. TAyrotd Abnormalities in the More Heavily Exposed Marshallese Group.* No. Exposep Hypotnyroipism Nopuces So. OF CASES PERCEN PAGE 13 5 38.5 5 3 60.0 0.0 NO} OF CASES Tora. ABNORMALITIES PERCENTAGE NO. OF CASES PRROUES SAGE NOOW ~] Ex posure 53.8 60.0 0.0 OF GROUP 6-10 11-15 5 G 16-20 6 0 0.0 > 20 26 2 7.7 | 0-5 | rads 0.0 7.7 *S cases with minimal thyroid abnormalities not included; 1 45-yr.-old-woman in less exposed group in whom thyroid nodule developed also not included. formed. The gland was multinodular, with nodules up to about | cm. in diameter, and weighed about [2 gm. The histopathological diagnosis was adenomatoid goiter. The histologic description was as follows: The thyroid secuons ... 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 beheved that the overall picture does not justify a diaynosts of neoplastic disease. A state of persistent hypoparathyroidism followed the operation, necessitating the use of vitamin D, as well as thyroid-replacement therapy. Cast 3. . a 15-year-old yirl, was exposed to fallout ut the age of 4 with sivns and symptoms typical of tle eroup. In March, 1964, at 14 years of age, she was found to have 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 size up to 5 mm. in diameter. The following was reported: The normal thyroid architecture is effaced by , small nodules showing varying degrees of atrophy and hyperplasia. Some nodules consist of microfollicular tissue, and some show luxuriant papillary growth, whereas others are colloid cysts with flattened epithelium. There are foci of hemorrhage and calcification. Dense fibrous septums separate nodules. The diaynosts was adenomatoid voiter. Recovery was uneventful, and the patient ts being treate wh levothyroxine, 0.3 my. 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 showa lag in growth, based on anthropometric studies and radiographic determination of bone ave, so that he has continued | to |]¥%2 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 io- dine fractionation (by column chromatography*) was 7.1 microym, total, 2.0 microgm. iodoproetein and 4.2 microgm. per 100 ml. thyronine fraction (T, + T,): the cholesterol was 167 mg. per 100 mi., with 145 my. in the esterified form. thyroid autoantibodies (the tanned red-cell technic was used in all these determinations) indicated a titer under 1:16: the basal metabolic rate was —23 per cent. a thyroid scan (Tc) showed possible nodularity of the right lobe: studies of ['? uptake disclosed a level of 39 per cent at 6 hours. After TSH stimulation with 10 USP units daily for 3 days the uptake showed a slight decrease, with no increase In the 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 ex- posed to tallout at the age of 7. Since recovery from the acute effects of radiation he has been tn generally good health, and thought to be euthyroid (in 1958 the protein-bound iodine was 7.0 microgm. per 100 ml.). Compared with unexposed boys of the same age, however, he had shown a slight degree of retardauonin growth based on anthropometric and bone-ave 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 microgm., 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 mg. in the esterified form: the basal metabolic rate was —12 per cent: a thyroid scan (Tc*™) showed a “cold” nodule in the lower right lobe: studies of [3? uptake revealed 40 per cent uptake in 6 hours, with 39.5 per cent urinary excretion at that tme. After TSH, 10 US? units daily for 3 days, the uptake at 6 hours was 33.7 per cent, with a urinary excreuon 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. Hematoloyic 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. CiASE 6. , a 41-year-old Marshallese woman, was ex- posed to fallour at 30 years of age. Since recovery from radiation she has remained in relatively good 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 todine in March, 1965, was 10.0) microum, (high normal for the Marshallese), and the serum cholesterol in 1958 was 249 mg. per 100 mil. 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 Bapust Hospital for surgery. Thyroid work-up revealed the following values: on serum iodine fractionauion the total iodine was 8.5 microgm., the iodoprotein fraction 4.5 mi- crogm., the thyronine fraction (T, + T,) 3.4 microgm., and the protein-bound iodine 7.5 microgm. per 100) ml. the serum cholesterol was 239 my. per 100 ml. (in the esterified form, 183 my.): the basal metabolic rate was —27 per cent: 4 PRIVACY ACT MATERIAL REMOVED