PRIVACY ACT MATERIAL RE MOVED the exposed as compared with the unexposed population. Determinations of basal metabolic rate were not done owing to difficulties of carrying out the procedures under field conditions. Dietary iodine has apparently been adequate. In 28 cases the mean twenty-four-hour urinary iodine excretion was 105 microgm. (range, 19.5 to 279 microgm.). In 1963, nine vears after the accident, a twelveyear-old girl in the exposed group was found to have a nodule of the thyroid gland. In 1964, 2 additional cases with thyroid nodules were found in exposed girls thirteen and fourteen years old. In March, 1965, 3 additional cases in exposed people were noted in boys thirteen and eighteen years of age and in the first adult, a forty-one-year-old woman. In September, 1965, a further examination was carried out, and 5 additional exposed people with nodules varving in size from 2 to § mm. were found. One of these was a forty-five-year-old woman in the group that received only an estimated 69 rads. In addition, there were 5 people in whomthe thyroid glind appeared to be roughened or minimal nodularitvy was considered likely. These cases are not included in Table 1 because of the minimal nature of the physical findings. Table 1 lists the cases with thyroid abnormalities. Table 2 shows the incidence of thyroid disease in the more heavily exposed group of 55 living Rongelap people as a function of age. The 1 case in the Jess exposed group of 16 is not included. Not including the 5 recent cases with minimal changes, the incidence of thyroid abnormalities (nodules in addition to Hypothyroidism) was highest in the children exposed at less than ten vears of age (55 per cent of this group). The vreater incidence in females (8 of 16) than in males (5 of 13) exposedis in line with the greater in- cidence of thyroid abnormalities usually noted in the female. The first 6 patients have been hospitalized and have undergone surgery. These cases are briefly summarized below. Their response to the radiation was similar to that outlined above, and only specific differences are noted here. CASE REPORTS Case | , a I4-year-old Marshallese girl, was 3 years ald when exposed to radioactive fallout. Her response to this radiation was typical of the yroup. Clinically, she has remained euthyroid throughout the period of observation (in 1957 the cholesterol was [35 mg., and in [964 the proteinbound iodine was 6.8 microgm. per 100 ml.). In March, 1963, she was found to have a 2-cm. nontender, firm nodule of the left lobe of the thyroid gland. In August, 1964, a total thyroidectomy was performed, with dissection of the anterior compartment of the neck. (It was at first thought from the frozen section that the nodules were malignant.) Grossly, the glands showed multiple nodules with cystic and hemorrhayic areas (Fig. 1). The gland weighed [2 gm. Phe patholovical diagnosis was adenomatoid goiter. The microscopical appearance was reported as follows: Amony the nodular formations .. . there are adenomaton! nodules, with and without regeneration and’ hemorrhage, and adenomas, some consisting of very pale, almost clear cells. Numerous papillary formations present are somewhat alarming. However, no evidence of malig- nunt change is found. In some places the intranodular thyroid Ussue is arranged in lozenye-shaped masses associated with somewhat atypical celts. Yhe recovery from the operation was uneventful except for a transitory episode of hypoparathyroid tetany, and the patient is being treated with levothyroxine, 0.3 mg. per day. Case 2. a |4-year-old Marshallese girl, was exposed to fallout at 3 years of age and showed a typical course. She was apparently euthyroid during repeated examinations (the protein-bound iodine being 7.4 microgm. in 1958 and 8.1 microgm. per 100 ml. in 1964, and the cholesterol being 128 my. per 100 ml. in 1959). In March, 1964, a firm, nontender nodule, 1.5 cm. tn diameter, was discovered in the left lobe of the thyroid vland. In Auyust, 1964, a total thyroidectomy was per- TABLE 1. Thyrotd Abnormalities in Exposed Marshatlese.* PATIENT Present AGE AGE aT Exposure wr. Jr, 14 14 Dtacnosis TREATMENT Sex Date ABNORMALITY Noreo 3 3 F F 3/63 3/64 Adenomatoid thyroid nodules Adenomatoid thyroid nodules 15 18 12 41 4 7 | 30 F Al M F 3/64 3/65 3/65 3/65 Adenomatoid thyroid nodules Adenomatoid thyroid nodules Papillary & follicular thyroid Partial thyroidectomy (1965) Partial thvroidectomy (1965) Thyroidectomy-~-surgical & with 17 14 19 40 45 12 6 3 8 29 34 1 F F F M F MM 9/65 9/65 9/65 9/65 9/65 3/65 3-mm. nodule of 2-mm. nodule of 6-8-mm., smooth 2-mm. nodule of Levothyroxine, Levothyroxine, Levothyroxine, Levothyroxine, 12 I M 3/65 Adenomatoid thyroid nodules carcinoma left lobe right lower lobe nodule ofleft lower pole right lower pole 5-mm. nodule at midline Hypothyroidism protein-bound iodine < 2 microgm./100 ml. (Mar, 1965}; marked retardation of growth, Hvpothvroidism protein-bound iodine < 2 microgm./100 ml. (Mar. 1965); Complete thyroidectomy (1964) Complete thyroidectomy & parathy- roidectomy (1964) Partial thyroidectomy (1964) radioiodine (1965) 0.3 0.3 0.3 U3 mg./day my./day my.:day mg/day Levothyroxine, 0.3 my./day Levothyroxine, O.3) mu./day Levotbyroaine, U3 myr./day marked retardation of growth. *Does not include § patients believed to have minimal thyroid irregularities (2 were |2-yr. old girls, | a 26-yr.-cid woman, & 2 men 31 & 37 vr. of age); no thyroid nodules detected in 200 unexposed Rongelap people. tExpased to only 69 r of whole-body radianon (see rext). PRIVACY ACT MATERIAL REMOVED