PRIVACY ACT MATERIAL REMOVED thyroid autoantibodies were present in a titer under 1:16. A thyroid scan showed a large “cold” nodute replacing the lower pole of the right lobe of the gland. X-ray examination of the chest and bones gave no evidence of metastatic lesions. A study of thyroid uptake with I? showed a 6-hour value of 22.3 per cent, with urinary excretion of 33 per cent. After treatment with TSH, !0 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 left lobe, was carried out. [t 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 me- tastasis 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 1? to destroy the remaining thyroid tissue. The subsequent course has been uneventful, and treatment with levothyroxine was started in August, 1965. 4 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 oper- ation in Case 1. In the patient with carcinoma(Case 6) the gland did not show the same degree of nodularity, except for the presence of 2 firm, yellow nod- ules about 1 cm. in diameter (Fig. 2). Microscopical Appearance Ficure 1. Benen Adenomatoid Thyroid Nodutes in a Fourteen-YearOld Girt 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 character. The microscopical section (B) shows wide variations int folficle vizes (original magnification X14); some are small and atrophic, others were atrophic, some contained large cysts of normal seven-year-old Marshallese boys. Their nodules of widely varying sizes, some containing microfollicular elements with and without colloid; with colloid, some with hemorrhage, and still others showed extensive proliferation of the epithelial layers with marked infolding, giving an “arboreal” appearance. Figure | indicates some of the changes. The tumor in Case 6 showing papillary and follic- ular 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 exposedat fifteen and eighteen months of age respectively, have had the greatest retardation of growth and development. (Fig. 3) has shown no change in bone maturation since 1961 and at present has a bone age of that of a threeyear-old child. The bone age of has showed continuing slow growth and in 1965 was five and a The gross specimen ofthe sectoned gtand (A) indicates the nodular and others ave large and cystic. The nodule at the upper right shows Ayperplasia, with papillary infolding of epithetuan. half years. Both these boys in 1965 have the height dwarfism has been particularly marked in comparison with younger siblings who now are taller than they are (Fig. 3).3 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 appear to 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 Unstitutes af Health. for carrving out the TSH determinations. PRIVACY ACT MATERIAL REMOVED