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THE NEW ENGLAND JOURNAL OF MEDICINE
June 23, 1966
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TABLE 2. Thyroid Abnormalities in the More Heavily Exposed Marshallese Group.*
*
Expesune
No.
Exrosen
Hiypotinygeainiss
NODULES
NOP GF GASES
PERCENTAGE
MUL GH
@
USES
Total ABNORMALITIES
mae
a
eK pS AGE
S40 GPP
GASES
VRMC RNG AGE
feb dice
13
5
5
6
> 20
3
3
0
0
26
2
38.5
60.0
0.0
0.0
7.7
1
O-5
10
11-15
16-20
53.8
60.0
0.0
0.0
77
woDM 4
teed
ae
"S cases with minimal thyraid abnormalities nat included, | 45-vr.-old-woman in less exposed group in when thyroid nodule developed also not included.
formed. The gland was moltinodafar, with nodules up to
about
Poem. in diameter, and weighed about T2 gm. The
histopatholovical diagnosis was adenomatotd goiter. The
fustologic description was as follows:
The thyroid sections
show multiple adenomatoid
nodules of widely varying pattern. Most of them contain
level of protein-bound jodine. Hematologic examination and
x-ray study of the chest were considered to be within normal
lirnits.
The right lobe of the thyroid: gland was removed at the
New Enyland Baptist: Hospital and showed multiple nodules
upto b2 em. a diameter. The pathological diagnosis was
papillary fornnitions that make it necessary to consider the
possibility of carcinoma. Although ao few microscopical
adenomatous Borer,
.
Recovery from surgery was uneventful, and in September,
leved that the overall picture does not justify a diagnosis
of neoplastic disease.
posed to fullout at the aye of 7. Since recovery from the
fields on high-power examination appear bizarre it is) be-
A state of persistent: hypoparathyroidism followed the operation. necessitating the use of vitamin D, as well as thyroid-replacement therapy.
Clank 3
a )d-vear-oldb girl, was exposed to fallout at
the age of Po owith signs and symptoms typical of the group.
fo March, PoG4, aa 1-4 vears of ave, she was found to have a
sna, nentender thyroid nodide (2 or 3 mine in size) in thé
iInffmus. Vhe right lobe, isthmas and medial half of the left
lohe were romeved. Miuy nodules were present, varying: in
siveoup to 3 mm in diameter. Phe following was reported:
The pormal thyrokd architecture is efTaced bv sonal
nodules showing varying degrees of atrophy and hyperplasia, Some nodules consist of microfollicular tissue, ancl
some show luxuriant papillary growth, whereas others are
colloid evsts with flattened epithelium. Uhere are foot of
hemorrhage and cileification. Dense fibrous septums scparate nodutes., Vhe chagnosis was adenomatord goiter.
Recovers was uneventful, and the patient ts being treared
with levothyroxine, 0.3 mg. per day.
Clase ch.
a T2-vear-olcl boy, was exposed to fallout at
Tosearof age. During the ten-vear period after exposure, he
was found to show a dag in growth, based on anthropometric
studies and radiographic determination of bone age, so chat
he has continued J ote 1/2 years behind inexposed children
of his ave. He hus had no obvious evidence of thyroid matluncheon. During the past several years 2 determinations of
protamebound iodine and | of cholesterol have been within
the normal range. He has remained in’ generally ewood
1965, treatment with levothyroxine was instituted.
Clash 5.
a, oan
PS-yeur-oll Marshallese boy, was) ex-
acute effects of radiation he has been in generally good healtia,
and:
thought
to
be cuthyroid
(in
P58
the protein-bound
iodine was 7.0 microgm. per PQQ ink). Compared with unexposed bovs of the same age, however, he had shown a
inhi dexree of returdanen in growth based on anthropometric
and bone-age studies.
In March, 1965, a firm nodule, 1.9 cm. in) diameter, was
neted inthe 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 microum., iocdoprotent of
lower
of ihe
sions.
value
cent.
thyrois
tein-l«
logic st
A st
left. lo
each a
pathol:
carciti
tastasts
glanct:
change
Rece
was th
4th di
tissue.
trearm
Gross
In
‘multi:
surge:
nodul
variex
consis
color
was
j
ares.
ation
6) the
microgm. and thyronine CF, +71) of 2 microgm., per 1Go
mL: thyrotd amoantibedies were ander 1:16. the cholesterol
was P70 ine. per LOO mb, with EEE me. in the esterified
form: the basal metabolic rate was 12 per cent: a thyroid
scan (Ue!) showed a “coldnodule in the lower right lobe:
studies of IP! uptake revealed 10 per cent uptake in 6
larity,
ules ;
Afier TSH, 10 CSP? units daily for 3 days, the uptake at 6
hours was 33.7 per centy with a urinary excretion of 18.5
per cent. The protem-bound iodine it that time was about
nodul
hours, with 32.5) per cent
urinary excretion at that dime.
Micro:
The
the same as before TSH stimulation. Films of the chest and
an clectrocardiogram were normal. Hematologic studies were
not remarkable.
goites
nodules was removed. The nodules varied in size tp tol
others
senticyslic. Phe diagnosis was adenomatous goiter,
with «
The right lobe of the thyroid gland containing multiple
cm. and were pale grav to deep red, firni and pulpy and
Clash o.
_t Hleveat-old
Marshallese worn, wis ex-
posed to fallout at 300 vears of ave. Since recovery front ra-
The ;.
nodul
micro
shows
ers
w
health,
dition she has reniined in redatively good diealth, with no
appea
bit
frrim. dieely movable nodule in the right Jobe of the
serious ilnesses or injuries. She has had O children, - of
them born since the fallout exposure. She tris apparendy
ular t
roid-lonction tests showed Uhe following results: serum io-
1965, was POO microm. (high nermal lor the Marshallese)
and the seruny cholesterol in P9S8 was 24 meg. per LOO wl
In March, 165, he was found to lave a 2-cm., nontender
thyreand elind. Noo lymphadenopathy was palpated. He was
tken te Brookbaven National Laboratory in’ June. “Phydine tractionaion (by column chromatography’) was 7.1
microgn toned, 2.0 microgm., iodoprotein and f.2 microgm
per
TOO mE thyromne fraction (1, +78: the cholesterol was
P67 ome. per LOO mi, with TS me. in the esterified form
Hhvred autoantibedies (the tanped red-cell techmie was used
reall these cetermimitions) indicated a ater under btG: the
haesal metabelie rite was 723 per cents thyroid scan (Pet)
showed possible nodularity of the right lobe: studies of 1'#
Uplike aisclosed
a
level of 39 per cent
at 6 hours. Miter
PSI} stunaiiien with EO) O87? unis dail for 3 days the
uptake slrowed aoslivht decrease, with noo inerease ip the
reinained: cathivroid, “Vhe protein-bound iodine an March,
In March, F065, a d-cm. nodule, hard bert aot tender, wis
found ta othe rehbe lower pole of the divrord ahind. Ne lyme
phadenopathy was detectuble. She was luken to Brookhaven
National Laboratory for study and liter to the New England —
Harpist Hospital lor surgery, Thyroid work-“Ipreve: dled the,
following vadites: On seria iodine Pragions Won the cou”
iodine was S23 micrewni. the lodeproven fraction 5 mi
croun, the thyronine Praction (EP, + PA) 3. fucrogur, wn
the protein-bound iodine 7.5 microgm. per’ L000 mb; the
serum cholesterol wis 230 me. per 100 dnl. (irr the “esterified
forma, T&S aie: the basal mictabolic made wis 27 per cers
The
a Ih rH
Thyroi
Tw
had hb
2
age rn. q
ofang
show;
and ;
Y@i.- -y
Con: