PRIVACY ACT MATERIAL REMOVED
9
D. HORMONE TREATMENT
In 1965, the seriousness of the developmentof
thyroid lesions in the Rongelap people was recognized, and a panel of experts was called together
to review the findings and make recommendations
regarding the possibility of initiating preventive
therapy.!9-23 The concensus was that the more
heavily exposed Rongelap group should be placed
on replacementthyroxineforlife in order to block
TSH secretion by the pituitary gland. It was
hoped that nullifying the stimulating activity of
this hormoneon the thyroid would inhibit development of benign and malignant nodules, and
that growth and development in the hormonedeficient children would be improved. The possibility of developmentof pituitary tumors, which
has been noted in hypothyroid animals® and human beings,86 might be prevented. Ethical considerations ruled out randomizedclinicaltrials of
therapy.
Synthetic L-thyroxine (Synthroid, Flint Drug
Co.), which might be more stable than dessicated
thyroid under tropical conditions, was recommended at a dose of 0.3 mg/day for people <50
years of age and 0.2 mg/dayfor those >50. Treatment was supervised by the health aide, but difficulties in maintaininga strictly regular treatment
Figure 37. Same comparisonas in Figure 36,
for subject No. 3 and his younger brother (No.83).
regimen soon became apparent. In an effort to
overcomethis problem it was found that giving
the entire weekly dose at one time waseffective
and safe, and resulted in maintenance of normal
levels of thyroxine.87 Even on this simplified treatment schedule a few of the people, including some
who had undergone thyroidectomy, showed low
thyroxine levels indicating that they were not consistently taking the medication. (This was one of
the reasons for establishing the post of resident
physician in the Islands in 1972 to monitor the
treatment program as well as offer health care.)
For 4 people on this regimen who developed abovenormal T, levels, associated with complaints of
nervousness and palpitation, the dose was reduced.
In view of the recent appearanceof thyroid nodules among the Ailingnae group andin a subject
exposed in uéero, all persons exposed on theatoll
are now included in the treatment program.
The hormonetherapy has unquestionably enhanced growth and development in the growthretarded Rongelap children (Figures 21, 36, and
37 show the improvementin the two most stunted
boys). However, the benefit of such treatmentre-
Figure 36. Left: Subject No. 5 (shorter) and his younger
brother (No. 85) in 1963. Right: Same two boys in 1973
after No. 5 had been given thyroid hormonefor 8 years.
garding developmentof nodularities in the thyroid
is uncertain. Of the children exposed at age < 10
years in the more highly exposed Rongelap group,
only two have not developed lesions. Theless exposed Ailingnae group,in which developmentof