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 twelve-
vear-old yirl 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 yirls 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 varying in size from 2 to 8 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 whom the
thyroid gland appeared to be roughened or minimal
nodularity 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 less 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 years of age (55 per cent of this group).
The greater incidence in females (8 of 16) than in
males (5 of 13) exposed is in line with the greater incidence of thyroid abnormalities usually noted in the
female.
was similar to that outlined above, and only specific
differences are noted here.
CASE REPORTS
Case |.
a |4-year-old Marshallese girl, was 3 years
old when exposed to radioactive Fallout. Her response to this
radiation was typical of the group. Clinically, she has re-
mained euthyroid throughout the period of observation (in
1957 the cholesterol was 135 mg., and in 1964 the protein-
bound 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 thefrozen section that the nodules
were malignant.) Grossly, the glands showed multiple nodules with cystic and hemorrhagic areas (Fig. 1). The gland
weighed 12 gm. The pathological diagnosis was adenomatoid
goiter. The microscopical appearance was reported as follows:
Among the nodular formations ... there are adeno-
matoid nodules, with and without regeneration and hemorrhage, and adenomas, some consisting of very pale,
almost clear celis. Numerous papillary formations present
are somewhat alarming. However, no evidence of talignant change is found. In some places the intranodular
thyroid tissue is arranged in lozenge-shaped masses associated with somewhat atypical cells.
The 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.
GASE 2.
, a 14-year-old Marshallese yirl, was exposed
to fallout at 3 years of age and showed a typical course. She
was apparenuy euthyroid during repeated examinauons (the
protefn-bound iodine being 7.4 microgm. in 1958 and 8,1
microgm: per 100 ml. in 1964, and the cholesterol being 128
mg. per 100 ml. in 1959).
In March, 1964, a firm, nontender nodule,
1.5 cm. in
diameter, was discovered in the left lobe of the thyroid
yland. In August, 1964, a total thyroidectomy was per-
Tase 1. TAyrotd Abnormalities in Exposed Marshallese.*
Patient
PRESENT
AGE aT
AGE
Ex posure
vr
oe
14
3
14
Sex
F
F
15
18
4
7
F
M
41
30
F
17
14
6
3
F
F
29
34
M
F
19
40
45
12
12
1
8
1
1
Diacnosia
TREATMENT
Noteo
3
12
Date
ABNORMALITY
M
3/63
Adenomatoid thyroid nodules
Complete thyroidectomy (1964)
3/64
3/65
Adenomatoid thyroid nodules
Adenomatoid thyroid nocules
roidectomy (1964)
Partial thyroidectomy (1964)
Partial thyroidectomy (1965)
3/65
Papillary & follicular thyroid
carcinoma
Thyroidectomy—surgical & with
radioiodine (1965)
Levothyroxine, 0.3 my./day
3/64
3/65
9/65
9/65
Adcnomatoid thyroid nodules
Adenomatoid thyroid nodules
3-mm. nodule of left lobe
2-mm. nodule of right lower lobe
F
9/65
6-8-mm., smooth nodule of left lower pole
M
3/65
Hypothyroidism protein-bound iodine
< 2 microgm./100 mi. (Mar. 1965);
M
9/65
9/65
3/65
2-mm. nodule of right lower pale
5-mm. nodule at midline
marked retardation of growth,
Hvporhvroidism protein-bound iodine
< 2 microgm./100 ml. (Mar, 1965);
Complete thyroidectomy & parathy-
Partial thyroidectomy (1965)
Levothyroxine, 0.3 my./day
Levothyroxine, 0.3 mg/day
Levothyroxine, 0.3 mg/day
Levothyroxine, 0.3 mys./day
Levothyroxine, 0.3 my./day
‘
Levothyroxine, 0.3 mg/day
marked retardation of growth.
*Does not include 5 patients believed 10 have minimal thyroid irregularities (2 were 12-yr. old girls, 1 a 26-yr.-old woman, & 2 men 31 & 37 yr. of age); no
thyroid nodules detected in 200 unexposed Rongelap people.
tExposed to only 69 r of whole-body radiation (see text).
9012951
PRIVACY ACT MATERIAL REMOVED-
St eq ee.
The first 6 patients have been hospitalized and
have undergone surgery. These cases are briefly
summarized below. Their response to the radiation
Srp NT rs PRA OS ST UR TYBee aces
the exposed as compared with the unexposed population. Determinations of basal metabolic rate were
not done owing to difficulties of carrying out the