The Current Status of Thyroid Disease Among the Marshallese Exposed to Fallout from the Bravo Test, March 1, 1954

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THE CURRENT STATUS OF THYROID DISEASE A&lONG THE MARSHALLBE EXPOSED TO FALLOUT FROM THE BRAVO TEST, MAJJCH 1, 1354 (The following data are taken from an informal report by Dr. Conard dated 4/20/71) current status may be updated as follows: . Young Rongelapese exposed to fallout March 1, 1954, when they were 1 to 8 years of age. (Estimated dose: 175 rads external gamma plus 600 to 1400 rem internal irradiation.) 1. Currently-normal by clinical and biochemical tests. (There may be a slight unevenness of the gland in 2. Currently hypothyroid with minimal nodularity. Responding satisfactorily to oral thyroid hormone 3. Have undergone surgery in the U. S. prior to 1969 because of nodular thyroid disease; histologic diagnosis of adenomatous goiter and‘Huerthle cell tumor. Responding satisfactorily to oral thyroid hormone therapy with one exception: This patient shows some enlargement of the remnant-of thyroid left from a partial thyroidectomy in 1964; as she has not followed her post-operative 'thyroid hormone regimen, there is question as to whether she should have further surgery. 4. Young people operated on for thyroid disease during August 1969 and recovered. Diagnoses: Priaary benign adenomatdus goiter in two and papillary adenoma of serious grade-malignancy in one. 3 (16%) (None of six Ailinginae children exposed to an estimated kxternal dose of 69 rads hake shown thyroid dysfunction.) II. Surviving adult Rongelapese exposed to fallout. (Es.timateddase: 175 rads external plus 160 rem internal irradiation.) 1. Papillary carcinoma removed surgically at age 41. No recurrence. Taking oral thyroid hormone therapy. 1

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2. Small nodule at age 40 which disappeared under oral 3. This patient operated on in 1969 for removal of an invasive adenoma; has recovered satisfactorily ’ 1 (All the above in I and II who underwent surgery appear to be in good health without evidence of recurrence.) III. Surviving adult Ailinginae people exposed to fallout. (Estimated dose: 69 rads external gamma irradiation.) 1. Adenoanatous goiter removed at age 45; recovered and was on thyroid therapy. Died of influenza in 1968. IV. Surviving adult Utirik people exposed to fallout. (Estimated dose: 14 rads external gamma plus 1. One person developed a nodular underwent surgery in 1969. As a follicular adenoma in frozen 15 rem internal irradiation.) thyroid gland and the tissue resembled thyroidectomy was performed; histologic sections confirmed the diagnosis and upgraded.the degree of malignancy. She has recovered satisfactorily. 2. . One person with slight enlargement of one lobe of the thyroid to be treated conservatively and observed. One case of nodular thyroid has been found in a non-exposed Rongelap woman living on Ebeye. Thyroid surgery has been recommended for this . patient at Majuro Hospital. No other instances of thyroid abnormalities have been found in the control populations living on Utirik, Majuro or Ebeye, It appears that the exposed populations have stabilized so far as the

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The following reports concerning the Pacific Proving Grounds, the Bravo Test and the subsequent events are in the public domain. Those referenced are placed first. The bibliography under Published Reports and Articles in Medical Journals below is not complete. Papers have been omitted which dealt with the development of techniques used in the laboratory or have reported some aspect of the study which has a limited or specific scientific interest. Also omitted are reprints of speeches made by members of the tdams at various times and places. On the other hand the reluctance of editors or biomedical journals to publish bulk data has caused Dr. Conard to record summarized* versions of the bulk data of a survey or group of surveys as Brookhaven National Laboratory. These can be used as source books‘and in fact have been so used by agencies such as the United Nations. Subjects of special interest to medicine and radiation biology have been developed from the data in.these source books and published in the journals and proceedings referenced. 1. PROVING GROUND: An Account of the Radiobiological Studies in the Pacific, 1946-1961. N. 0. Hine. Chapters 7-11. Univ. Wash. Press, Seattle, 1962. 2. Some effects of ionizing radiation on human beings: A report of the Marshallese and Americans accidentally exposed to radiation from fallout and a discussion of radjation injury in the human being. E. P. Cronkite, V. P. Bond, and C. L. Dunham, eds. Naval Med. Res. Inst., Naval Radiol. Defense Lab. and Brookhaven Nat. Lab., 114 p., TID 5356, 1956. 3. THE VOYAGE OF THE LUCKY DRAGON. R. E. Lapp. Harper 0. Brothers, New York, 4. APPENDIX B IN THE EFFECTS OF NUCLEAR WEAPONS. Ed. S. Glasstone. Revised Edition. USDOD and USAEC. supt. of Documents, U. S. Govt. Print. Off., PUBLISHED REPORTS AND ARTICLES IN MEDICAL JOURNALS Twelve-month post-exposure survey on Marshallese exposed to fallout radiation. Physical factors and dosimetry in the Marshall Island radiation exposures,

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Skin lesions; epilation and nail pigmentation in Marshallese and Americans accidentally contaminated with radioactive fallout. Naval Medical Research Institute and Naval Radiological Defense Laboratory, Response of human beings accidentally exposed to significant fallout radiation from a thermonuclear explosion. J. em. Med. Assoc. 159: 430-434, 1955. Medical examination of the Rongelap people six months after exposure to fallout radiation during Operation Castle. Operation Castle Addendum Report 4.1A WT-937, April, 1955. The effects of fallout radiation on the skin. In: THE SHORTER TERM BIOLOGICAL HAZARDS OF A FALLOUT F‘IELD. AEC-DOD, pp. 135-42, Response of human beings accidentally exposed to significant fallout radiation from a thermonuclear explosion (summary). Oliver'and Boyd, Edinborough, London, pp. 491-493, 1956. Medical survey of the Marshallese two years after exposure to fallout radiation. J. Am. Med. Assoc. 164 (11): 1192-1197, 1957. Radioactive contamination of Certain areas in the Pacific Ocean from nuclear tests, a summary of the data from the radiological surveys and medical examination. March 1957 medical survey of Rongelap and Utirik people three years after exposure to radioactive fallout.

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'The determination of internally deposited radioactive isotopes in the Marshallese people by excretion analysis. May 5, 6, 7, and 9, 1959. Joint Comm. on Atomic Energy, Special Subcommittee Medical survey of Rongelap people, March 1958, four years after exposure to Medical status of Rongelap people.five years after exposure to fallout radiation. In:. Biological and Environmental Effects of Nuclear War, hearings before the Special Subcommittee on Radiation, Joint Committee on Atomic Energy, 86th Congr., 1st sess., June 22-26, 1959, Part 1, pp. 430-2, U. S. Government Printing Office, An intestinal parasite survey on Rongelap Atoll in the Marshall Islands. American J. Tropical Med. and Hygiene 8 (4): 417-423, 1959. Blood groupings in Marshallese. Effects of fallout radiation on a human pppulation. Radiation Research. Supplement 1: 280-295, 1959. Health Survey of the Trust Territory of the Pacific Islands. U. S. Armed Forces Medical Journal 10 (10): '1199-1222, 1959. High prevalence of high-level B-amino-isobutyric acid excretors in Micronesians. Medical survey of Marshallese people five years after exposure to fallout Presented at the symposium on the Immediate and Low Level Effects of Ionizing Radiations, Venice, June, 1959. Special supplement (Suppl. 1) to the Int. J. Radiation Biology, Taylor and Francis, Ltd., London, pp. 269-81, 1960.

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Radioisotopes and environmental circumstances: The internal radioactive contamination of a Pacific Island Community exposed to local fallout. In: RADIOSIOTOPES IN THE BIOSPHERE. Chapter XXI. Eds. R. S. Caldecott and L. A. Snyder, University of Minnesota Center for Continuation Study of the General Extension Division, pp. 306-36, 1960. Medical status of Marshall Islanders'in 1959, five years after exposure to Medical survey of Rongelap people five and six years after exposure to fallout. Addendum: A note on the vegetation of the northern islets of Rongelap Atoll, Marshall Islands; March, 1959. The biological hazards of a fallout field. In: RADIOACTIVITY IN MAN. Ed. G. R. Meneely, Charles C. Thomas, Springfield, Gm phenotypes and genotypes in U. S. Whites and Negroes; in American Indians and Eskimos; in Africans; and in Micronesians. Am. J. Human Genetics 13: 205-13, 1961. Medical survey of Rongelap people seven years after exposure to fallout. 'Use of a portable whole-body counter to measure internal contamination in a Medical.survey of Rongelap people eight years after exposure to fallout.

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Metabolism of fission products in man: Marshallese experience. I.A.E.A. Int. Symp. on Diagnosis and Treatment of Radioactive Poisoning, 15-18 October 1962, Vienna. International Atomic Energy Agency, Austria, Long Term intra-oral findings in humans after exposure to total body irradiation from sudeen radioactive fallout. I. Five years post-detonation studies. J. Amer. Dent. Assoc. 68: 49-56, 1964. In: ATOMIC MEDICINE. Chapter 10, 4th Edition, Ed. C. F. Behrens, The Williams and Wilkins Co., Baltimore, pp. 190-221, 1964. Fallout radiation: Effects on skin. In: ATOMIC MEDICINE, Chapter 12, 4th Edition, Ed. C. F. Behrens, The Williams and Wilkins Co., Baltimore, pp.,281-302, 1964. Providing for the settlement of claims of certain residents of the Trust Territory of the Pacific Islands. Report No. 1257 from the Committee on Interior and Insular Affairs, 2nd Session of the 88th Congress, Washington, July 29, 1964. (To accompany Health aspects of nuclear weapons testing. Cesium-137 and strontium-90 rentention following an acute ingestion of Presented at the Second Conference on Radioactive Fallout from Nuclear Weapons Tests, Germantown, Maryland, 11/,3-6/64. In: AEC 5th Symposium Series, "Radioactive Fallout from Nuclear Weapons Growth status of children exposed to fallout radiation on Marshall Isianda Effects of ionizing radiation in children.

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iatMedical findings in Marshallese people exposed to fallout rad J. Am. Med. Assoc. 192 (6): 457-459, 1965. Medical survey of the people of Rongelap and Utirik Islands nine and ten years after exposure to fallout radiation (March 1963 and March 1964). Fallout of the cold war. New Eng. J. Med. 274 (25): 1462-1463, June 23, 1966. Elevation of the serum protein-bound iodine level-in inhabitants of the Thyroid nodules as a late sequela of radioactive fallout in a Marshall Island population exposed in 1954. New Eng. J. Med. 274: 1392-1399, 1966. Aging studies in a Marshallese population exposeh to radioactive fallout in Presented at the Colloquium on.Radiation and Aging, Semmering, Austria, June.23-24, 1966. In: RADIATION AND AGEING. Eds. P. J. Lindop and Medical Survey of'the People of Rongelap and Utirik Islands Eleven and Twelve Years After Exposure to Fallout Radiation' (March 1965 and March 1966). Chromosome Studies on Marshallese 1,slandersExposed to Fallout Radiation. Late Effects of Radioactive Iodine-in Fallout. Ann. Int. Med. 66: 1214-1242, 1967. I

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Further Developments of ThyroidiNodules in the Marshallese Population Accidentally Exposed to Radioactive Fallout in 1954. Fallout Radiation: Effects on the Marshallese People. and .I.W.'J. Carpender. Williams and Wilkins Co., Baltimore, 1969. Thyroid Nodules as .a Late Effect of Exposure to Fallout. I.A.E.A. Symposium on Radiation-Induced Cancer. International Atomic Energy Agency, Vienna, 1969. pp. 325-335. Effects of Fallout Radiation on Marshallese Children. In: RADIATION BIOLOGY OF THE FETAL AND JUVENILE MAMMAL. Eds. M. R. Sikov May 5-9, 1969. AEC Symp. Series 17. USAEC-TID, Oak Ridge, Tenn. pp. 661-673. Medical Survey of the People of Rongelap and Utirik Islands Thirteen, Fourteen ’ and Fifteen Years.After Exposure to Fallout Radiation (March 1967, March 1965, Possible Radiation-Induced Aging as Measured by Immuno-Hematological Changes Proc. Fourth International Congress in Radiation Research, Evian, France, Thyroid Neoplasia as a Late,Effect of Acute Exposure to Radioactive Iodine in J. Am. Med. Assoc. 214: 3167324, 1970. Immunohematological Studies of Marshall Islands Sixteen Years After Exposure