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

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TllE CURRENT STATUS OF THYROID DISEASE AMONG (The followirLg data are taken fr@n an informal report by Dr. Conard dated 4/20/71) The current =tatus may be updated as follows: I. 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 bicc;,emical tests. (There may be a slight unevenness uf the gland in 2. Currently hypothyroid with minimal modularity. Responding satisfactorily to oral thyroid hormone 3. Have under~one surgery in the U. S. prior to 1969 because of nodular thyroid disease; histologic diagnosis of adenomstous goiter and Huerthle cell tumor. P.esponclingsatisfactorily to oral thyyoid hormone therapy v,,itk,one exception: This patient shows some enlargement of the remnant of thyroid left frmr z partizl tkyroidectocy in 1565: as she has not followed iler po~t-operative thyroid hormone regimen, there is question as to whether she should have further surgery. 11 (58%) 4. Young people operated on for thyroid disease during August 1969 and recaver-ed. Diagnoses: Primary benign adenoxatous goiter in two and papillary adenoma of serious grade malignancy in one. 3 (167.) (None of six Ailinginae childyeu exposed to an estimated external dose of 69 rads have shown thyroid dysfunction.) II. Surviving adult Rongelapese exposed to fallout. (Estimated dose: 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 thyroid hormone therapy. 1 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.) 111. Surviving adult Ailinginae people exposed to fallout. (Estimated dose : 69 rads external ganma irradiation.) 1. Adenomatous goiter removed at age 45; reco~~ered end was on thyroid ~herapy. Died of influenza in 1968. Iv. Surviving adult L?tirik people exposed to fallout. (Estimated dose: 14 rads external gamma plus 15 rem internal irradiation.) 1. One person developed a nodular thyroid gland and underwent surgery in 1969. As the tissue resembled a follicular adenoma in frozen. section, a total thyroidectomy was performed; histologic sections confirmed the diag~osis and up~i~?~ti the degree of malignancy. She has recovered satisfactorily. 2. One persori with slight enlargement of one lobe of the thyroid to be treated conservatively and observed. One case of nodular thyroid hes been frond 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 iJtirik, Majuro or Ebeye. It appears that the exposed populations have stabilized so far as the thyroid reactions are concerned.

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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 conplete. 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 teams 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 grcm;~ of surveys as Brookhaven National Laboratory reports. These can be used as source books and in fact have been so used by agencies such as the Unite3 Nations. Subjects of special interest to medicine and radiation biology have been developed from the data these source books and published in the journals and proceedings referenced. PROVING GROUND: An Account of the Radiobiological Studies in the Pacific, 1946-1961. N. O. Hine. Chapters 7-11. Univ. Wash. Press, Seattle, 1962. 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 radiation 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. THE VOYAGE OF THE LUCKY DRAGON. R. E. Lapp. Harper O. Brothers, New York, 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. Brookhaven National Laboratory Report, BNL 384 (T-71), 1955. Physical factors and dosimetry in the Marshall Island radiation exposures.

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Skin lesions, epilation and nail piSm.entation in Marshallese and Americans l;aval >Iedical Research Institute and Naval Radiological Defense Laboratory, Response of human beings accidentally exposed to significant fallout radiation from a thermonuclear explosion. 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 TER’1 BIOLOGICAL HAZARDS OF A FALLOUT FIELD. 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 ?larshallese two years after 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 internall>- deposited radioactive isotopes in the Marshallese people by excretion analysis. >lay 5, 6, 7, and 9, 1959. Joint COE-XI.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 ~ongelap Atoll in the Marshall Islands. American J. Tropical Med. and Hygiene 8 (4): 417-423, 1959. Blood groupings in !q~rshallese. Effects of fallout radiation on a human population. -. 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 13-amino-isobutyric acid excretors in Micronesians. Medical survey of %larshallese 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 Conmunity exposed to local fallout. In: RADIOSIO”NPES IN THE BIOSPHERE. Chapter HI. Eds. R. S. Caldecott and L. A. Snyder, University of );innesota 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, 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. S~mp, on Diagnosis and Treatment of Radioactive Poisoning, 15-18 October 1962, Vienna. International Atomic Ener-gy 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 Cominittee on Interior and Insular Affairs, 2nd Session of the 88th Congr.ss, Washington, July 29, 1964. (To accompany Health aspects of nuclear weapons testing. Cesium-137 and strontium-90 retention 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 Islands. Effects of ionizing radiation in children.

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Medical findings in Marshallcse people exposed to fallout radiation: Results from a ten-year study. 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 sequels of radioactive fallout in a Marshall Island population exposed in 1954. New Eng. J. Med. 274: 1392-1399, 1966. Aging studies in a Marshallcse population exposed to radioactive fallout in Presented at tbtiColloquium 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 Islanders Exposed to Fallout Radiation. Late Effects of Radioactive Iodine in Fallout. Ann. Int. Med. 66: 1214-1242, 1967.

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Further Developments of Thyroid Nodules in the }larshallese Population Accidentally Exposed to Radioactive Fallout in 1954. Fallout Radiation: Effects on the Marshallese People. and J. 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 lfarshallese Children. In: RADIATION BIOLOGY OF THE FETAL AND JUVENILE MAM31AL. Eds. M. R. Sikov and D. D. Mahlum. Ninth Hanford Biology Symp., Richland, Washington, May 5-9, 1969. AEC Symp. Series 17. USAEC-TID, Oak Ridge, Term. pp. 661-673. Medical Survey of the People of Rongelap and Utirik Islands Thirteen, Fourteen and Fifteen Years Af~er Exposure to Fallout Radiation (March 1967, March 1968, Possible Radiation-Induced Aging as Measured by Immuno-Hematological Changes Proc. Fourth International Congress in Radiation Research, Evian, France, Thyroid Ncoplasia as a Late Effect of Acute Exposure to Radioactive Iodine in J. Am. Med. Assoc. 214: 316-324, 1970. Immunohematological Studies of Marshall Islands Sixteen Years After Exposure