al a Utirik 2212 HOSPITAL OF THE MEDICAL RESEARCH CENTER, @NIT NO) DISCHARGE SUMMARY , . DISCHARGED: June 10, 1973 This 54-year-old Marshallese woman, who had a slight exposure to fallout radiation in the Marshall Islands in 1954,was admitted here for studies of thyroid nodularity ° In 1966, a emall 0.5 cm nodule was found . in the right lobe of the thyroid. Subsequent examinations showed an increase in the number of nodules of the gland,and in 1 The nodules were slightly tender to palpation. No lymphadenopathy was noted. She noticed the "lumps" on swallowing. She appeared euthyroid though her T-4 level in March was slightly low (3.7 gt). , ry March of this year three distinct nodules were palpated, two in the left lobe and lL near the isthmus, the largest being about 2 cm in the lower part of the left Lobe. She was exposed to 14 rada of gamma radiation and about 22 rads to her thyroid gland in 1954 from fallout exposure. No effects from thia exposure have been discernible. Examinations over the 19 years since the exposure have revealed the following: occasional cough, frequent worms in stools, joint pains with arthritic changes, tonsillar hypertrophy, multiple ilpomata. FAMILY AND SOCIAL HISTORY: Non-contributory. She appears euthyroid. . . CT ec ’ LABORATORY AND X-RAY DATA: wy ' Thyroid scan shows a large non-functioning nodule in the lower left lobe. Radioactive fodine uptake and response to TSH stimulation were adequate. T-4 level is not available yet. Her serum was non-reactive for antithyroid globulin antibodies.. Chest x-ray shoved cardiomegaly but the lungs were clear. EKG showed incomplete bundle branch block which was not considered significant. The hemogram showed alight Lymphocytosis (46%) and eosinophilia (14%) and increased ESR to 28.. She was found to be diabetic with FBS of 262 agi and spillage of sugar in the urine. Her kidney function was somewhat reduced with BUN of 27 ogi, urine albumin 50 mg, creatinine clearance 40.5%, urea clearance 30 agh. The AG ratio was 1.13 (not unusual io the Marshallese), cholesterol 264 mgZ, triglycerides 148 mg%, electrolytes and liver test generally normal. The syphilis serology was reactive (titer of 2) but was not considered significant in view of past history of yaws in so many of these people. Her stools were positive for trichuris trichura. o amination. it Positive findings on physical examinations included: slight obesity, multiple lipomata (asymptomatic), reduced hearing left ear and BP generally normal, but slightly elevated at times; slight cardiomegaly with no evidence of decompensation. Ber thyroid findings have not changed since those outlined above for the March ex- cl , fe PHYSICAL EXAMINATION: She remained generally asymptomatic during her 8-day hospital stay here except for a slight cough and non-specific muscle pains at times. With the finding of diabetes, she was placed on a 1400 calorie (ADA) diet. Since she continued to spill some sugar & HOSPITAL COURSE: ' . BML 720A - 128 - dott. MEDICAL HISTORY: * and evaluation of physical status for thyroid surgery. spect fetta Aiates al June 2, 1973 dnanantleded — therein ADMITTED: tosdetendaban htt bethaebaboans, dns ote nen allt tCni alllRae te RL eat, ae pandas? feed te Siete, tiaaatblBOAMR ahs Aa wee tld oe he 8-45-38 UPTON, NEW YORK 11973 Ares Code 516 YAphank 4-6262 oe BROOKHAVEN NATIONAL LABORATORY