Rongelap 51 (NAME UPTON, NEW YORK 11973 08-50-52 R DISCHARGE SUMMARY CIRC 63 Ares Code 516 YAphank 4-6262 DISCHARGED: 3 June 1974 * ADMITTED: 27 May 1974 WNT NO) red BROOKHAVEN NATIONAL LABORATORY This 45-year-old Marshallese female was admitted for evaluation of her thyroid status in anticipation of possible surgery. MEDICAL HISTORY: In September 1973, a small nodule 0.5 cm in diameter was noted in the region of the lower left lobe of the thyroid, > By March 1974, che nodule - appeared to have grown slightly in size, She had always appeared euthyroid and her T4 levels were in the normal range. The patient was accitentally exposed to fallouc radiation in 1954 at age 24. She received an estimated 69 rads of whole body gamma radiation which caused mild depression of her blood elements during the first few weeks after exposure. Fallout contamination of the skin caused mild, transitory, beta burns of the skin during the first few weeks also, She also absorbed internally some radionuclides, the most serious of which were radioiodines. She remained generally healchy until ebour 1970, except that she was somewhat underweight and had an early menopause (age 42), after having had one miscarriage and one child, Since 1971 she has complained of frequent boucs of coughing, dyspnea, night sweating at times, and chest pain. She has had white-to-yellowish sputum, but denies hemoptysis. She claims to become dyspneic on exertion, and during the bouts of coughing sleeps propped up on pillows, Thyroid scan using 123, shows a focal area Of decreased radioactivity in people. She hadapositive syphilis serology, reactive, titer II. (In che Marshallese, infection with yaws, which was endemic years ago, not infrequently results in positive serology.) ree HOSPITAL COURSE: , , During the first few days of hospitalization, the patient remained in bed ae a good deal of the time. She coughed frequently and had slight increase in respiration, bringing up a whitish-yellowish sputum. She became dyspneic on exertion, She had a low-grade fever in the evenings. Her appetite was poor. In view of possible TB infection, isolation procedures were instituted, though subsequent tests and sputum findings did not substantifate such a diagnosis. Considering the possibility of bronchial infection, she was given tetracyclines and Tedral for cough. She improved in the last few days of hospitalization Ae Her RAI * te the middle and lower 1/3 of che left lobe of the thyroid laterally. uptake was 15.8% (Chest x ray showed increased lung markings, possible due to chronic bronchial disease. Numerous exams for AFB of che sputum were negative, boch on smear and by culture. No other consistent pathogenic organisme were found in the sputum. The EKG showed some T-wave abnormalities, which were not necessarily considered significant, Her hen_pgraa was negative except for. increased eceinophile which may have been related to the finding of whip-worm and trichurts trichura in her stools. She had slightly increased blood proteins, particularly globulins, which is not an unusual finding in the Marshallese 2 rw eae ntaeal LABORATORY & X-RAY DATA: ede wed, aes eget. bas HOSPITAL OF THE MEDICAL RESEARCH CENTER, -l- BML 720A - 138 -