Uririk 2221 HOSPITAL OF THE MEDICAL RESEARCH CENTER, BROOKHAVEN NATIONAL LASORATORY UPTON, NEW YORK 11973 Area Code $16 YAphank 4-6262 8-45-37R n AME) (UNIT NO) DISCHARGE SUMMARY ADMITTED: June 2, 1973 MEDICAL HISTORY: DISCHARGED: June 10, 1973 This 7li-year-old Marshallese woman was found to have a small thyroid nodule mune dba ce at the time of the regular annual examination of the Marshallese exposed to radioactive fallout this past March. The nodule was pea-sized, freely movable, and in the midportion of the right lobe. There was no lymphadenopathy noted. She was brought to the U.S. and admitted to this Hospital for thyroid studies and evaluation for thyroid surgery. Her previous thyroid history had been negative and she had always appeared euthyroid with low-co-normal thyroxin levels. Because of her radiation exposure, surgical exploration was deemed advisable. : She was exposed on Ucirik Island in 1954 to about 14 rads of gamma radiation fron fallout with a thyroid dose of about 22 rads (partly from radiviodine absorption). She showed no effects of the slight exposure, and the principal medical findings over the 19-year period since exposure have concerned the development of essential hypertension with possibly slight kidney involvement. Complaints have largely centered around arthritic pains and stiffness of the knees and legs and the develop- ment of poor vision. FAMILY Soc HISTORY: Irrelevant. This. slender, elderly, alert lady appeared healthy, euthyroid, and well-preserved for her age. The thyroid findings were as described above and during the March examination. Other findings included an early cataract formation of the lefe eye and the presence of hypertension (BP 200/96), and a moderately lewd systolic murnur. The heart was not thought to be enlarged and there was no evidence of cardiac decompensation. Pain and stiffness on moving the knees and lega may have been associatedwith arthritic changes. beue bo t me dase meow in tetas hake at one Mead Ade Dad ge + PHYSICAL EXAMINATION: - LABORATORY. AND X-RAY DATA: The thyroid scan showed a “cold” nodule hme at the lateral border of the right lode. Radioactive iodine uptake wes low-normal, and TSH administration showed reduced thyroid reserve. Her serum was non-reactive to antithyroid globulin antibodies. | Chest x-ray showed cardicmegaly and aortic sclerosis; alight increase in density near the- cardiac apex "probably due to old inflammatory disease", and a slight et ST , os ‘ - 130 - sa abel a Helle ee bli nb ate te deviation of the trachea. X-ray of the knees was negative. EKG was within norsal limits...The hemogram was normal except for 8% eosinophils and an ESR of 38. Aldoeterone- level was normal. Some kidney dysfunction was evidenced by BUN of 27, urine albumin 50 mgZ with 8-12 RBC/HPF, urea clearance 55% and creatinine clearance _ 39%. Other clinical chemistry Cests were generally negative, including tests for liver function, electrolytes, lipids, and serum prvteins. Stools were positive for ascaris lumbricoides and trichuris trichura. Syphilis serology was slightly positive (titer of 2) but this low level is not considered significant, particularly in view of possible yaws in the past which was prevalent in these people.