Appendix § HOSPITAL RBQORDS OF THYROID CASES (1968-1969) BROGKHAVEN NATIONAL LABORATORY HOSPITAL of the MEDICAL RESEARCH CENTER UPTON, NEW UNIT NO. ongelap 19 8-18-91 B YORK DISCHARGE SUMMARY ADMITTED: [N AUGUST 4, 1968 PAVILION 1 OPD DISCHARGED: AUGUST 30, 1968 This 17-year-old boy was admitted to this Hospital for evaluation of a nodular thyroid gland which did not respond satisfactorily to treatment in the islands. Do Nol Write In Binding Margin HISTORY OF PRESENT ILLNESS: In 1966 che thyroid gland was found to be slightly enlarged with irregular soft nodularity with a more distinct I cm. nodule detected in the right lower lobe. — He had been put on thyroid hormone therapy (Synthroid, 0.3 mg. / day) since September 1965 but had only taken the drug for one month. e took thyroid medication thereafter however and in 1967 it was thought that his thyroid nodularity had reduced somewhat, However in 1968 a new 1 cm. thyroid nodule was palpated in the upper left lobe, and a nodule was still palpated in the right lower lobe. Earlier PBI's were 6.4 we% in 1958 and 4.1 pg in 1959 with BEI of 2.7 wed. His 1968 serum was lost. He has appeared to be euthyroid. His stature has remained abouc 2 years behind his peers, In view of his Lack of response to thyroid hormone therapy it was decided that he should be fully evaluated here, — The patient was 5 years old at the time of the fallouc, He received an estimated 175 rads of whole body gamma radiation, irradiation of the skin from the fallout deposited thereon and internal absorption of radicisotopes. His thyroid gland received about 700-1400 rads plus 175 rads of gamma radiation, During the first two days he experienced loss of appetite and nausea. About 2 weeks postexposure he developed "Beta burns" of the skin mainly on the scalp, axillary and anal region and feet. These healed rapidly. He also developed rather marked epilation with normal regrowth of hair occuring in several months. His pertpheral blood leukocyte count was depressed but within a year had returned to near normal levele. There was no evidence of che clinical radiation syndrome associated with the hematologic depression. Following recovery from the early radiation effects he remained in good health with no serious illnesses or injuries. No evidence of thyroid disease has been apparent and the PBI and thoroxine (T-4) levels were 3.9 and 3.3 uwg% in 1966. His serum TSH level was not elevated at that time. statural growth has been somewhat below that of his peers. His PHYSICAL EXAMINATION: This 17-year-old Marshallese boy was of rather shorter stature than most Marshallese males of his age but he appeared well-nourished and wae wtthoat complaints. The only notable physical findings were related to the thyroid gland. The left lobe of that gland was slightly enlarged, soft and slightly tender. In the lower pole of the right lobe there was a 1-2 cm, nodule of firmer consistency. No regional lymph adenopathy was noted. The patient appeared to be euthyroid, LABORATORY & X-RAY DATA: Thyroid workup: Thyroxine 3.0 ugi; cholesterol 110 mg% (82% esters); BMR -1, -16; thyroid scan winh 99m, showed a cold nodule indenting the lower right pole of che thyroid, I uptake and a repeat uptake study following TSH, 10 units daily for 3 days, showed a poor response to the pituitary hormone. The BNL 720A - 67 -