. BROOKHAVEN NATIONAL LABORATORY [ Name UNIT NO. 8-18-89 R HOSPITAL of the MEDICAL RESEARCH CENTER Reneelap 23 UPTON, NEW YORK DISCHARGE SUMMARY PAVILION ADMITTED: AUGUST 4, 1968 1 OPD DISCHARGED: AUGUST 30, 1968 This 18-year-old Marshallese boy was admitted to this Hospital for evaluation of nodules of the thyroid gland resulting from fallout exposure in 1954. HISTORY OF PRESENT ILLNESS: Though nodules of the thyroid Do Not Write in Binding Margin gland were first noted at the time of the 1967 medicel examinations development of the nodules could have occurred earlier since the boy had not been examined in 1966. Multiple, small, non-tender nodules were palpated in the gland with one larger nodule about 1.5 cm. in the right lobe, and a smaller one in the left lobe. He appeared to be euthyroid and normally developed, His serum thyroxin level in March was 4.5 ug and serum cholesterol 188 mg% (in 1967 his thyroxin level was 2.3 gi). L-thyroxine (Synthroid, 0.3 mg./day) was prescribed in 1967 but his adherence to the treatment regimen was spasmodic. Therefore during the 1968 examinations it was decided that since his thyroid nodules had not reduced, hospital evaluation was indicated. The patient was 4 years of age at the time of exposure to fallout on Rongelap. He received a whole body dose estimated to be 175 rads, expesure to the skin (unknown dose} and a dose to the thyroid gland from absorbed radioiodines of about 700-1400 rads plus 175 rads of penetrating gamma radiation. Relative lymphopenia was noted at 3 days slight leukopenia at 6 weeks followed by rapid return to the normal range. He developed slight "Beta burns" on che neck, axillary and anal region which cleared up in a few weeks. He had moderate epilation of the temple with complete regrowth of hair by 6 months. Wo clinical evidence of irradiation syndrome was apparent at any time. Anthropometric measurements and skeletal age studies have revealed normal growth and development with no evidence of thyroid deficiency. A PBI level in 1958 was 9.6 pgh. Since the examination in March, 1968 he has been asymptomatic and in goodhealth, He has been on thyroid medication intermittently. PHYSICAL EXAMINATION: The patient is a husky 18-year-old Marshallese boy and appears to be in excellent health, Principal findings were related to the thyroid gland. The tight lobe showed enlargement with a 3 cm. soft irregular nodule in the lower portion. The nodule was slightly tender to deep palpation. An enlarged lymph node was noted in the right submaxillary region but no other regional adneopathy was noted, The patient appeared to be euthyroid. Except for a slight ringworm infection over the shoulders the remainder of the physical examination was essentially negative. LABORATORY & X-RAY DATA: Thyroid workup showed the following: the thyroxin level was 4.6 pgt, cholesterol 119 mgh (72Zesters). Test for serum antithyroglobulin antibodies was negative: a thyroid scan (using 99mp¢) showed tater ee cold area over most of the right lobe of che gland. Thyroid uptake of uptake was in the lower BML 720A - §9 +