BROOKHAVEN NATIONAL LABORATORY HOSPITAL of the MEDICAL RESEARCH CENTER UPTON, NEW YORK DISCHARGE SUMMARY ADMITTED: [ NAME Rengelap 54 PAVILION AUGUST 4, 1968 UNIT NO. DISCHARGED: 8-18-90 R 1 OPD AUGUST 30, 1968 This 15-year-old Marshallese boy was admitted to this Hospital for evaluation of a nodular thyroid gland resulting from exposure to radioactive fallout in 1954, Do Not Write In Binding Margin HISTORY OF PRESENT ILLNESS: In 1965 the patient's thyroid revealed a slight diffuse enlargement. In 1966 more definite enlargement with small nodules in the left lobe and isthmus ' were detected, He was placed on L-thyroxine treatment, but he has been very inconsistent in taking the drug. The 1967 and 1968 examinations revealed that the nodules had enlarged, the one in the left lobe being about 2 cm. in diameter. The nodules were firm but not hard and not tender. Though some exposed Rongelap children have shown some degree of hypothyroidism and growth retardation this boy has appeared euthyroid with normal growth and development. His serum thyroxin level (T-4) over the pase three years has been 4.3, 4.8 and 4.6 u:g% and his serum cholesterol 98 mgi. The patient was 1 year of age at the time of exposure. He received an estimated 175 rads of whole body gamma irradiation, heavy irradiation of the skin and internal absorption of radioisotopea. The thyroid gland receivéed about 700-1400 rad from radioiodines absorbed plus 175 rad of gamma radiation. He developed marked "Beta burns" of the skin. The lesions cleared however without complications within several weeks. He had slight transient epilatim of the scalp and cyanotic changes in the fingernails also. During the first six weeks he developed a leukopenia and a platelet depression. However he never shaed any clinical evidence of the radiation syndrome and hia blood counts approached normal by one year, Yearly anthropometric measurements and skeletal age studies have revealed normal growth and development and he has always appeared to be euthroid (substantiated by normal PBI's and serum cholesterol levels). Since examined in March 1968 che patient has been asymptomatic and in good health. has taken his thyroid medication intermittently. He PHYSICAL EXAMINATION: This 15-year-old Marshallese boy appeared to be well-nourished and of normal size for his age, Examination of the thyroid gland revealed that the left lobe was enlarged with multiple soft nodules palpable. A few small nodules were believed to be present also in the right lobe. A few small anterior cervical lymph nodes were palpable. The patient appeared to be euthyroid. There were no other no notable findings on physical examinations other than a mild tenia versicola infection of the face, arms and trunk. LABORATORY & X-RAY DATA: Thyroid workup: serum thyroxin 4.9 ueg%, cholesterol 145 mgZ, (75Zesters); BMR - 13, -10; serum antithyroglobulin antibodies negative. Thyroid scan using I.V. 9%™tc showed large defects along the lateral aspects of the left lobe I uptake was normal and a good response was obtained to TSH stimulation (10 units, I.M. daily for 3 days); thyroxin level increased from 4.9 to 6.3 gt. @NL 720A -71-