BROOKHAVEN NATIONAL LABORATORY [Name UNIT NIT NO. MOSPITAL of the MEDICAL RESEARCH CENTER UPTON, NEW YORK Rengelap 36 DISCHARGE SUMMARY ADMITTED: PAVILION Aug. 26, 1969 08-22-60R 1 DISCHARGED: OPD Sept. 22, 1969 This 22-year-old Marshallese boy was admitted to this Hospital for evaluation of nodularity of the thyroid gland following exposure to radioactive fallout 15 years ago (1954). Do Not Write In Binding Margin HISTORY OF PRESENT ILLNESS: The patient was 8 years old at the time he was exposed to fallout and received an estimated 17£ rads of whole body gamma radiation, beta radiation of the skin, and interz:l absorption of radioisotopes, It is estimated that his thyroid gland received approximately 500-1000 rads from radioiodines plus the gamma dose of radiation. He experienced early effects of radiation exposure including beta burns of the skin and transient leukopenia and platelet depression. He never showed any clinical evidence of the radiation exposure and by one year he had recovered from the acute findings. His subsequent medical history has been largely negative up to the present thyroid findings. He has had no retardation of growth and development and has always appeared to be euthyroid, The first indication of thyroid abnormality was noted in 1966 when the gland was found to be slightly enlarged with a soft, 1 cm, diameter prominence in the lower right lobe with several small nodules noted on the left side also. His PBI and cholesterol levels were normal at that time. During the next two years continued enlargement of the nodules of the thyroid were noted and the T-4 level had reduced 2.6 ug.%. Examination this past March (1969) revealed chat the mass in the lower right lobe was about 2-3 cm. in diameter with a cluster of smaller nodules in the left side believed to be attached to the trachea. The T-4 level was again 2.6 wg.%. However, he appeared to be euthyroid. The patient had two brothers who had benign nodules removed a year ago, and his mother had a malignant lesion removed several years ago from the thyroid, PHYSICAL EXAMINATION: The patient was alert, healthy, and appeared to be euthyroid. Except for mild fungus infection of the skin the main findings were related to the thyroid gland. <A soft prominence, 2-3 cm. in diameter, was noted in the right lower pole of the thyroid, Several lesser nodularities appeared to be present on the left side. No associated lymphadenopathy was detected. LABORATORY AND X-RAY FINDINGS: Thyroid studies revealed: PBI 4.3 wg.%, total Llodines 4.6 wg.%, Lodoproteins 1.6 ug.%, and T-4 3.2 yx.%; BMR +32; cholesterol 142, esters 107 mg.%. Thyroid scan showed a multinodular thyroid with rather marked enlargement of the right lower lobe which contained mainly nonfunctioning tissue, Iodine uptake was normal but response to TSH stimulation was poor, Hemogram and blood chemistry findings were generally negative. X-ray of the chest was normal, 1-16 dilution reaction, Thyroid autoantibodies showed less chen BNL 720A - BO -