BROOKHAVEN NATIONAL LABORATORY | NAM : + UNIV NO. HOSPITAL of the MEDICAL RESEARCH CENTER DISCHARGE SUMMARY ADMITTED: 08-22-56R PAVILION Aug. 26, 1969 DISCHARGED: 1 OPD Sept. 22, 1969 This 2l-year-old Marshallese girl was admitted to this Hospital for evaluation of nodularity of the thyroid gland believed to result from radioactive fallout exposure in 1954, HISTORY OF PRESENT ILLNESS: She received an estimated’ 175 rads of whole body gamma radiation, radiation of the skin, and internal absorption of radioisotopes. The thyroid received in the range of 500-1000 rads from radioiodines absorbed, She had acute symptoms of radiation effects including transient anorexia and nausea followed by hematopoietic depression the development of wide-spread beta burns over che scalp and neck regions. She recovered from these effects during the firse year of post exposure. During the years following her exposure she has remained in generally good health and has had two normal deliveries of healthy Do Net Write In Binding Margin children, the last occurring in July, She has always appeared to be euthyroid with normal PBI and cholesterol values, In 1965 a small 3 om. nodule was discovered in the right lower lobe of the thyroid. In the following two years, however, the nodule was not noted. During the survey this past March 1969 she complained of a "lump in the throat" and a slightly irregular 1-2 cm, mass was noted in the lower left lobe. She had been very irregular about taking her thyroid hormone medication, since she has been on distant islands a large part of the time. PHYSICAL EXAMINATION: The physical examination revealed an alert, apparently euthyroid Marshallese female of about her stated age. The examination was essentially negative except for findings related to the thyroid gland. A slightly irregular mass was noted in the lower part of the left lobe of the thyroid. It was fairly far posterior and seemed to be slightly adherent to the trachea, Another B-B sized mass was noted anteriorly near the junction of the isthmus. LABORATORY AND X-RAY FINDINGS: Thyroid studies revealed: PBI 5.3 ug.%, total Llodine 5.5 ug.%, fodoprotein 0.8 wg.%, and T-4 4,2 g.%; BMR +3.5; cholesterol 187 mg.% and esters 136 mg.%. Thyroid autoantibodies showed less than 1-16 dilution reaction; scan showed a multinodular gland with slight enlargement of the left lobe; thyroid iodine uptake was normal but the response following TSH stimulation was poor. X-ray of the chest was negative. The only other laboratory finding of significance was the presence of ascaries and trichuris in the stool specimens. SURGERY AT THE CLEVELAND METROPOLITAN GENERAL HOSPITAL: The patient was transferred to the Cleveland Metropolitan Hospital on September 7, On September 9 Dr. Brown Dobbins carried out thyroid surgery. The gland contained several nodular areas some of which on frozen section appeared to be adenomatous lesions but others on frozen section appeared to be ONL 720A - 82 -