APPENDIX 6 Hospital Summaries of Thyroid Surgical Cases PATIENT NO, 1? This AGE SEX 14 F HOSPITAL DATE U.S. Naval Hospital, Guam August, 1964 14 year old female, a native of Rongelap Atoll, was referred here for manage- ment of a palpable nodule in the left lobe of the thyroid, recently discovered, associated with no symptoms suggestive of dysfunction of the thyroid gland. Rongelap was inadvertently irradiated by fallout from an atomic bomb blast in 1954, when this child was 4 years of age. After the fallout she had developed an anemia, a leukopenia, and second degree burns, all of which lasted for several months. Admission work-up was within the limits of normal except for the presence of a soft, 1.2 cm nodule in the left lobe of the thyroid, near the isthmus. Laboratory studies including chest x-ray were within the limits of normal. r She was admitted on 8/17/64, and a total thyroidectomy performed on 8/19/64, with dissection of the anterior compartment of the neck. Postoperatively the patient did well so far as healing of the wound was concerned, but within 24 hours she showed a suggestion of neuromuscular hyperirritability. On that same day a serum calcium was reported as 8.5 with a phosphorus of 4.3. She was begun on oral vitamin B, and-calcium lactate tablets. A few days later aluminum hydroxide gel was added as another oral medication, and a high calcium, low phosphorus diet was begun. Thereafter the patient began rapidly to show evidence of regeneration of parathyroid function of her own, so that a gradual weaning of medications was begun. By 9/16/64 she was off all medication except the diet and amphojel. These were discontinued on 9/23/64, and when her serum calcium and phosphorus remained normal she was discharged on 10/1/64. Throughout her hospital stay after the completion of her thyroidectomy she was maintained on thyroid extract gr. 1 - 3 times daily. This is believed necessary for replacement therapy, and it is recommended that this be continued indefinitely. Microscopic examination of the removed thyroid was strongly suggestive of the suspected malignancy. However, review of the slide by the AFIP yielded a final diagnosis of nodular thyroid goiter with no evidence of malignancy. Follow-Up: Since discharge from the hospital the patient has remained asymptomatic on thyroxine therapy. In March, 1966, after being off thyroid hormone for three weeks (temporarily for test purposes), her TSH level was elevated to 342 mug/ml and 132y uptake nil, indicative of athyroid status. She had maintained a euthyroid status on 3 mg levothyroxine daily and has shown no recurrence = ve of nodules. 96