PATIENT NO. 42 (continued) Discharge Medication: Thyroid hormone medication to be continued indefinitely. This patient was seen in September, 1966, in the Marshall Islands, and she was found to be éuthyroid on the hormone treatment,with no complications. PATIENT NO, AGE 59 46 SEX HOSPITAL DATE F Hospital of Medical Research Center, BNL June, 1966 This 46 year old Marshallese woman had been exposed to radioactive fallout in 1954 and was admitted for evaluation of a nodule of the thyroid gland. History of Present Illness: In September, 1965, during a thyroid survey of the Rongelap people, a 0.5 cm nodule was noted in the left isthmic region of the thyroid. This patient had received a smaller dose of radiation at the time of the fallout than the other Rongelap patients admitted here at this time. The calculated dose to the thyroid gland was about 115 rads (69 rads from whole body gamma radiation, and about 40 rads from radioiodines)}. She had few signs of acute radiation effects except for mild "beta burns", and slight thrombocytopenia following exposure. Since this time she had remained generally in good health. Her disease history includes chickenpox, mumps, yaws, and gonorrhea. She has had recurring attacks of bronchitis though x-rays of the chest have been considered negative in the past. She had always appeared to be euthyroid with PBIs in 1958 and 1965 in the normal range for the Marshallese. lLodine fractionation studies in March, 19646, were normal. : Physical Examination: On admission the patient was febrile, and it was thought that she might have bronchopneumonia, bronchitis, influenza, or possibly tuberculosis. Thyroid examination showed the gland not to be enlarged, but a freely moveable 1 cm nodule in the lower part of the gland was palpated. There was no lymphadenopathy. The remainder of the physical examination was essentially negative. Laboratory and X-Ray Data: Pulmonary Studies: Chest plates on May 26 and 27 showed possible pneumonitis in the upper and middle right lobes of the lungs which were believed to be of partly acute, partly chronic nature (Tbc?). A chest plate on 5/31 showed that the middle lobes remained essentially unchanged. PPD showed slight reaction to second strength test. Hemogram showed neutrophilic leukocytosis on admission which returned to normal about 5 days later. Thyroid Studies: BMR -27 and -24. PBI 6.4 wgi, T3 13.9%, thyroxin iodine 5.0 pe%. Antithyroid antibodies under 1:16. Cholesterol 102.8 (94.3 esters). Thyroid scan using 99m~¢ revealed no nodules and normal uptake. 132] showed 19.8% uptake in 6 hours with 45% urinary excretion. Following TSH (10 units daily for 3 days), the uptake increased to 54.9% in 6 hours with urinary excretion rate of 20.3%. EKG was normal. Except for weakly positive VDRL and REITER protein complement fixation test, other laboratory tests were generally negative. 106