Ucirik 2212
HOSPITAL OF THE MEDICAL RESEARCH CENTER,
BROOKHAVEN NATIONAL LABORATORY
8-45-38
UPTON, NEW YORK 11973
Area Code 516 YAphank 46262
,
{UNIT NO.)
DISCHARGE SUMMARY
ADMITTED:
June 2, 1973
DISCHARGED:
June 10, 1973
This 54-year-old Marshallese woman, who
had a slight exposure to fallout radiation
in the Marshall Islands in 1954,was admitted here for studies of thyroid nodularity
and evaluation of physical status for thyroid surgery.
MEDICAL HISTORY:
In 1966, a emall 0.5 cm nodule was found
in the right lobe of the thyroid.
Subse-
quent examinations showed an increase in the number of nodules of the gland,and in
March of this year three distinct nodules were palpated, two in the left lobe and
1 near the isthmus, the largest being about 2 cm in the lower part of the left Lobe.
The nodules were slightly tender to palpation. No lymphadenopathy was noted. She
noticed the "lumps" on swallowing. She appeared euthyroid though her T-4 level in
March was slightly low (3.7 wg%).
She was exposed to 14 rads of gamma
radiation and about 22 rads to her thyroid
gland in 1954 from fallout exposure. No effects from this exposure have been discernible. Examinations over the 19 years since the exposure have revealed the
following:
occasional cough, frequent worms in stools, joint pains with arthritic
changes, tonsillar hypertrophy, multiple lipomata.
FAMILY” AND SOCIAL HISTORY:
Non-contributory.
PHYSICAL EXAMINATION:
Positive findings on physical examinations
included:
slight obesity, multiple
lipomata (asymptomatic), reduced hearing left ear and BP generally normal, but
slightly elevated at times; slight cardiomegaly with no evidence of decompensation.
Her thyroid findings have not changed since those outlined above for the March examination.
She appears euthyroid.
LABORATORY AND X-RAY DATA:
Thyroid scan shows a large non-functioning
nodule in the lower left lobe.
Radioactive
iodine uptake and response to TSH stimulation were adequate. T-4 level is not
available yet, Her serum was non-reactive for antithyroid globulin antibodies.
Chest x-ray showed cardiomegaly but the lungs were clear. EKG showed incomplete
bundle branch block which was not considered significant. The hemogram showed
slight lymphocytosis (46%) and eosinophilia (14%) and increased ESR to 28%. She was
found to be diabetic with PBS of 262 mg% and spillage of sugar in the urine. Her
kidney function wae somewhat reduced with BUN of 27 mg%, urine albumin 50 mg%,
creatinine clearance 40.5%, urea clearance 30 mg%Z.
The AG ratio wae 1.13 (not
unusual in the Marshallese), cholesterol 264 mg, triglycerides 148 mg%, electrolytes
and liver test generally normal. The syphilis serology was reactive (titer of 2)
but was not considered significant in view of past history of yaws in so many of
these people.
Her stools were positive for trichuris trichura.
HOSPITAL COURSE:
She remained generally asymptomatic during
her 8-day hospital stay here except for a
slight cough and non-specific muscle pains at times.
she was placed on a 1400 calorte (ADA) diet.
With the finding of diabetes,
Since she continued to spill some sugar
ONL 720A
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