PATIENT NO, 20 (continued) skin surfaces, and s ome gamma dose of 175 rads, an undetermined dose to the ted that the thyroid estima internal absorption of fallout material. It was largely from radiorads, 400 gland received a dose of somewhere between 700-1, t iodine absorbed in the fallout. He was nauseated the day following the fallou two weeks and also complained of some itching and burning of the skin. About of burns ion radiat with along head, the after exposure, he had epilation of only with healed and severe not s were lesion These the sealp, neck, and toes. 6 by regrew hair The weeks. ing follow the on in slight residual depigmentati months. He showed mild leukopenia and platelet depression during the first several months following exposure but with no complications. His blood elements Since that had returned to the normal range by the end of the first year. euthyroid been ntly appare has and health good lly in genera been has he time (1963 PBI 5.5 wg%). Compared with unexposed boys of the same age, however, he has shown a slight degree of retardation in growth based on anthropometric and bone age studies. Physical Examination: The patient was well nourished and developed but appeared to be somewhat smaller than normal for his age. The thyroid was not enlarged, but a 1.5 em diameter nodule, firm in character, was noted in the right lower pole of the gland. The nodule was not tender and moved on swallowing. No other nodules were palpated and no regional adenopathy was noted. of the physical examination was essentially negative. Laboratory and X-Ray Data: Thyroid Work-Up: PBI 6.1 we%, The remainder iodine fractionation: totul I 6.5 pe%, iodoprotein 1.3 wg%, thyronine (T4 + 13) 4.2 pg%. Thyroid autoantibodies under 1:16. Cholesterol 170 mg% with esters 144 mg%. BMR -12. Thyroid Sean (99™Tc) showed "cold" nodule at lower lobe. 132] uptake studies showed 40% uptake in 6 hours with 32.5% urinary excretion at that time. Following TSH stimula: tion for three days, the uptake was only 33.7% at 5-1/2 hours, with urinary excretion 18.5%. PBI 6.8 ueg%. The blood count was within normal limits; alkaline phosphatase was slightly low (4.4 units), total protein slightly elevated, 8.2 gm with globulins 3.9 gm. Within normal ranges were: prothrombin time, sedimentation rate, bilirubin, cephalin flocculation, transaminase, Ca, P, thymol turbidity, FBS, BUN, CO>, Cl, Na, K. Normal also were EKG, slit lamp examination, urinalysis, and stools for ova and parasites. chest. Chest plate showed no active disease in the Hospital Course: The patient remained asymptomatic while here. On July 5 he was taken to New England Baptist Hospital in Boston, Massachusetts for surgery. Dr. Bentley P. Colcock removed about 3.1 cm of thyroid tissue which contained multiple nodules varying in size up to 1 cm in diameter. They varied from pale grey and firm to pulpy and semicystic and deep red. The pathologic diagnosis was adenomatous goiter. His recovery was rapid and uneventful. He was returned to Brookhaven on July 13 where he remained asymptomatic and was discharged on July 18, 1965, fit to travel back to the Marshall Islands. Diagnosis: Adenomatous goiter. Discharge Medication: No immediate drug therapy was recommended. However, this patient will receive desiccated thyroid, 180 mg daily beginning in September, along with the remainder of the exposed Rungela>d people. 101