PATIENT NO. 64 (continued) s. The EKG was within normal limits. Stools were negative for ova and parasite . negative were is metastas for bones Roentgenograms of the chest and Her hospital course was uneventful. Hospital Course: Surgery at New England Baptist Hospital, Boston, Massachusetts: The patient was transferred to the Baptist Hospital in Boston on July 5, 1965, and the following day under general anesthesia the neck was explored by Dr. Bentley P. Colcock. The thyroid nodule was found to be malignant, and he performed a subtotal thyroidMicroscopic study of ectomy leaving a small portion of the left lobe intact. the tissues gave the following pathologic diagnosis: "Mixed papillary and follicular carcinoma of the right lobe with blood vessel invasion and metastasis to one lymph node. Negative parathyroid (right). Left lobe of thyroid shows no Aside from mild postoperative nausea and vomiting, she significant changes." In_ view of the positive diagnosis recovered very rapidly from the operation. of malignancy, on July 15 she was given 30 mc 131r in order to wblate the remainder of the th: roid gland and any possible residual meta: .tic foci. She was returned to this hospital on July 16, 1965. She remained iv: good health and was discharged on July 18, fit for travel back to the Marshall Islands. Mixed papillary and follicular carcinoma of the right lobe of the Diagnosis: thyroid gland with blood vessel invasion and metastasis to one lymph nede. Discharge Medication; On August 1 she is to begin taking desiccated thyroid, 120 mg daily. She is to remain under the direct supervision of one of the Marshallese practitioners on her return. Follow-Up: Patient has apparently maintained "euthyroid status" on 3 mg of levothyroxine daily. In March, 1966, she was to have a complete hospital checkup at Tripler Army Hospital in Hawaii but was found to be 5 months pregnant, and the examination was delayed until after birth of her baby. In September, 1966, at Tripler General Hospital, Hawaii, thyroid uptake studies following TSH stimulation (10 units daily for two days), thyroid scans, and skeletal surveys for metastasis showed absence of the thyroid and no detectable metastasis. PATIENT NO. 33 AGE 13 SEX F HOSPITAL Hospital of Medical Research Center, BNL DATE June, 1966 This 13 year old Marshallese girl was admitted to evaluate a thyroid nodule which was discovered during the past year. History of Present Illness: The patient was 1 year old at time of exposure to fallout and received about 175 rads of gamma radiation, radiation of the skin from falloti deposited thereon and some internal absorption of radioisotopes. It was estimated that her thyroid gland received 700-1,400 rads from the radioiodines absorbed in addition to the 175 rads of gamma radiation. Acute effects of her exposure consisted of beta burns of the skin and extensive epilation of the scalp. She also developed transient leukopenia and thrombocytopenia. By one year she had recovered from these acute effects and remained generally in good health. Her growth and development has been about normal with menarche occurring at age 13. In September, 1965, she was thought to have an irregularity of the thyroid gland, 103