PATLENT NO. 59 (continued) to The acute pneumonitis noted on admission responded well Hospital Course: le and asymptoacromycin and penicillin therapy, and the patient became afebri the upper matic within a few days. The right middle lobe showed clearing, but second ve positi ly slight the of view in and , lobe showed persistent changes that tuberculous strength reaction to the PPD, Dr. L. R. Sonders, Boston, felt infection was consistent with the findings though he considered it likely that . the process was inactive and not contraindicative to surgery The results of the thyroid study did not suggest any thyroid metabolic imbalance. Though the s BMR was somewhat low and the cholesterol low, the iodine fractionation studie was She and uptake studies as well as effect of stimulus of TSH were normal. on admitted to the New England Deaconess Hospital on June 6, and surgical excisi of the thyroid isthmus containing a 0.4 cm nodule was accomplished on June 8. The The patient withstood the surgery well and the wound healed per primam. hospital this ed to She was return histological diagnosis was adenomatous goiter. y, zid therap isonia on placed on was she On Dr. Sonder's recommendati on June 11. llin, penici on placed gy was she ve serolo In view of her positi 100 mg t.i.d. In addition, she was 600,000 units daily for a total dose of 6.5 million units. started on desiccated thyroid, 180 mg daily. return to the Marshall Islands. She was discharged on June 16 to A letter was sent to the medical authorities in the Marshalls advising them to continue the isoniazid for 2 years and thyroid They would be informed later of the results of the tubertherapy indefinitely. culous cultures, and, if possible, it was recommended that she be placed in the hospital for treatment with PAS. Diagnosis: (1) Adenomatous goiter. (2) Pulmonary tuberculosis--unspecified activity (002.9). (3) Positive serology (028.3). Discharge Medication: To continue indefinitely on thyroid hormone medication. This patient was seen in September, 1966, in the Marshall Islands, and she was found to be euthyroid on the hormone treatment, with no complications. PATIENT NO, 61 AGE 20 SEX HOSPITAL F Hospital of Medical Research Center, BNL This 20 year old Marshallese female was admitted to this hospital of a thyroid nodule which was discovered during the past year. DATE June, 1966 for evaluation History of Present Illness: As a 7 year old girl the patient was exposed to radioactive fallout in 1954. She was exposed to an estimated dose of 175 rads of whole-body gamma radiation, significant amounts of radiation to the exposed skin surfaces from deposition of fallout material thereon, and some internal absorption of fallout. It was estimated that the radioiodines absorbed delivered a dose to the thyroid in a range of 300-1,000 rads in addition to the 175 rads of gamma radiation. She had transient early gastrointestinal symptomatology which was followed some two weeks later by mild beta burns of the skin and moderate degree of epilation of the head. She also had leukopenia and thrombocytopenia within the first six weeks. She had largely recovered from these acute effects by one year post exposure. Her subsequent medical history shows no findings which could be related to radiation exposure. There were no noteworthy illnesses. Her growth 107