Rongelap 40 HOSPITAL OF THE MEDICAL RESEARCH CENTER. BROOKHAVEN NATIONAL LABORATORY UPTON, NEW YORK 11973 Area Code 516 YAphank 4—6262 _ (NAME) 08=45-42R ‘eat NO) DISCHARGE SUMMARY ADMITTED: June 2, 1973 DISCHARGED: June 10, 1973 Thia 48-year old Marshallese man who had been exposed to radioactive fallout in 1954 was admitted for evaluation of thyroid nodularity and physical status for possible thyroid surgery. HISTORY: A small nodule in the right lobe of the thyroid was first detected in 1965. He, along with other people of Rongelap who had been exposed to radiation had been placed on L-thyroxin treatment and the nodule disappeared on this treatment. However, during the recent examinations in March, he was again discovered to have a hardened area in the right lobe with indistinct boundaries. No lymphadenopathy was noted. He has always appeared euthyroid and his thyroxin levels have generally been in the normal range, with only one reading slightly slow. He was exposed to 175 rad of gamma radiation from accidential fallout of 1954 and his thyroid gland probably received about 330 rads partly from radioactive iodines absorbed. He had early acute effects with hemological depression and mild “beta burns of the skin which he recovered from within a year. Examinations over the past 19 years have revealed only a few findings: The history of yaws in childhood, measles, occasionally bronchitis, one possible attack of pneumonia, a fistula-in-ano which was surgically corrected. He has remained in very good health and is a hard worker and leader of his people. He was magistrate of the village at the time of the fallout. His wife was operated for cancer of the thyroid, three sona for benign thyroid lesions, and 1 son died at 19 years of age with acute leukemia (possible from radiation exposure). EXAMINATION: This well developed, muscular, alert man JABORATORYANDX-RAYDATA: Thyroid scans showed no distinct nodularity appeared quite healthy and euthyroid. The thyroid findings noted were the same as were reported above for the March examination. The only other findings were bilateralprer;;..c , missing teeth and gingivitis. but slightly increased aize of the right lobe. Radioactive iodine uptake was normal and response to TSH stimulation was fair. T-4 levels are not reported yet. Serum was nonreactive for antithyroid globulin anti- bodies. Chest X-Ray was normal. Hemogram was normal. Syphilis serology was reactive (titer of 4) but this low level waa not considered significant in view of his history of having had the yaws. Tests of kidney function and liver function were normal. Electrolytes normal, EKG normal, proteina normal, electrolytes and lipids normal. Stools were positive for whipworn. HOSPITALCOURSE: During the 8 days of his hospital stay, the patient was a symptomatic until the Sth day when following TSH injection (given the previous day) he developed an acute thyroiditis with low grade fever, nausea, anorexia and slight neutrophilia. showed some enlargement of the gland.. The thyroiditis reduced rapidly and at the SNL 720A - 122 - Scan