Utirik 2212 HOSPITAL OF THE MEDICAL RESEARCH CENTER, BROOKHAVEN NATIONAL LABORATORY UPTON, NEW YORK 11973 Area Code 516 YAphank 4-6262 8-45-38 (NAME (UNIT NO] “DISCHARGE SUMMARY -2in the urine, she was placed on 15 units NPH Insulin daily which controlled her diabetes. With the diabetes controlled, the slightly impaired kidney function was not considered serious enough to preclude surgery and she was discharged June 10th for transfer to Cleveland. At Cleveland Metropolitan General Hospital, Brown Dobyns. thyroid surgery was performed by Dr, The day before surgery she was given 25 pCi 13lz in order to do autoradiographic studies on the removed thyroid tissues. At surgery, a left lobectomy was performed removing several cystic nodules from that lobe. A diagnosis of Hurthle cell adenomata on frozen section prompted the complete removal of that lobe. A further adenoma was removed from the isthmus and several tiny nodules were removed from the right lobe. The patient withstood surgery well and her convalescence was uneventful. She was continued on insulin and dietary treatment. FINAL DIAGNOSIS : : Mixed follicular cell and Burthle cell adenomata of the thyroid. Borderline hypertension with slightly reduced kidney function. DISCHARGE HEDICATION: Under normal circumstances with a left thyroid lobectomy and subtotal on the right, somewhat depressed metabolism might be expected and 0.1 to 0.2 mg of L- thyroxin would be given daily. However, since this lady is older, has diabetes and a tendency to hypertension, it was deemed advisable to observe her for a few months before making the final decision on treatment. She was advised to attend the diabetic clinic at the Majuro hospital and maintain her diet. The practitioner accompanying the patients was advised to continue the insulin therapy. If the patient later was moved back to her isolated home at Utirik Island, the treatment would have to be re-evaluated. RAC: bwa obert A. Conard, M.D. Dict: 6/27/73 Typed: 6/29/73 Nt 720A - 129 -