HOSPITAL OF THE BROOKHAVEN UPTON, Area Code Utirik 2212 MEDICAL RESEARCH CENTER, NATIONAL LABORATORY NEW YORK 11973 516 YAphank 4-6262 8-45-38 NAME) {UNIT NO.) DISCHARGE SUMMARY ADMITTED: June 2, 1973 DISCHARGED: June 10, 1973 This 54-year-old Marshallese woman, who had a slight exposure to fallout radiation in the Marshall Islands in 1954,was admitted here for studies of thyroid nodularity and evaluation of physical status for thyroid surgery. MEDICAL HISTORY: In 1966, a emall 0.5 cm nodule was found in the right lobe of the thyroid. Subsequent examinations showed an increase in the number of nodules of the gland,and in March of this year three distinct nodules were palpated, two in the left lobe and 1 near the isthmus, the largest being about 2 cm in the lower part of the left lobe. The nodules were slightly tender to palpation. noticed the "jumps" on swallowing. March was slightly low (3.7 pg). No lymphadenopathy was noted. She She appeared euthyroid though her T-4 level in She was exposed to 14 rads of gamma radiation and about 22 rads to her thyroid gland in 1954 from fallout exposure. No effects from this exposure have been discernible. Examinations over the 19 years since the exposure have revealed the following: occasional cough, frequent worms in stools, joint pains with arthritic changes, tonsillar hypertrophy, multiple lipomata. FAMILYAND SOCIAL HISTORY: Non-contributory. PHYSICAL EXAMINATION: Positive findings on physical examinations included: slight obesity, multiple lipomata (asymptomatic), reduced hearing left ear and BP generally normal, but slightiy elevated at times; slight cardiomegaly with no evidence of decompensation. Her thyroid findings have not changed since those outlined above for the March ex- amination. She appears euthyroid. LABORATORY AND X-RAY DATA: Thyroid scan shows a large non-functioning nodule in the lower left lobe. Radioactive fodine uptake and response to TSH stimulation were adequate. T-4 level is not avallable yet. Her serum was non-reactive for antithyroid globulin antibodies, Chest x-ray showed cardiomegaly but the lungs were clear. EKG showed incomplete bundle branch block which was not considered significant. The hemogram showed slight lymphocytosis (46%) and eosinophilia (14%) and increased ESR to 2@.. She was found to be diabetic with FBS of 262 mgZ and spillage of sugar in the urine, Her kidney function was somewhat reduced with BUN of 27 ag%, urine albumin 50 mgZ, creatinine clearance 40.5%, urea clearance 30 mg%. The AG ratio was 1.13 (not unusual in the Marshallese), cholesterol 264 mgZ, triglycerides 148 mg, electrolytes and liver test generally normal, The syphilia serology was reactive (titer of 2) but was not considered significant in view of past history of yaws in so many of these people. Her stools were positive for trichuris trichura. HOS PITAL COURSE: She remained generally asymptomatic during her 8-day hospital stay here except for a slight cough and non-specific muscle pains at times. With the finding of diabetes, she was placed on a 1400 calorie (ADA) diet. Since she continued to spill some sugar BML 720A - 128 -