Ucirik 2221 HOSPITAL OF THE MEDICAL RESEARCH CENTER, BROOKHAVEN NATIONAL LABORATORY UPTON, NEW YORK 11973 _ (NAM 8-45-32 (UNIT NO) Area Code 516 YAphank 4-6262 DISCHARGE SUMMARY ADMITTED: June 2, 1973 MEDICAL HISTORY: DISCHARGED: This June 10, 1973 7l-year-old Marshailese woman was found to have a small thyroid nodule at the time of the regular annual examination of the Marshallese exposed to radioactive fallout this past March. The nodule was pea-sized, freely movable, and in the midportion of the right lobe. There was no lymphadenopathy noted. She was brought to the U.S. and admitted to this Hospital for thyroid studies and evaluation for thyroid surgery. Her previous thyroid history had been negative and she had always appeared euthyroid with low-to-normal thyroxin levels. Because of her radiation exposure, surgical exploration was deemed advisable. She was exposed on Utirik Island in 1954 to about 14 rads of gamma radiation from fallout with a thyroid dose of about 22 rads (partly from radioiodine absorption). She showed no effects of the slight exposure, and the principal medical findings over the 19-year period since exposure have concerned the development of essential ‘hypertension with possibly slight kidney involvement, Complaints have largely centered around arthritic pains and stiffness of the knees and legs and the develop- ment of poor vision. FAMILY AND SOCIAL HISTORY: Irrelevant. PHYSICAL EXAMINATION: This slender, elderly, alert lady appeared heaithy, euthyroid, and well-preserved for her age. The thyroid findings were as described above and during the March examination. Other findings included an early cataract formation of the left eye and the presence of hypertension (BP 200/96), and a moderately lewsé systolic murmur. The heart was not thought to be enlarged and there was no evidence of cardiac decompensation. Pain and stiffness on moving the knees and legs may have been associated with arthritic changes. LABORATORY AND X-RAY DATA: The thyroid scan showed a "cold" nodule . at the lateral border of the right lobe. Radioactive iodine uptake was low-normal, and TSH administration showed reduced thyroid reserve. Her serum was non-reactive to antithyroid globulin antibodies. Chest x-ray showed cardiomegaly and aortic sclerosis; slight increase in density near the cardiac apex "probably due to old inflammatory disease", and a slight deviation of the trachea. X-ray of the knees was negative. EKG waa within normal limits. The hemogram was normal except for 8% eosinophils and an ESR of 38. Aldosterone level was normal. Some kidney dysfunction was evidenced by BUN of 27, urine albumin 50 mg% with 8-12 RBC/HPF, urea clearance 55% and creatinine clearance 39%. Other clinical chemistry tests were generally negative, including tests for liver function, electrolytes, lipids, and serum prvteins. Stools were positive for ascaris lumbricoides and trichuris trichura. Syphilis serology was slightly positive (titer of 2) but this low level is not considered significant, particularly in view of possible yaws in the past which was prevalent in these people. BML 720A - 130 -