Rongelap 51 NAME) HOSPITAL OF THE MEDICAL RESEARCH CENTER, _ BROOKHAVEN NATIONAL LABORATORY UPTON, NEW YORK 11973 Area Code 516 YAphank 4~6262 08-50-52 R “(UNIT NO) DISCHARGE SUMMARY ADMITTED: 27 May 1974 CIRC 63 . DISCHARGED: 3 June 1974 This 45-year-old Marshallese female was admitted for evaluation of her thyroid statua in anticipation of possible surgery. MEDICAL HISTORY: In September 1973, a small nodule 0.5 cm in diameter was noted in the region of the lower left lobe of the thyroid, By March 1974, the nodule appeared to have grown slightly in size. She had always appeared euthyroid and her T4 levels were in the normal range. The patient was accidentally exposed to fallout radiation in 1954 at age 24, She received an estimated 69 rads of whole body gamma radiation which caused mild depression of her blood elements during the first few weeks after exposure. Fallout contamination of the skin caused mild, transitory, beta burns of the skin during the first few weeks also, She also absorbed internally some radionuclides, the most serious of which were radioiodines, She remained generally healthy until about 1970, except that she was somewhat underweight and had an early menopause (age 42), after having had one miscarriage and one child, Since 1971 she has complained cf frequent bouts of coughing, dyspnea, night sweating at times, and chest pain. white-to-yellowish sputum, but denies hemoptysis, She has had She claims to become dyspneic on “exertion, and during the bouts of coughing aleeps propped up on pillows. LABORATORY & X-RAY DATA: Thyroid scan using 123) shows a focal area of decreased radioactivity in the middle and lower 1/3 of the left lobe of the thyroid laterally, Her RAI uptake was 15.8%. Chest x ray showed increased lung markings, possible due to chronic bronchial disease. Numerous exams for AFB of the sputum were negative, both on smear and by culture. No other consistent pathogenic organisms were found in the sputum. The EKG showed some T-wave abnormalities, which were not necessarily considered significant. Her hem_pgram was negative except for increased eosinophils which may have been related to the finding of whip-worm and trichuris trichura in her stools. She had slightly increased blood proteins, particularly globulins, which is not an unusual finding in the Marshallese people. She had a positive syphilis serology, reactive, titer II, (In the Marshallese, infection with yaws, which was endemic years ago, not infrequently results in positive serology.) HOSPITAL COURSE: a good deal of the time. During the first few days of hospitalization, the patient remained in bed She coughed frequently and had slight increase in respiration, bringing up a whitish-yellowish sputum, She became dyspneic on exertion. She had a low-grade fever in the evenings. Her appetite was poor. In view of possible TB infection, isolation procedures were instituted, though subsequent tests and sputum findings did not substantifatésuch a diagnosis. Considering the possibility of bronchial infection, she was given tetracyclines and Tedral for cough. She improved in the last few days of hospitalization -lSNL 720A - 138 -