Utirik 2221 HOSPITAL OF THE MEDICAL RESEARCH CENTER BROOKHAVEN NATIONAL LABORATORY UPTON, NEW YORK 11973 Area Cade 516 YAphank 4-4262 8-45-37 NAME] UNIT NO} DISCHARGE SUMMARY ADMITIED: June 2, 1973 MEDICAL HISTORY: DESCHARGED: June 10, 1973 This 7l-year-old Marshallese 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 Hespital 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 cthyroxin 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 i9-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. FAM SOc HISTORY: PHYSICAL EXAMINATION: her age. Irrelevant. This slender, elderly, alert lady appeared healthy, euthyroid, and well-preserved for The thyroid findings were as described above and during the March exam- ination. Other findings included an early cataract formation of the left eye and the presence of hypertension (BP 200/96), and a moderately lems 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 che 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 was within normal limits. The hemogram was normal except for 8% eosinophils and an ESR of 38. Aldosterone level was normal. Soma 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 tasts for liver function, electrolytes, lipids, and serum proteins. Stools were positive for ascaris lumbricoides and trichuris trichura. Syphilis serology was slightly positive (titer of 2) buc this low level is not considered significant, particularly in view of possible yawe in the past which was prevalent in these people. ONt 720A - 130 - JOU0e 226