Ueirik 2212 SAMO HOSPITAL OF THE MEDICAL RESEARCH CENTER, BROOKHAVEN NATIONAL LABORATORY UPTON, NEW YORK 11973 §-45-38R Aree Code 514 YAphank 4-6262 (UNIT NO.) DISCHARGE SUMMARY ADMITTED: June 2, 1973 DISCHARGED: June 10, 1973 Thia 54-year-old Marshallese woman, who had a slight exposure to failout 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 small 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 l near the isthmus, the largest being about 2 cm in the lower part of the left lobe. The nodules were slightly tender to palpation. No lymphadenopathy was noted. She noticed the "lumps'' on swallowing. She appeared euthyroid though her T-4 level in March was-slightly low (3.7 ugh). She was exposed to 14 rads of gamma gland in 1954 from fallout exposure. radiation and about 22 rads to her thyroid No effects from this exposure have been dis- cernible. Examinations over the 19 years since che exposure have revealed the following: occasional cough, frequent worms in stools, joint pains with arthritic changes, tonsillar hypertrophy, multiple Lipomata. FAMILY AND SOCIAL HISTORY: Non-contributory. PHYSICAL EXAMINATION: Positive findings on physical examinationa included: slight obesity, multiple lipomata (asymptomatic), reducad hearing left ear and BP generally normal, but slightly elevated at times; slight cardiomegaly with no evidence of decompensation, Her thyroid findings have not changed since those outlined above for the March examination. She appears euthyroid, LABORATORY AND X-RAY DATA: Thyroid scan shows a large non-functioning nodule in che lower left lobe. Radioactive iodine uptake and response to TSH stimilation were adequate. T-4 level is not available yet. Her serum was non-reactive for antithyroid globulin antibodies. Chest x-ray showed cardiomegaly but the lungs were clear. EXG 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 mg% and spillage of sugar in the urine. Her kidney function was somewhat reduced with BUN of 27 wg%, urine albumin 50 mg%, creatinine clearance 40.5%, urea clearance 30 mg%. The AG ratio was 1.13 (not unusual in the Marshallese}, cholesterol 264 mg%, triglycerides 148 mg%, electrolytes and liver test generally normal. The syphilis 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 stoois were positive for trichuris trichura. BOSPT COURSE : She remained generally asymptomatic during her S-day hospital stay here except for a slight cough and non-epecific 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 oa TI0A - 128 -