Bo eares ve ee oe 2 PATIENT NO, 42 AGE 15 SEX HOSPITAL F Hospital of Medical Research Center, BNL DATE June, 1966 This 15 year old Marshallese girl was admitted to this hospital for evaluation of a thyroid nodule which had developed during the past year. History of Present Iliness: This girl had been exposed at 3 years of age to radioactive fallout, receiving an estimated dose of 175 rads of whole-body gamma radiation, irradiation of the exposed skin surfaces from direct deposition of fallout material, and some degree of internal absorption of radioactive materials from ingestion of contaminated food and water. It was estimated that the radioiodine absorbed in the fallout delivered a dose to the thyroid gland in the range of 700-1,400 rads and an additional dose of 175 rads was received by the gland from gamma radiation. She had transient gastrointestinal symptoms during the first two days and subsequently developed a leukopenia and thrombocytopenia. Beginning about two weeks after exposure she developed rather marked "beta burns "W of the skin and epilation. All of these acute effects had disappeared at about l year post exposure. With the exception of the present illness, subsequent examinations have revealed no serious illnesses or injuries in this girl. Her statural growth over the past 12 years has been slightly below the mean curve for the unexposed Marshallese girls in the comparison population. Menarche occurred in 1965. In September, 1965, a small nodule was noted in the right lower pole of the thyroid. [In spite of treatment with thyroid hormone the nodule She had always been considered increased in size to about 0.5 mm by March, 1966. to be euthyroid. Her PBI level in March, 1966, was 5.0 ped. Physical Examination: A small nodule (2-3 mm) was palpated in its left lower lobe. The remainder of the physical examination was essentially negative except for impetigo-like lesions of the skin. Laboratory and X-Ray Data: Thyroid Work-Up: PBI was 6.5 ug% with 4.5 yeh of thyroxin; 73 12.9%; antithyroglobulin titre under 1:16; thyroid scan with I9mp ¢ showed normal uptake with several "hot" nodules noted in the right upper lobe, ' right middle lobe and left upper lobe; 1327 uptake was normal and showed normal increase following TSH stimulation. BMR was +25 and +28; cholesterol level was low (118 mg% with 105.8 mg% esters). In contrast to some of the other Marshallese cases, these findings seemed to indicate a slightly increased functioning gland. Chest plate and EKG were normal. The hemogram and the remainder of the laboratory work-up was essentially negative. Hospital Course: Following the initial examination at this hospital, the patient Was removed on June 5 to the New England Deaconess Hospital, Boston. On June 8, 1966, a bilateral subtotal thyroidectomy was performed by Dr. Bentley P. Colcock of the Lahey Clinic, removing thyroid tissue which contained multiple nodules, the largest being about 0.5 cm. Dr. W. A. Meissner of the New England Deaconess Hospital reported that the surgical specimens contained multiple nodules of varying sizes and his pathological diagnosis was; adenomatous goiter. The patient's recovery from surgery was uneventful, and she was returned to Brookhaven on June ll. She was started on desiccated thyroid treatment, 180 mg daily to be continued indefinitely. Her surgical wound healed nicely and she was asymptomatic. Diagnosis: Adenomatous goiter. 105 Deo he