oo r a Lis vg re F ona a *. a, - 7 1. 7 - : Sh ee Wettede ak tt te eat wt a et PATIENT NO. 59 (continued) Hospital Course: The acute pneumonitis noted on admission responded well to acromycin and penicillin therapy, and the patient became afebrile and asymptomatic within a few days. The right middle lobe showed clearing, but the upper lobe showed persistent changes, and in view of the slightly positive secondstrength reaction to the PPD, Dr. L. R. Sonders, Boston, felt that tuberculous infection was consistent with the findings though he considered it likely that the process was inactive and not contraindicative to surgery. The results of the thyroid study did not suggest any thyroid metabolic imbalance. Though the BMR was somewhat low and the cholesterol low, the iodine fractionation studies and uptake studies as well as effect of stimulus of TSH were normal. She was admitted to the New England Deaconess Hospital on June 6, and surgical excision of the thyroid isthmus containing a 0.4 cm nodule was accomplished on June 8. The patient withstood the surgery well and the wound healed perprimam. The 600,000 units daily for a total dose of 6.5 million units. she was histological diagnosis was adenomatous goiter. She was returned to this hospital on June 11. On Dr. Sonder’s recommendation she was placed on isoniazid therapy, 100 mg t.i.d. In view of her positive serology she was placed on penicillin, In addition, started on desiccated thyroid, 180 mg daily. She was discharged on June 16 to return to the Marshall Islands. A letter was sent to the medical authorities in the Marshalls advising them to continue the isoniazid for 2 years and thyroid therapy indefinitely. They would be informed later of the results of the tuberculous cultures, and, if possible, hospital for treatment with PAS. it was recommended that she be placed in the Diagnosis: (1) Adenomatous goiter. (2) Pulmonary tuberculosis--unspecified activity (002.9). (3) Positive serology (028.3). Discharge Medication: To continue indefinitely on thyroid hormone medication. This patient was seen in September, 1966, in the Marshall Islands, and she was found to be euthyroid on the hormone treatment, with no complications. PATIENT NO. 61 AGE 20 SEX HOSPITAL F Hospital of Medical Research Center, BNL DATE June, 1966 This 20 year old Marshallese female was admitted to this hospital for evaluation of a thyroid nodule which was discovered during the past year. History of Present Iliness: As a 7 year old girl the patient was exposed to radioactive fallout in 1954. She was exposed to an estimated dose of 175 rads of whole-body gamma radiation, significant amounts of radiation to the exposed skin surfaces from deposition of fallout material thereon, and some internal absorption of failout. It was estimated that the radioicdines absorbed delivered a dose to the thyroid in a range of 300-1,000 rads in addition to the 175 rads of gamma radiation. She had transient early gastrointestinal symptomatology which was followed some two weeks later by mild beta burns of the skin and moderate degree of epilation of the head. She also had leukopenia and thrombocytopenia within the first six weeks. She had largely recovered from these acute effects by one year post exposure. Her subsequent medical history shows no findings which could be related to radiation exposure. There were no noteworthy illnesses. Her growth 9008341 LO? .