coe ee ee ee PATIENT NO. 33 (continued) Six months later, in spite of being on thyroid hormone therapy, the thyroid gland had, enlarged and a hard 5 mm nodule was palpable in the lower left lobe with irregularity of the remainder of the gland. She had been thought to be euthyroid. In 1965 her PBI was 7.0 uwg%. However, in March, 1966, a thyroxin iodine level of only 3.1 uyg% was obtained, and it was thought that her Achilles reflexes were somewhat sluggish. Her TSH level was elevated. Physical Examination: The patient appeared well developed and slightly older than her stated age of 13. A firm 1 cm nodule was palpated in the left lateral thyroid area which was freely movable. There was no regional adenopathy palpable. The remainder of the physical examination was essentially negative. Laboratory and X-Ray Data: Thyroid Studies: PBI was 6.2 uwg% with thyroxin iodine 4.5 ugh; T3 was 12.8%. BMR was -32 and -19; antithyroglobulin titre under 1:16; thyroid scan with 99mPe showed slight asymmetry of the gland with the right lobe being slightly larger than the left. There was a suggestion of a "cold" nodule in the isthmus. 327 uptake studies showed normal uptake and normal increase following TSH stimulation. Cholesterol was normal (138 mg% with esters 119 mg%). The sedimentation rate was slightly elevated as is usual with the Marshallese. The homogram, chest plate, EKG, as well as other laboratory findings were all within normal limits. Hospital Course: The patient was taken to the New England Deaconess Hospital in Boston, Massachusetts, on June 5, 1966. On June 6, Dr. Bentley P. Colcock of Lahey Clinic carried out a bilateral subtotal thyroidectomy, removing multinodular thyroid tissue from both lobes. One nodule was white and firmer than the rest in the left lobe and proved to be Hurthle cell adenoma without evidence of invasion of the capsule. Dr. W. A. Meissner of the New England Deaconess Hospital examined these tissues and his pathological diagnosis was “adenomatous goiter, both lobes; small follicular adenoma, Hurthle cell type right lobe; one negative parathyroid, left; fragment of thymus."" Recovery from surgery was uneventful, and the patient was transferred back to this hospital on June 11. She was started on thyroid hormone therapy (desiccated thyroid), 3 grains daily, indefinitely. By June 16 her wound had healed nicely, she was asymptomatic, and she was discharged in order to return to the Marshall Islands. Diagnosis: (1) Adenomatous goiter. type, right lobe. et eee 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. Pm To continue on thyroid hormone therapy indefinitely. ee ne ee ele Discharge Medication: (2) Small follicular adenoma, Hurthle cell 104 5008388