Rongelap 40 Puasa) MOSFITAL OF THE ageCan BESLARCH CINTER BQOKHAYIN NATIONAL LABORATIORT WHION, Now YORE 11979 08-45-42 Aree Code 51d WAphenh 4-4742 Mul NO) OISCHARGE SUMMARY ADMITTED: June 2, 1973 PISCHARCED: June 10, 1973 This 48*year old Marshallese man who had been exposed ta radivuactive fallout tn 1956 was admitted for evaluation of thyroid nodulacity and physical status for possible thyroid surgery. HESTORY: A small nodule in the righe lobe of the thyrold was firse detected in 1965. He, along with other people of Rongelap who had been exposed to radiation had been phaced on L-thyroxin treatment and the nodule disappeared on this treatment. However, during the recent examinations in March, he was again discovered to have a hardened area in the righe lobe with indiwcince boundaries. Na lymphadenopachy was noted. He has always appeared euthyrold and his thyroxia levels have generally been in the normal range, with only one reading slightly slow. He was exposed to 175 rad of gamma radiation from accldential fallout of 1954 and his thyroid gland probably received about JW) rads partly from radioactive bodines absorbed, He had early acure effects with hemlogical depression and mild “beta” burns of the skin which he recovered from within a year. Examinations over the pase 19 years have revealed only a few findings: The history of yawa in childhood, measles, occasion= ally bronchitia, one possible attack of pneumonia, a fiscula-ineano which was surgically corrected, He has remained in very good health and is a hard worker and leader of nls people. He was magistrate of the village at the time of the fallout. iia wife was Operated for cancer of the thyroid, three sons for benign thyroid lesions, and 1 son died at 19 years of age with acute leukemia (possible from radiation cxposure). FHYSICALEXAMINATION: This well developed, muscular, alert man appeared quite healthy and euthyroid, The thyroid findings noced were the same as were reported above for the Murch examinativn. The only other findings were bilateral prted. ~¢ , missing teeth and gingivitis, JDABORATORYANDX-RAYDATA: Thyroid scans showed no distinet modularity but slightly increased size of the right lobe. Radicaceive lodine uptake was normal and response to TSH stimulation was fair. TeS levels are noe reported yee. Serum was nonreactive for antithyroid globulin antibodies. Chest X-Ray was normal. Hemogram was normal. Syphilis servlegy was reactive (elter of 4) but Chis low level was not considered algnificane in view of his history of having iad the yawea. Tests of kidney function and liver function were normal. Elec* trolytes normal, EKG nurmal, were positive for whipworm,. HOSPITALCOURSE: proteins normal, electrolytes and Lipids normal. Stvovls During the 8 daya of his hospital stay, the patient was a symptomatic until the 5th day when foilowlng TSH injection (given the previous day) he developed an acute thyroiditis with low grade fever, nausea, anorexia and slight neutruphilia. Scan showed some enlargement of the gland... The thyroiditis reduced rapidly and at the ma 7204