ate wee ote - mee camera a tale ebenetenate Rel AMne Urdrik 2222 phased HOSPITAL OF THE MIDICAL MLSCARCH CINTER, REQOKHAVIN MATIONAL Lasoraloay 8-45-3R UFTOM, NEW YORK 1197] Aves Cade Sld VApnash 6-6142 prat NO) DISCHARGE SUMMARY ADMITTED: June 2, 1973 DISCHARCED: June 10, 1973 MEDICAL HISTORY: This Jleyeareold Marshallese woman was found to have a small thyroid nodule at the time of the regular annual examination of the Marshallese expused to radios active fatlouc this past March, The nodule was pea-sized, freely movable, and Ln the midportion vf the right lobe. There was no lymphadenopathy noted. She was brought to the U.S. and admitted to this Hospital for thyroid studies and evaluation for thyroid surgery. Her previous thyroid history had been negative and she had always appeared euthyrold with low-to-normal thyroxin levels, Because of her radiation exposure, surgical exploraticn was deemed advisable, She was exposed on Utirik Island in 1954 to about 14 rads of gamma radiativun From fallout with a thyrcid dose of about 22 rads (partly from radiuiudine absorption). She showed no effecets of the slight exposure, and the principal medical findings over the [9-year period since exposure have concerned the development of casential hypertension with possibly slight kidney involvement, Complaints have largely centered around arthritic pains and stiffness cf the knees and legs and the development of poor visicn. FAMILY AND SOCIAL HISTORY: Irrelevant. PHYSTCAL EXAMINATION: This slender, elderly, alert lady appeared healthy, euthyroid, and well-preserved for her age. The thyroid findings were as described above and during Che March ¢xamination, Other {Lndings included an early catarace formation of the left eye and the presence of hypertension (BP 200/96), and a moderately laws systolic murmur. The heart was noc thought to be enlarged and there was no evidence of cardiac de~ Compensation. Pain and stiffness 4 aoving the associated with arthritic changes. LABORATORY AND X-RAY DATA: Radloactive fodine uptake was thyroid reserve. knees and lege may have been The thyroid acan showed a “cold” nodule at the lateral border of the right lobe, low-normal, and TSH administration showed reduced Her serum was non-reactive to antithyroid gtubulin antibodies. Chest x-ray showed cardiomegaly and aortic sclerosia; slight Increase in density Rear the cardiac apex “probably due to old Inflammatory disease", and a slight deviation of the trachea. X-ray of che knees was negative. EKO was within normal limits. The hemogram was normal except for 81 eosinophils and an ESR of 38. Aldosterone level was normal. Some kidney dysfunction was evidenced by BUN of 27, urine albumin 50 mg% with 8-12 RBC/HPF, urea clearance 552% and creatinine clearance 39%. Other clinical chemistry tests were generally negative, including tests for liver function, electrolytes, Lipids, and serum pruteins. Stools vere positive for ascaris lumbricoides and trichuris trichura, Syphilis serology was shightly positive (titer of 2) buc this low level is not considered significant, particularly in view of possible yaus in the past which was prevalent in these people. ! a