Rongelap 51 PiAne) MOSATAL OF Trl aniDeCat RESEARCH CENTER BROORHAVIN NATIONAL LABOSATORS UPTON, Miw TOK 187} 08-50-52 a OISCHARGE SUMMARY CIRC 63 Ares Coda 516 FAprenh 64-4167 ADMITTED: 27 May 1974 DISCHARCED: Aral HO) J June (974 This 65-year-old Marshallese fermle was admitted for evaluation of her thyroid status in anticipation of possible surgery. MEDICAL HISTORY: In Seprember 1973, a small nodule 0.5 cm in diameter was noted in the region of the lower left lobe of the thyroid. By March 1974, the nodule appeared to have grown slightly in elze. She had always appeared esthyroid and her To levels were in the normal range, The patient was accidentally exposed to falkouc radiacion in 1954 at age 24, She received an estimated 69 rads of whole body gamma radiation which caused mild depression of her blood elements during the firsc few weeks after exposure, Fallout contamination of the skin caused mild, transitory, beta burns of the skin during the first few weeka also, She also absorbed internally some radionuclides, the most serious of which were radioiodines, She remalned generally healthy until about 1970, except that she was somewhat underweight and had an early menopause (age 42), after having had one miscarriage and one child, Since 1972 she has complained of frequent bouts of coughing, dyspnea, might sweating at times, and chest pain, She has had whitesto-yellowlsh sputum, but denies hemoptysis, She claims to become dyspreic on exertion, and during the bouts of coughing sleeps propped up on pillows, LABORATORY & X-RAY DATA: Thyrold scan using 123, shows a tecal area of decreased radioactivity in the middle and lower 1/3 of the left lobe of the thyroid laterally, uptake was 15.8%, Chest x ray showed Increased lung markings, Her RAL possible due to chronic bronchial disease, Numerous exams for AFB of che sputum were negative, both on smear and by culture, No other consistent pathogenle organisms were found In the sputum, The EXC showed some T-wave abnormalities, which were not necessarily considered significant, Her hempgram was negative excepe for increased eosinophils which may have been relaced to the finding of whip-worm and trichuris trichura in her stools, She had slight!ty increased blood proteins, particularly globulins, which is noc an unusual finding in the Marshallese people, She had a positive syphilis serology, reactive, titer If, (tn che Marshallese, infection with yaws, which was endemic years ago, not infrequently results in positive serology, } HOSPITAL COURSE: During the first few days of hospftalizacion, the patient remained [n bed a good deal of the time, She coughed frequently and had slight increase in resplration, bringing up a whitish-yellowish spucum, She became dyspnete on exertion, She had a low-grade fever in the evenings. Her appetite was poor, In view of possible TB infection, isolation procedures were instituted, though subsequence tests and sputum findings did noc subscancifatesuch a dlagnoasis. Considering the posalbility of bronchial Infection, she was yiven tetracyclines and Tedral for cough, She improved {nm the last few days of hospitallzarion -l» ONL 720A - 136 -