Uctrik 2212 HOSTAL OF THE MEDICAL RESEARCH CENTER . BLOOKNAVIN NANONAL LABORATORI ; . 8-45-358 UPTON, NEW YORK 1197) Ares Code Si4 YAphent 4~6262 BNIT NO) DISCHARGE SUMMARY ADMITTED: June 2, 1973 DISCHARCED: June 10, 1973 This 54-year-old Marshallese woman, who had a slight exposure to fallout radiation in the Marshall Islands in [954,was admitted here for studies of thyroid nodularity and evaluation of physical status for thyroid surgery. MEDICAL HISTORY: In 1966, a emall 0.5 em nodule was found im the right lote of the thyroid. Subsequent examinations showed an increase in the number of nodules of the gland,and ia March of this year three distinct nodules were palpated, Cwo in the left lobe and 1 near the (sthmus, the largest being about 2 cm in the lower part of the left lobe. The nodules were slightly tender to palpation. No lymphadenopathy was noted. She noticed the “tumps" on swallowing. She appeared euthyroid though her T-4 level in March was slightly low (3.7 pgi). She was exposed to 14 rads of gamma tadiation and about 22 rade to her thyroid giand in 1954 from fallout exposure. No effects from this exposure have been discernible. Examinations over the [9 years since the exposure have revealed the following: occasional cough, frequent worms in s¢ools, joint paina with arthritic changes, Conailiar hypertrophy, multiple lipomata. FAMILY AND SOCIAL HISTORY; Non-contributory. PHYSICAL EXAMINATION? Posktive findings on physical examinations included: slight obesity, suitiple \fpomata (asymptomatic), reduced hearing left ear and BP generally normal, but elightly elevated at times; slight cardicmegaly with no evidence of decompensation, Her thyroid findings have not changed since those outlined above for the March examination. She appears euthyroid. LABORATORY AND X-RAY DATA: Thyroid scan shows a large non-functioning nodule in the lower left lobe. Radloaccive fodine uptake and response to TSH stimulation were adequate, T+4 level is not available yet. Her serum was non-reactive for antithyroid globulin antibodies. Chest u-ray showed cardiomegaly but the lungs were clear. EKG showed incomplete bundle branch block which was not considered significant. The hemogram showed #light lymphocytosis (46%) and eosinophilia (14%) and increased ESR to 26... She was found to be dlabecic with FBS of 262 mg and aplllage of sugar in the urine, Her kidney function was somewhat reduced with BUN of 27 wg%, urine albumin 50 mgi, Creatinine clearance 40.52, urea clearance 30 mg%. The AG ratio was 1.13 (not unusual in the Marshallese), cholesterol 264 mg%, triglycerides 148 mg%, electrolytes and Liver test generally normal, The syphilis serology was reactive (ticer of 2) but was not considered significant in view of past history of yawa in ao many of these peopla., Her stools were positive for trichuris trichura, HOSPITAL COURSE: ! | She remained generally agymptomatic during her 8-day hospital atay here except for a @light cough and non-specific muscle pains at times. With the finding of dlabetes, she wat placed om a 1400 calorie (ADA) diet. ot 7704 Since she continued to spill some sugar