RY prookKHAVEN NATIONAL LABORATO UNIT NO. [» 8-18-89 R HOSPITAL of the MEDICAL RESEARCH CENTER Rengelap 23 UPTON, NEW YORK P ISCHARGE SUMMARY PAVILION 1 OPD DISCHARGED: AUGUST 30, 1968 ADMITIED: AUGUST 4, 1968 a This 18-year-old Marshallese boy was admitted to this Hospital for evaluation of nodules of the thyroid gland resulting from fallout exposure in 1954. HISTORY OF PRESENT LLLNESS: Though nodules of the thyroid gland were first noted at the time earlier since the boy had not been examined in 1966. Multiple, small, non-tender nodules were palpated in the gland with one larger nodule about 1.5 cm. in the right lobe, and a smaller one in the left lobe. He appeared to be euthyroid and normally developed. His serum thyroxin level in March was 4.5 wg% and serum cholesterol 188 mg% (in 1967 his thyroxin level was 2.3 pgh}). L-thyroxine (Synthroid, 0.3 mg./day) was prescribed in 1967 but his adherence to the treatment regimen was spasmodic. Therefore during the 1968 examinations it was decided that since his thyroid nodules had not reduced, hospital evaluation was indicated. The patient was 4 years of age at the time of exposure to fallout on Rongelap. He received a whole body dose estimated to be 175 rads, expesure to the skin (unknown dose) and a dose to the thyroid gland from absorbed radioiodines of about 700-1400 rads plus 175 rads of penetrating gamma radiation, Relative lymphopenia was noted at 3 days slight leukopenia at 6 weeks followed by rapid return to the normal range. He developed slight "Beta burns” on the neck, axillary and anal region which cleared up in a few weeks. He had moderate epilation of the temple with complete regrowth of hair by 6 months. No clinical evidence of irradiation syndrome was apparent at any time. Anthropometric Measurements and skeletal age studies have revealed normal growth and development with no evidence of thyroid deficiency. A PBI level in 1958 was 9.6 yg%. Since the examination in March, 1968 he has been asymptomatic and in goodhealth. He has been on thyroid medication intermittently. PHYSICAL EXAMINATION: in excellent health. The patient is a husky 18-year-old Marshallese boy and appears to be Principal findings were related to the thyroid gland. The Tight lobe showed enlargement with a 3 cm. soft irregular nodule in the lower portion, The nodule was. slightly tender to deep palpation. An enlarged lyaph node was noted in the right submaxillary region but no other regional adneopathy was noted. The patient appeared to be euthyroid. Except for a slight ringworm infection over the shoulders the remsinder of the physical examination was essentlally negative. LABORATORY & X-RAY DATA: Thyroid workup showed the following: the thyroxin level was 4.6 jgl, cholesterol 119 mg% (72Zesters). Test for serum antithyroglobulin antibodies was negative: a thyroid scan (using 99@Tc) showed ? jorge cold area over most of the right lobe of the gland. Thyroid uptake of 3 uptake was in the lower [> or Lad C7 ~ cy SNL 720A cn Do Not White In Binding Margen of the 1967 medical examinations development of the nodules could have occurred - 69 -