BROOKHAVEN NATIONAL LABORATORY | NAME UNIT NO. HOSPITAL of the MEDICAL RESEARCH CENTER (Rongelap 18) DISCHARGE SUMMARY ADMITTED: PAVILION Aug. 26, 1969 DISCHARGED: Hospital for evaluation of a nodular-thyroid ghand. 1 OPD Sept. 22, 1969 This 36-year-old Marshallese woman was admitted to this De Not Write in Binding Margin The patient was 2i-years of age at the time of exposure to fallout. She was in the more heavily exposed group, receiving an estimated 175 rads of whole body gamma radiation, beta radiation to the skin, and internal absorption of radioisotopes, Her thyroid gland received an estimated 160 rads from radioiedines absorbed, plus 175 rads from whole body exposure. She had signs of mild hematopoietic depression shortly after exposure but no signs of infection or bleeding and by one year her blood elements ‘had recovered to normal levels. During the early period she also experienced mild transient beta burns to the skin, HISTORY OF PRESENT ILLNESS: Her thyroid abnormality was detected for the first time this past March when a multi-lobulated mass in the left lower pole of the thyroid was noted. Up until this time she had always appeared to be euthyroid, A serum sample taken at that time of examination showed a T-4 level of 3.9 tg.%. This is the third adult case in the more heavily exposed group that has developed thyroid pathology. The patient claims she had been taking her thyroid-hormone therapy regularly. Two of her sons, who were less than 10 years of age at exposure, have had excisions of benign nodules during the past: two years, PHYSICAL EXAMINATION: This mother of nine children appeared to be in excellent health, She appeared to be euthyroid. The only positive findings of significance in her physical examination were referable to the thyroid gland. Since the examination in March a discrete mass in the right upper pole was noted for the first time, The mass was hard and spherical. Less distinct nodulation was noted in the lower left lobe. No lymphadenopathy was noted. The thyroid studies revealed the following: PBI 9.2 yg.%, total iodine 9.2 pg.%, fodoprotein 2.3 ug.%, and T-4 6.2 yg.%; thyroid autoantibodies less than 1-16; thyroid scan showed a non-functioning nodule in the right upper lobe; uptake of radioiodine showed normal. function of the gland; fodine uptake response to TSH stimulation, however, was poor. The 99mre studies showed good trapping function; cholesterol 172 mg.%, esters 120 mg.%. Her BMR was +16. Positive stool examinations from ascaries and trichuris was the only other positive laboratory Finding of significance. The high sedimentation rate and reversal of the A/G ratio is common to the Marshallese people, X-ray of the chest was LABORATORY AND X-RAY DATA: negative. BWL 720A Cs Los | 4 - Caf oT) cry cri - 78 - St FPceases re UPTON, NEW YORK 08-22-58R