BROOKHAVEN NATIONAL LABORATORY Name UNTT NO. HOSPITAL of the MEDICAL RESEARCH CENTER UPTON, NEW YORK 08-22-56R DISCHARGE SUMMARY — PAVILION 1 OPD malignant including involvement of two closely adjacent lymph nodes and several distant lymph nodes. In view of the metastizing nature of this malignancy on the left side, radical dissection was carried out removing all lymph nodes on that side of the anterior neck, No enlargement of lymph nodes was seen on the right side. A complete thyroidectomy was lone carefully preserving the parathyroid glands, POSTOPERATIVE HOSPITAL COURSE: The patient recovered satis- ; factorily from the operation but with some degree of edema of the subcutaneous tissues in the left side of the neck and lower jaw and a positive Chvostek for several days. She was returned to this Hospital on September 10. On arrival here there was slight drainage of the lower part of the incision of the neck which gradually reduced with daily care, The edema of the left side of the neck. along with slight tenderness gradually reduced though at the time of her discharge from the Hospital on September 22 there was still some edema and discomfort on the left side of the neck. The wound had healed nicely except for a small granulating area in the lower part of the incision. Her serum-calcium Level rose from 7.1 mg.% at the time of her return to 7.9 mg.% just before her discharge, The positive Chvostek noted earlier had disappeared at the time of departure. A repeat scan and radioiodine uptake study (following 350 mCi 151y) showed almost complete removal of the entire thyroid gland. However, scintophotos revealed a slight remnant of thyroid tissue in what had been the lower-right pole region, At the time of surgery the patient had been given a blood transfusion, However, it was noted on her return that she was slightly anemic. Therefore, she was placed on Ferrous Sulfate treatment. DIAGNOSIS: 1. Mixed follicular-papillary carcinoma of the thyroid wth Localized metastasis to cervical lymph nodes, Multiple macrofollicular adenomatous nodules were also present. DISCHARGE MEDICATION: The mandatory continued treatment with thyroid hormone was impressed on the patient. Dr. Riklon, the Marshallese practitioner who accompanied the patient here will supervise her continued medication and on her return to Kwajalein will have the patient seen by the Head of the Kwajalein Hospital for a checkup. He has been requested also to check her serum calcium from time to time to be sure that it returnes to normal. MekoD@Cruwer Robert A, Conard, M. D. RC:LR cx) ta c c. BML 720A ¢ ct Do Not Write In Binding Margin . - 83 -