BROOKHAVEN NATIONAL LABORATORY NOSPITAL of the MEDICAL RESEARCH CENTER UPTON, NEW YORK DISCHARGE SUMMARY ADMITTED: Aug. 26, 1969 [NAME UNIT NO. Utirik 2229 08-22-S9R PAVILION t OPD DISCHARGED: Sept. 22, 1969 This 34-year-old Marshallese lady from Utrik Island was admitted to this Hospital for evaluation of a nodular lesion of the thyroid gland suspected of being malignant. The patient was exposed to a small] amount of fallout on Utrik Island during the time of the accident in 1954, It was estimated that her thyroid gland received only about 13 rads from radioiodines absorbed plus 14 rads from whole-body gamma radiation. There were no detectable effects related to radiation exposure, The patient has only been seen several times during the past 15 years, and her medical history during this period reveals very little of significance. When she was examinaed this past March, she was found to have a single, firm, smooth, freely movable mass of the right lobe of the thyroid. No cervical lymphadenopathy was noted, She apparently had been completely euthyroid though there is no record of any PBI or cholesterol tests. During the past several months she has noted some pain in the lower front of the neck region when she Do Not Write In Binding Margin HISTORY OF PRESENT ILLNESS: coughes and a slight hoarseness in her voice. PHYSICAL EXAMINATION: "The patient is somewhat obese and appeared slightly older than her stated age. Aside from thyroid findings, the physical examination was generally negative except for slight errosion of the cervix, The thyroid gland was found to be visibly enlarged and a firm to hard nodular enlargement of the right lower lobe, several cm. in diameter was palpated. The mass was movable and nontender, Thetrachea was thought to be slightly shifted to the left. No lymphadenopathy was. noted. LABORATORY AND X-RAY FINDINGS: Thyroid findings revealed; . PBI 5.8 pg.%, total iodines 5.8 g.%, iodoproteins 1.4 yg.%, and T~4 3.4 g.%s BMR -25; cholesterol 188 mg.%, esters 148 mg.%; thyroid autoantibodies showed less than 1-16 dilution reaction; thyroid scan showeda nonfunctioning nodule in the lower right pole; the gland gave good ¢ response after TSH stimulation but no increase in iodine uptake response. The chest x-ray revealed slight shift in the trachea to the left, presumably resulting from thyroid pressure. Stool examinations revealed trichuris. Urinalyses showed moderate number of RBC and WBC. Soon after hospitalization, PREOPERATIVE HOSPITAL COURSE: the patient had a bout of upper respiratory infection with slight fever and cough which cleared up within several days. In view of the positive urinary findings Gantrisin treatments were Started. Later urine samples were noted to be free of RBC arid WBC. .On September 7 the patient.was transferred to the Cleveland Metropolitan General Hospital. SURGERY AT THE METROPOLITAN GENERAL HOSPITAL: On September 8, the thyroid was explored by Dr, Brown B. Dobbins. A total right lobectomy was performed removing an encapsulated nodular mass about 3-4 em. in diameter whose cut surface was white with fine granular ONL 720A - 84 - |