prooOKHAVEN NATIONAL LABORATORY IN UNIT NO. HOSPITAL of the MEDICAL RESEARCH CENTER gengetap 70 8-18-89 R UPTON, NEW YORK DISCHARGE SUMMARY ADMITTED: PAVILION AUGUST 4, 1968 DISCHARGED: 1 OPD AUGUST 30, 1968 This 29-year-old woman was admitted to this Hospital for evaluation of a mass in the left region of the neck discovered during the 1968 annual medical survey at Rongelap Island. During the routine medical examination of the Rongelap people this patient was discovered to have a 1-2 cm, firm mass in the left side of che neck lateral to the thyroid gland near the insertion of the sternocleidomastoid muscle. The mass was non-tender, firm and did not move with the thyroid gland on swallowing. No lymph adenopathy in this region or elsewhere was noted, During the past two years the patient has complained of loss of appetite, weight loss and not feeling very well. (Her weight of 110 pounds on the past survey is 5-10 pounds below her usual weight. In 1954 her RBI was 5.7 we% and in March of this year her serum thyroxine level (T-4) was 4.3 ug% and serum cholesterol 230. mg%. In view of the prevalence of thyroid abnormalities in the exposed Marshallese people and the suspicious nature of this patient's lesion it was considered wise to hospitalize her for full evaluation. - The patient was 15 years of age in 1954 at the time of the fallout accident. At that time she was one of a group of 18 that was away on a nearby atoll (Alingnae). This group received a whole body gamma dose of 70 rads about half the exposure of the other Rongelap people. Before the accident she was apparently healthy with a history of only occasional headaches. Following the accident only a few transient effects of exposure were noted: (a) very slight fallout iesions on the back of her neck at three weeks post exposure with some eyanotic changes in her fingernail beds, both of which cleared up within a few weeks; (b) and slight transient leukopenia . It was estimated that the dose to her thyroid gland was about 55 rads from radioiodines absorbed plus 70 rada of gamma radiation. Following these early findings the patient remained generally in good health, No serious illnesses or injuries were noted. Growth and development was normal except for slight immaturity of sexual development (sparse pubic and axillary hair and smail breasts). Menarche was at 14 years of age followed by normal menstrual periods. She has had four pregnancies, her first (1958) resulted in a stillbirth following a bre@ch delivery due to "contracted pelvis": the second (1963) resulted in a normal delivery and baby. She has since had aother stillbirth and a miscarriage. From the time of the first examinations she has remained somewhat anemic (not uncommon in Marshallese females) with hematocrit readings ranging from 28-33, Since the survey examination of March 1968 she has noted occasional pain on swallowing, eating meals and drinking fluids. The pain is BNL 720A Cc. aed wd cD cz? ca - 73 Csi Go Not Write tn Binding Margin HISTORY OF PRESENT ILLNESS: