PATIENT NO, 20 (continued)
skin surfaces, and s ome
gamma dose of 175 rads, an undetermined dose to the
ted that the thyroid
estima
internal absorption of fallout material. It was
largely from radiorads,
400
gland received a dose of somewhere between 700-1,
t
iodine absorbed in the fallout.
He was nauseated the day following the fallou
two weeks
and also complained of some itching and burning of the skin. About
of
burns
ion
radiat
with
along
head,
the
after exposure, he had epilation of
only
with
healed
and
severe
not
s
were
lesion
These
the sealp, neck, and toes.
6
by
regrew
hair
The
weeks.
ing
follow
the
on
in
slight residual depigmentati
months.
He showed mild leukopenia and platelet depression during the first
several months following exposure but with no complications.
His blood elements
Since that
had returned to the normal range by the end of the first year.
euthyroid
been
ntly
appare
has
and
health
good
lly
in
genera
been
has
he
time
(1963 PBI 5.5 wg%). Compared with unexposed boys of the same age, however,
he has shown a slight degree of retardation in growth based on anthropometric
and bone age studies.
Physical Examination:
The patient was well nourished and developed but appeared
to be somewhat smaller than normal for his age. The thyroid was not enlarged,
but a 1.5 em diameter nodule, firm in character, was noted in the right lower
pole of the gland. The nodule was not tender and moved on swallowing. No
other nodules were palpated and no regional adenopathy was noted.
of the physical examination was essentially negative.
Laboratory and X-Ray Data:
Thyroid Work-Up:
PBI 6.1 we%,
The remainder
iodine fractionation:
totul I 6.5 pe%, iodoprotein 1.3 wg%, thyronine (T4 + 13) 4.2 pg%. Thyroid autoantibodies under 1:16. Cholesterol 170 mg% with esters 144 mg%. BMR -12. Thyroid
Sean (99™Tc) showed "cold" nodule at lower lobe.
132] uptake studies showed 40%
uptake in 6 hours with 32.5% urinary excretion at that time. Following TSH stimula:
tion for three days, the uptake was only 33.7% at 5-1/2 hours, with urinary
excretion 18.5%. PBI 6.8 ueg%. The blood count was within normal limits; alkaline
phosphatase was slightly low (4.4 units), total protein slightly elevated, 8.2 gm
with globulins 3.9 gm.
Within normal ranges were:
prothrombin time, sedimentation rate, bilirubin, cephalin flocculation, transaminase, Ca, P, thymol turbidity,
FBS, BUN, CO>, Cl, Na, K.
Normal also were EKG, slit lamp examination, urinalysis,
and stools for ova and parasites.
chest.
Chest plate showed no active disease in the
Hospital Course:
The patient remained asymptomatic while here.
On July 5 he
was taken to New England Baptist Hospital in Boston, Massachusetts for surgery.
Dr. Bentley P. Colcock removed about 3.1 cm of thyroid tissue which contained
multiple nodules varying in size up to 1 cm in diameter.
They varied from pale
grey and firm to pulpy and semicystic and deep red.
The pathologic diagnosis
was adenomatous goiter.
His recovery was rapid and uneventful.
He was returned
to Brookhaven on July 13 where he remained asymptomatic and was discharged on
July 18, 1965, fit to travel back to the Marshall Islands.
Diagnosis:
Adenomatous goiter.
Discharge Medication:
No immediate drug therapy was recommended.
However, this
patient will receive desiccated thyroid, 180 mg daily beginning in September,
along with the remainder of the exposed Rungela>d people.
101