The History of the Parathyroids

The parathyroids are four small glands in the neck that lie next to the thyroid. Sir Owen, the curator of the Natural History Museum, discovered them in 1852 when he was dissecting a great Indian rhinoceros that had died at the London Zoo. Sir Richard was a violent anti-Darwinist and taught Queen Victoria's children zoology. Sir Owen is best remembered for coining the word 'Dinosauria ' which translates to terrible reptile. In his description of neck anatomy, Sir Owen referred to ‘a small compact yellow glandular body attached to the thyroid at the point where the vein emerged’; this is now identified as a parathyroid gland.

In 1880, Ivar Sandström, a 25 year-old medical student working in Uppsala, described the glands in man. In his classic monograph 'On a New Gland in Man and Fellow Animals' he described what he called the ‘Glandulae parathyroidae’ in the dog, cat, rabbit, ox, horse and man. Sandström was not aware of Sir Owen’s description, as it had been published in a journal with limited circulation. Sandström's report was not well received and the work remained barely noticed for several years. Sandström suffered from a hereditary mental illness and unfortunately took his own life aged 37 years.

The significance of Sandström’s discovery was not appreciated until Eugene Gley (1857–1930), a French physiologist, observed that the tetany (spasms caused by calcium imbalance) and death caused by experimental thyroidectomy in dogs occurred only if the excised material included the glands described by Sandström. This was confirmed by several others during the first decade of the 20th Century, but the role of the parathyroid glands in calcium metabolism was still unrecognised.

The great American surgeon William Halstead, was reported as saying  "it hardly seems credible that the loss of bodies so tiny should be followed by a result so disastrous".

During the next 70 years investigation and experiments began to elucidate the glands' role in the regulation of calcium metabolism.

In 1891, Friedrich Daniel von Recklinghausen (1833–1910) reported on a patient who had experienced recurrent fractures of several bones with negligible trauma and had subsequently had ‘bending’ of the long bones with extensive fibrosis, cysts and brown tumours. This group of findings was subsequently termed ‘osteitis fibrosa cystica of von Recklinghausen’, now recognised as one of the most significant findings in advanced parathyroid disease. However, von Recklinghausen did not himself couple the bone disease with any parathyroid disorder, and it was not until 1915 that Friedrich Schlagenhaufer (1866–1930), a Professor of Pathology in Vienna, suggested that an enlarged parathyroid might be the cause of bone disease and not the result of it.

In 1906, Erdheim had described an overgrowth (hyperplasia) of the parathyroids in the calcium-deficient state of osteomalacia. Soon after in 1909, McCallum and Voegtlin demonstrated that low blood calcium (hypocalcaemia) and tetany following removal of the parathyroids could be controlled by calcium administration.

Albert Ghane, a tramcar conductor who was operated on at the University Surgical Clinic in Vienna in July 1925 by Felix Mandl, was widely credited with performing the first parathyroidectomy. Initially Albert was thought to be cured of his symptoms, but six years after the initial surgery, he developed a high serum calcium and renal stones. A second attempt to cure Albert failed and he died in February 1936. Despite there being no evidence of tumour at post mortem, Albert was most likely a case of parathyroid hyperplasia. There is some evidence that parathyroidectomy was in fact performed earlier around 1916 by Bland Sutton at the Middlesex Hospital in London. In 1926, the first parathyroidectomy in the USA was performed by EJ Lewis at the Cook County Hospital in Chicago. Between 1926 and 1932, Captain Charles Martell was treated initially in New York and subsequently in Boston undergoing a series of operations, the final and seventh one being a mediastinal parathyroidectomy that cured the his hypercalcaemia, only for him to die 6 weeks later from hypocalcaemic-induced laryngospasm while having a ureteric stone removed.

At the time of his retirement in 1978, Mr Selwyn Taylor, the endocrine surgeon at the Hammersmith Hospital and the first president of the International Society of Endocrine Surgeons, had performed less than 120 parathyroidectomies and was considered one of the most experienced parathyroid surgeons in the UK.

By 2006, my team and were performing that number in a year.

For more information, there is a wonderfully detailed review of the history of parathyroid surgery. The reference is: The History of Parathyroid Surgery by Claude H Organ Jr: Journal of The American College of Surgeons Vol 191: September 2000 p284-299.