A Timeline Report
Historical references to what we now know as the thyroid gland arose early in medical history. In 1600 BC the Chinese were using burnt sponge and seaweed for the treatment of goiters, which is an enlargement of the thyroid gland. Celsus first described a bronchoceole (tumour of the neck) in 15 AD. Around this time, Pliny referred to epidemics of the goitre in the Alps and also recommended the use of burnt seaweed in their treatment, in the same way that the Chinese had done 1600 years earlier. In 150 AD, Galen, an instrumental figure in the transition from ancient to modern medicine, referred to 'spongia usta' (burnt sponge) for the treatment of the goitre. He also suggested (incorrectly, as it turns out) that the role of the thyroid was to lubricate the larynx.
In 650 AD, Sun Ssu-Mo used a combination of seaweed, dried powdered mollusc shells and chopped up thyroid gland for the treatment of goitres. Ali-ibn-Abbas was the first to discuss surgery as a treatment method for goitres in 990 AD. Jurjani's 'Treasure of Medicine' in 1110 AD, first associated exophthalmus, (protrusion of the eyes) now associate with Graves' disease, with the goitre.
It was not until 1475 that Wang Hei anatomically described the thyroid gland and recommended that the treatment of goitres should be dried thyroid. Some fifty years later, Paracelsus attributed goitres to mineral impurities in the water. Finally in 1656, Thomas Wharton named it the thyroid gland, meaning shield due to its shape, as it resembled the shields commonly used in Ancient Greece.
In 1811, Paris discovered iodine in the burnt ashes of seaweed and the idea that this was the active ingredient in the treatments that were prescribed for goiters was developed. Ten years later, Prout was the first to recommend iodine in the treatment of goitres. In 1835,Robert James Graves, an Irish doctor published his accounts on the exophthalmic goitre. On the European Continent, exophthalmic goitre is known as Basedow's disease. Karl Adolph Basedow had described the entity independently in 1840. Sir William Gull, physician to Queen Victoria, although not the first to recognise the condition of myxoedema (hypothyroidism), was the first in 1873 to attribute it to atrophy of the thyroid gland. Due to language difficulties between European and English physicians, they were not aware of each other’s work.
In 1883 at a meeting of the Clinical Society of London, Felix Semon suggested that the symptoms of Swiss patients who had had a total thyroidectomy were very similar to those English patients who had myxoedema. Despite being treated with derision, Semon was persistent and persuaded the Society to set up a committee to investigate his suggestion. The committee took some five years to report and its chairman William Ord confirmed Semon's suggestion in1888. Ludwig Rehn a German a physician carried out the first thyroidectomy (removal of the thyroid gland) for exophthalmic goitre in 1880.
In Switzerland in the 1880s, Theodor Kocher demonstrated that total thyroidectomy caused hypothyroidism but initially thought that the symptoms were due to chronic airway obstruction. Kocher performed over 2000 thyroidectomies. He reported his early experience of thyroidectomy for Grave's disease, which had at that time a mortality of 13%. Later in in 1883, his mortality for total thyroidectomy for Grave's disease fell to a remarkable 1%. It was not until 1888 that he realised that the symptoms of a total thyroidectomy were due to lack of thyroid hormone. He recommended as a treatment for total thyroidectomy "half a sheep's thyroid lightly fried and taken with currant jelly once a week". The modern treatment of hypothyroidism was now born. Kocher was awarded the Nobel Prize for Medicine in 1909. Kocher was the greatest surgeon of the era, He was born in Berne in 1841 and died during World War I in 1917. The majority of his professional life was spent in the surgical clinic in Berne where he became the Head of Department, which is now a world famous centre.
The idea that the thyroid produces an iodine containing substance was investigated in the last century. In 1914, Edward Calvin Kendall isolated thyroxine, which is the active hormone of the thyroid gland. Interestingly, Kendall assigned the incorrect structure to L- thyroxine but his crystalline extract was of the correct structure and biological activity. Kendall erroneously thought that the compound contained an indole nucleus. This discovery by Kendall and his work on the adrenal gland hormones was rewarded the Nobel Prize for medicine in 1950. In the 1920s Kendall's thyroxine became available to clinicians but it was expensive as three tons of animal thyroid only vielded 33 g of thyroxine.
By the 1920s, thyroid surgery was commonplace and the great American surgeon William Halstead referred to the operation of thyroidectomy as a "feat which today can be accomplished by any competent operator without danger of mishap". This statement is true today only if the surgeon specialises in thyroid surgery. Kendall had patented his discovery but as it was a free acid it was not well absorbed by the body. Harrington's synthetic product was also costly, so thyroid replacement therapy in the 1960s was mainly desiccated animal thyroid.
The synthesis of sodium L-thyroxine and its ability to be absorbed orally revolutionised thyroid replacement making it safe and cheap. In 1952 Rosalind Pitt-Rivers and her post doctoral fellow Jack Gross discovered and synthesised tri-iodothyronine showing it was biologically more active than thyroxine.