The History of the Thyroid Gland

Historical references to what we now know as the thyroid gland arise early in medical history. In 1600 BC the Chinese were using burnt sponge and seaweed for the treatment of goitres (enlarged thyroid glands). Celsus first described a bronchoceole (a tumour of the neck) in 15 AD. Around this time Pliny referred to epidemics of goitre in the Alps and also mentioned the use of burnt seaweed in their treatment, in the same way as 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 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 goitre. Ali-ibn-Abbas was the first to discuss surgery as a treatment for goitres in 990 AD. Jurjani's 'Treasure of Medicine' in 1110 AD first associated exophthalmus, the protrusion of the eyes we now associate with Graves' disease, with goitre.

It was not until 1475 that Wang Hei anatomically described the thyroid gland and recommended that the treatment of goitre should be dried thyroid. Paracelsus, some fifty years later, attributed goitre to mineral impurities in the water. Finally, In 1656 Thomas Wharton named the gland the thyroid, meaning shield, as its shape 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 goitre developed. Ten years later Prout was the first to recommend iodine in the treatment of goitre. In 1835,Robert James Graves an Irish doctor published his accounts on exophthalmic goitre.On the European Continent exopthalmic goitre is known as Basedow's disease. Karl Adolph Basedow  had described the entity indepentlet in 1840. Sir WIlliam Gull physcian 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 .Because of language difficulties European physcians and English physcians were not aware of each others 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 described as myxoedema. Despite being treated with derision Semon was persistent and persauded the Society to set up a committe to  investigate his suggestion. The committee took some 5 years to report and its chairman WM Ord confirmed Semon's suggestion in1888. Ludwig Rehn a German a physcian carried out the first thyroidectomy (removal of the thyroid gland) for exophthalmic goitre in 1880.

Theodor KocherIn Switzerland in the 1880's Theodor Kocher demonstrated that total thyroidectomy caused hypothyroidism but thought initially that the symptoms were due to chronic air way obstruction. Kocher performed over 2000 thyroidectomies. He reported his early experience of thyroidectomy for Grave's disease which had a at that time a mortality of 13%. Later in in 1883 his mortality for total thyroidectomy for Grave's fell to a remarkable 1%. It was not until 1888 that he realised that the symptoms  of total thyroidectomy were due to lack of thyroid. He then Recommended as a treatment for total thyroidectomy "half a sheep's thyroid lightly fried and taken with current jelly once a week". The modern treatment of hypothyroidism was born. Kocher was awarded the Nobel Prize for Medicine in 1909. Kocher was the greatest surgeon of the era,he was born ar Berne in 1841 and died during the first world war in 1917. The majority of his professional life was spent in the surgical clinic in Berne where he was finally head of department  which is still a world famous centre.

The idea that the thyroid produced an iodine containing substance was investigated in the last century, and Edward  Calvin Kendall in 1914 isolated thyroxine the active principle of the thyroid gland. Interestingly Kendall assigned the incorrect  structure to L- thyroxine but his crystalline extract was of the correct stucture 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 with 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 grams of thyroxin. It was for in 1926 Harrington working at the University Medical School in London  to determine the correct stucture of of four iodine iodine atoms per moleclue of thyroxine. Identifing the correct strucure allowed thyroxine to be synthesied and to be readily  available to physicians. Much earlier In 1912 the Japanese physician Hashimoto Hakaru published in Germany a report on struma lymphomatosoma now recognised to be the comonest cause of hypothyroidism and which now bears his name. By 1920's 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. Harrington's synthetic product was also costly so even in the 1960's thyroid replacement therapy 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. Early workers had wondered if there were other thyroid hormones. In 1952 Rosalind Pitt-Rivers and her post doctoral fellow Gross discovered and synthesised tri-iodothyronine showing it was biologically more active than thyroxine.