Thyroid history

Thyroid Historic perspective Dr T Balasubramanian

Goitre & mountains
Goitre was first seen in inhabitants of Alps
Initially they did not know that goitre is enlargement of thyroid gland
It was documented that consuming sea weeds caused remarkable cure in these patients
It goes without saying that sea weeds contain large amounts of iodine

Goitre
Greeks used the term Bronchocele to explain the goitrous swelling
Thyroid gland was discovered 200 years before Greeks used this term

Davinci and thyroid
Davinci discovered thryoid gland as early as 1500
He drew sketches of the gland in great detail
He used the term laryngeal glands to describe the thyroid
He also discussed in great detail the vasculature of the thyroid gland

Fabricious
In 1619 it was Fabricious who described thyroid enlargement caused swelling in the midline of neck
He also clearly described that this swelling moved up and down when the patient attempts to swallow

The name ”Thyroid”
Thomas Wharton in 1656 used to term Thyroid first
Thyroid is a Greek word to indicate shield shape
It was coined with the thyroid cartilage in mind as it is shaped like a shield.

Cretinism & thyroid gland
Alpine travellers were the first to associate cretinism with goitre in mother
Paracelsus in 1527 was the first to link goitre and cretinism
Platter in 1562 came out with convincing proof that cretinism was seen in children born of goitrous mothers

History of thyroid physiology
Initially goiter was thought to be caused by excess of phlegm
Chinese merchants were the ones who taught the Europeans that consuming sea weed could cure goitre
Courtois in 1812 discovered that sea weeds contained large quantities of iodine
Coindet in 1820 popularized iodine treatment for goitre in Sweden

Mortiz Schiff's contribution
Mortiz Schiff a physiologist from Geneva showed in 1856 removal of thyroid glands in dogs caused death due to some deprivation
This work never got the recognition it deserved

Mortiz Schiff (contd)
It was Mortiz Schiff who first proved that thyroid hormone can be substituted
He used thyroid extracts to save dogs in whom he performed total thyroid removal

Role of iodine in preventing goitre
In 1850 Chatain a pharmacist suggested that goitre could be prevented by consuming iodine
It was only after Akron study which was carried out in school children that goitre preventive role of iodine came to be recognised

Thyrotoxicosis
Parry was the first person to describe thyrotoxicosis
His work was not published till much later
Coindet described the symptoms of thyrotoxicosis without realizing its significance
Graves in his talk described few of his patients with goitre and palpitation. He initially considered it to be a cardiac malady
Basedow discussed in detail the symptoms of thyrotoxicosis

Thyrotoxicosis (contd)
In 1890 it was observed consumption of too much thyroid extract caused tremors and palpitation
It was approximately during this time surgeons were successful in partially removing this hyperfunctioning thyroid glands

Myxoedema
Was discovered much later than thyrotoxicosis
It was first described in London. The term myxoedema was used because of oedematous skin due to accumulation of myxoid tissue
Initially it was considered to be a neurologic / skin disease

Felix Semon
Felix Semon Prussian otolaryngologist described that patients who underwent total thyroidectomy for goitre treatment developed puffy faces similar to that of myxodematous patients seen in London
He was not beleived at first
A committee was constituted which concluded 5 years later that his observation was true

Exogenous thyroxine
Brown sequard documented the regenuating effects of consuming testicular extract of dogs
This provoked scientists to try out other organ extracts too
In 1891 Murray injected sheep thyroid extract which cured a patient with myxoedema

Search for thyroxine
Kendell used iodine as a marker to identify T3. He used the term thyroxine
Baumann identified iodine in the thyroid gland extract
It was the english man Harrington who indentified the exact molecular structure of thyroxine
Harrington suspected there could be another hormone in addition to thyroxine

Thyroid hormone synthesis
Harington added an e to thyroxin
He successfully synthesized thyroxine
Since it was a free acid absorption was poor
Hence until 1960's dessicated thyroid was used in the management of goitre

Goitre & exophthalmos
Fredrich Muller in 1893 identified that patients with goitre and exophthalmos had increased metabolic rate
He was the first person to associate goitre with exophthalmos

Thyroid surgery (History)
Roger Frugadi in 1170 used shoe laces to transfix large goitres which he allowed to slough
First thyroid surgery was performed by Albucais in spain. This surgery was performed to treat a patient with goitre. He used a cruciate incision for this purpose.

Setaceum
This technique in thryoid surgery was practised by Roland and Roger
This was practised when the goitre was adherent
Shoe lace ligature is encircled around the mass and firmly kept tied for 3 hours
The goitre which had become avascular was sectioned away.

Thyroid tunneling
Guy de Chauliac tunneled thyroid tumors with cautery. He passed a seton through the tunnel and removed the mass in toto. He was able to produce reasonable results following this procedure.

Cure by King's touch
Was practised for more than 500 years from 1100 to 1600.
Heinrichs the IV started this procedure
He was credited with nearly 1000 cures by simply touching the neck of the patient. (Such was the devotion they had towards their king thosedays).

Benjamin Gooch's advice
According to Benjamin Gooch thryoid surgery is not for those with weak heart (he meant the surgeon's)
He described his futile attempts to stop bleeding from the neck following surgery by using digital pressure by his assistants for two days who worked as a relay team

Thyroid incisions
Albucasis – cruciate incision
Adolf Vogel – circular incision
Benjamin Gooch – Vertical incision
Desault – Median longitudinal incision

Desault's technique
Considered to be father of thyroid sugery
He was the first to emphasise ligation of superior / middle / inferior thyroid pedicles before removing thyroid
His feat was considered unbeleivable

Dupuytren's technique
He staged thyroidectomy procedure
This allowed for better wound healing during procedures
He was the first to observe tracheal flattening / distortion

Ischemic atrophy
Luiga porta ligated thyroid arteries to induce ischemic destruction of thyroid gland
He first ligated both superior arteries of thyroid gland and this was ineffective
He ligated both superior and inferior arteries of one side. This provided temporary relief for about 6 months
He proved that arteries supplying the opposite lobe was not capable of maintaining integrity of opposite lobe

Patrick Heron Watson's technique
In 1894 in completed 5 cases of thyroidectomy in Edinburg
He used long median incision to expose neck
Separated strap muscles / fascia – mobilized superior pole using fingers
Used aneurysm needle to thread around superior pole and ligated it. Repeated same maneuver in the other portions of gland and excised it in full

Excellence of Hedenus
He stimulated the interest of thyroid surgery in Germany
Used midline vertical incision to expose the gland
Ligated superior and inferior thyroid arteries
Transfixed and double ligated the isthumus
Removed the mass completely

Incisions

Paul Sick's contribution
Credited with the first total extirpation of thyroid gland in 1867
He was the first to report symptoms of thyroid deprivation

Theodor Kocher and his 100 thyroid surgeries
Kocher was credited with more than 100 thyroid surgeries
He advised against total thyroidectomy
He believed total thyroidectomy somehow disturbed blood supply to the brain

Recurrent laryngeal nerve
Anton Wolfer was the first to draw attention to the recurrent laryngeal nerve
He also beleived ligation of inferior thyroid artery somehow damaged the nerve

Billroth's approach
He used lateral incisions placed over the inner border of sternomastoid muscle
He divided sternohyoid, omohyoid and sternothyroid muscles transversely
Artery forceps was freely used by Billroth. This facilitated better haemostasis

Near total thyroidectomy
First performed by Mikulicz
He left a sleeve of thyroid gland along the tracheo oesophageal groove in order to protect the recurrent laryngeal nerve from injury
He insisted that this technique is useful even in treating malignant lesions of thyroid gland

Study of thyroid vasculature
Kocher studied vasculature of thyriod gland by injecting colored fluid in the cadaver large vessels
He attempted to explain the tracheal oedema that followed thyroid surgery by suggesting vascular congestion to be the cause.

Berne's classification of thyroid surgeries
Total extirpation
Partial thyroidectomy
Enucleation

Mayo's contribution
Mayo could boast of the most experience in thyroid surgery than anyone else in this world
He was instrumental in disseminating vital knowledge pertaining to thyroid surgery to other surgeons
His clinic played a vital role in this purpose and still continues to do so

Thank you

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Thyroid history

by Balasubramanian Thiagarajan on Jul 21, 2011

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Thyroid history — Presentation Transcript