Thyroid history

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This presentation discusses the historical evolution of thyroid surgery

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Thyroid history

  1. 1. Thyroid Historic perspective Dr T Balasubramanian
  2. 2. Goitre & mountains <ul><li>Goitre was first seen in inhabitants of Alps
  3. 3. Initially they did not know that goitre is enlargement of thyroid gland
  4. 4. It was documented that consuming sea weeds caused remarkable cure in these patients
  5. 5. It goes without saying that sea weeds contain large amounts of iodine </li></ul>
  6. 6. Goitre <ul><li>Greeks used the term Bronchocele to explain the goitrous swelling
  7. 7. Thyroid gland was discovered 200 years before Greeks used this term </li></ul>
  8. 8. Davinci and thyroid <ul><li>Davinci discovered thryoid gland as early as 1500
  9. 9. He drew sketches of the gland in great detail
  10. 10. He used the term laryngeal glands to describe the thyroid
  11. 11. He also discussed in great detail the vasculature of the thyroid gland </li></ul>
  12. 12. Fabricious <ul><li>In 1619 it was Fabricious who described thyroid enlargement caused swelling in the midline of neck
  13. 13. He also clearly described that this swelling moved up and down when the patient attempts to swallow </li></ul>
  14. 14. The name ”Thyroid” <ul><li>Thomas Wharton in 1656 used to term Thyroid first
  15. 15. Thyroid is a Greek word to indicate shield shape
  16. 16. It was coined with the thyroid cartilage in mind as it is shaped like a shield. </li></ul>
  17. 17. Cretinism & thyroid gland <ul><li>Alpine travellers were the first to associate cretinism with goitre in mother
  18. 18. Paracelsus in 1527 was the first to link goitre and cretinism
  19. 19. Platter in 1562 came out with convincing proof that cretinism was seen in children born of goitrous mothers </li></ul>
  20. 20. History of thyroid physiology <ul><li>Initially goiter was thought to be caused by excess of phlegm
  21. 21. Chinese merchants were the ones who taught the Europeans that consuming sea weed could cure goitre
  22. 22. Courtois in 1812 discovered that sea weeds contained large quantities of iodine
  23. 23. Coindet in 1820 popularized iodine treatment for goitre in Sweden </li></ul>
  24. 24. Mortiz Schiff's contribution <ul><li>Mortiz Schiff a physiologist from Geneva showed in 1856 removal of thyroid glands in dogs caused death due to some deprivation
  25. 25. This work never got the recognition it deserved </li></ul>
  26. 26. Mortiz Schiff (contd) <ul><li>It was Mortiz Schiff who first proved that thyroid hormone can be substituted
  27. 27. He used thyroid extracts to save dogs in whom he performed total thyroid removal </li></ul>
  28. 28. Role of iodine in preventing goitre <ul><li>In 1850 Chatain a pharmacist suggested that goitre could be prevented by consuming iodine
  29. 29. It was only after Akron study which was carried out in school children that goitre preventive role of iodine came to be recognised </li></ul>
  30. 30. Thyrotoxicosis <ul><li>Parry was the first person to describe thyrotoxicosis
  31. 31. His work was not published till much later
  32. 32. Coindet described the symptoms of thyrotoxicosis without realizing its significance
  33. 33. Graves in his talk described few of his patients with goitre and palpitation. He initially considered it to be a cardiac malady
  34. 34. Basedow discussed in detail the symptoms of thyrotoxicosis </li></ul>
  35. 35. Thyrotoxicosis (contd) <ul><li>In 1890 it was observed consumption of too much thyroid extract caused tremors and palpitation
  36. 36. It was approximately during this time surgeons were successful in partially removing this hyperfunctioning thyroid glands </li></ul>
  37. 37. Myxoedema <ul><li>Was discovered much later than thyrotoxicosis
  38. 38. It was first described in London. The term myxoedema was used because of oedematous skin due to accumulation of myxoid tissue
  39. 39. Initially it was considered to be a neurologic / skin disease </li></ul>
  40. 40. Felix Semon <ul><li>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
  41. 41. He was not beleived at first
  42. 42. A committee was constituted which concluded 5 years later that his observation was true </li></ul>
  43. 43. Exogenous thyroxine <ul><li>Brown sequard documented the regenuating effects of consuming testicular extract of dogs
  44. 44. This provoked scientists to try out other organ extracts too
  45. 45. In 1891 Murray injected sheep thyroid extract which cured a patient with myxoedema </li></ul>
  46. 46. Search for thyroxine <ul><li>Kendell used iodine as a marker to identify T3. He used the term thyroxine
  47. 47. Baumann identified iodine in the thyroid gland extract
  48. 48. It was the english man Harrington who indentified the exact molecular structure of thyroxine
  49. 49. Harrington suspected there could be another hormone in addition to thyroxine </li></ul>
  50. 50. Thyroid hormone synthesis <ul><li>Harington added an e to thyroxin
  51. 51. He successfully synthesized thyroxine
  52. 52. Since it was a free acid absorption was poor
  53. 53. Hence until 1960's dessicated thyroid was used in the management of goitre </li></ul>
  54. 54. Goitre & exophthalmos <ul><li>Fredrich Muller in 1893 identified that patients with goitre and exophthalmos had increased metabolic rate
  55. 55. He was the first person to associate goitre with exophthalmos </li></ul>
  56. 56. Thyroid surgery (History) <ul><li>Roger Frugadi in 1170 used shoe laces to transfix large goitres which he allowed to slough
  57. 57. 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. </li></ul>
  58. 58. Setaceum <ul><li>This technique in thryoid surgery was practised by Roland and Roger
  59. 59. This was practised when the goitre was adherent
  60. 60. Shoe lace ligature is encircled around the mass and firmly kept tied for 3 hours
  61. 61. The goitre which had become avascular was sectioned away. </li></ul>
  62. 62. Thyroid tunneling <ul>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. </ul>
  63. 63. Cure by King's touch <ul><li>Was practised for more than 500 years from 1100 to 1600.
  64. 64. Heinrichs the IV started this procedure
  65. 65. 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). </li></ul>
  66. 66. Benjamin Gooch's advice <ul><li>According to Benjamin Gooch thryoid surgery is not for those with weak heart (he meant the surgeon's)
  67. 67. 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 </li></ul>
  68. 68. Thyroid incisions <ul><li>Albucasis – cruciate incision
  69. 69. Adolf Vogel – circular incision
  70. 70. Benjamin Gooch – Vertical incision
  71. 71. Desault – Median longitudinal incision </li></ul>
  72. 72. Desault's technique <ul><li>Considered to be father of thyroid sugery
  73. 73. He was the first to emphasise ligation of superior / middle / inferior thyroid pedicles before removing thyroid
  74. 74. His feat was considered unbeleivable </li></ul>
  75. 75. Dupuytren's technique <ul><li>He staged thyroidectomy procedure
  76. 76. This allowed for better wound healing during procedures
  77. 77. He was the first to observe tracheal flattening / distortion </li></ul>
  78. 78. Ischemic atrophy <ul><li>Luiga porta ligated thyroid arteries to induce ischemic destruction of thyroid gland
  79. 79. He first ligated both superior arteries of thyroid gland and this was ineffective
  80. 80. He ligated both superior and inferior arteries of one side. This provided temporary relief for about 6 months
  81. 81. He proved that arteries supplying the opposite lobe was not capable of maintaining integrity of opposite lobe </li></ul>
  82. 82. Patrick Heron Watson's technique <ul><li>In 1894 in completed 5 cases of thyroidectomy in Edinburg
  83. 83. He used long median incision to expose neck
  84. 84. Separated strap muscles / fascia – mobilized superior pole using fingers
  85. 85. 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 </li></ul>
  86. 86. Excellence of Hedenus <ul><li>He stimulated the interest of thyroid surgery in Germany
  87. 87. Used midline vertical incision to expose the gland
  88. 88. Ligated superior and inferior thyroid arteries
  89. 89. Transfixed and double ligated the isthumus
  90. 90. Removed the mass completely </li></ul>
  91. 91. Incisions
  92. 92. Paul Sick's contribution <ul><li>Credited with the first total extirpation of thyroid gland in 1867
  93. 93. He was the first to report symptoms of thyroid deprivation </li></ul>
  94. 94. Theodor Kocher and his 100 thyroid surgeries <ul><li>Kocher was credited with more than 100 thyroid surgeries
  95. 95. He advised against total thyroidectomy
  96. 96. He believed total thyroidectomy somehow disturbed blood supply to the brain </li></ul>
  97. 97. Recurrent laryngeal nerve <ul><li>Anton Wolfer was the first to draw attention to the recurrent laryngeal nerve
  98. 98. He also beleived ligation of inferior thyroid artery somehow damaged the nerve </li></ul>
  99. 99. Billroth's approach <ul><li>He used lateral incisions placed over the inner border of sternomastoid muscle
  100. 100. He divided sternohyoid, omohyoid and sternothyroid muscles transversely
  101. 101. Artery forceps was freely used by Billroth. This facilitated better haemostasis </li></ul>
  102. 102. Near total thyroidectomy <ul><li>First performed by Mikulicz
  103. 103. He left a sleeve of thyroid gland along the tracheo oesophageal groove in order to protect the recurrent laryngeal nerve from injury
  104. 104. He insisted that this technique is useful even in treating malignant lesions of thyroid gland </li></ul>
  105. 105. Study of thyroid vasculature <ul><li>Kocher studied vasculature of thyriod gland by injecting colored fluid in the cadaver large vessels
  106. 106. He attempted to explain the tracheal oedema that followed thyroid surgery by suggesting vascular congestion to be the cause. </li></ul>
  107. 107. Berne's classification of thyroid surgeries <ul><li>Total extirpation
  108. 108. Partial thyroidectomy
  109. 109. Enucleation </li></ul>
  110. 110. Mayo's contribution <ul><li>Mayo could boast of the most experience in thyroid surgery than anyone else in this world
  111. 111. He was instrumental in disseminating vital knowledge pertaining to thyroid surgery to other surgeons
  112. 112. His clinic played a vital role in this purpose and still continues to do so </li></ul>
  113. 113. Thank you

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