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History of Disorders of Thyroid Dysfunction A.M

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History of Disorders of Thyroid Dysfunction A.M Eastern Mediterranean Health Journal, Vol. 11, No. 3, 2005 459 Review History of disorders of thyroid dysfunction A.M. Ahmed1 and N.H. Ahmed 2 ABSTRACT The first description of thyroid diseases as they are known today was that of Graves disease by Caleb Parry in 1786, but the pathogenesis of thyroid disease was not discovered until 1882–86. Thy- roidectomy for hyperthyroidism was first performed in 1880, and antithyroid drugs and radioiodine therapy were developed in the early 1940s. Thomas Curling first described hyopothyroidism (myxoedema) in 1850 and the cause and suitable treatment were established after 1883. This paper reviews the main landmarks in the history of thyroid disease, supplemented by a brief discussion of the historically relevant scientific aspects of the thyroid gland, and the evolution of endocrinology as a formal discipline. Histoire des troubles dysthyroïdiens RÉSUMÉ La première description des pathologies thyroïdiennes, telles qu’on les connaît aujourd’hui, a été celle de la maladie de Graves par Caleb Parry en 1786, mais la pathogenèse de l’affection thyroïdienne n’a pas été découverte avant 1882-1886. Une thyroïdectomie pour hyperthyroïdie a été réalisée pour la première fois en 1880, et les antithyroïdiens et le traitement par l’iode radioactif ont été mis au point au début des années 1940. Thomas Curling fut le premier à décrire l’hypothyroïdie (myxoedème) ainsi que sa cause en 1850 et un traitement adéquat a été établi après 1883. Cet article procède à un examen des principales étapes dans l’histoire de la pathologie de la thyroïde, avec une brève discussion des aspects scientifiques concernant la glande thyroïde qui ont eu une importance historique, et de l’évolution de l’endocrinologie en tant que discipline à part entière. 1Faculty of Medicine, University of Bahr Elghazal, Khartoum, Sudan (Correspondence to A.M. Ahmed: [email protected]). 2Ministry of Health, Khartoum, Sudan. Received: 17/08/03; accepted: 22/03/04 25 History of disorders.pmd 459 12/20/2005, 2:39 PM 460 La Revue de Santé de la Méditerranée orientale, Vol. 11, No 3, 2005 Introduction and the internal secretions form the blood sugar [2]. The history of thyroid disease is an exam- From 1855 to 1902 important research ple of the close inter-relationship of basic in endocrinology was carried out [3]. Add- and clinical sciences. Although we can see ison wrote an account on the disease of the a slow advancement in knowledge about suprarenal capsule [1]. Brown-Séquard the clinical features of thyroid disease since demonstrated that in animals death from the dawn of the 20th century, the methods adrenalectomy could be delayed by infu- of investigation and treatment advanced sion of blood from healthy animals. In 1889 rapidly. Minkowski and Von Merring performed the This paper reviews the main landmarks experimental production of diabetes [1]. By in the history of thyroid disease, starting the end of the 19th century a number of with a brief outline of the evolution of mod- diseases such as Graves disease and ac- ern endocrinology. Many endocrine con- romegaly were described along with their cepts such as feedback mechanisms, probable relation to a glandular dysfunction replacement therapy and the use of iso- [3]. topes were first established during studies English physiologists William Bayliss on the thyroid gland. Although the aim of (1860–1924) and Ernest Starling (1866– the paper was to discuss the historical as- 1927) made important discoveries in 1902 pects of thyroid disease, we have supple- mented the review with a description of the [3]. While they were studying the effects historical developments in our knowledge of “pancreatic juices” on the duodenal mu- of anatomy and physiology of the thyroid cosa, they isolated a substance, giving it gland. the name “secretin”. When secretin was in- jected into the bloodstream of an experi- mental animal, it resulted in marked Endocrinology: historical increased secretion from the pancreas. landmarks This result reinforced Bernard’s concept of internal secretion [3]. In 1905 Starling Some endocrine facts, such as the sequelae coined the term “hormone” for this internal of castration, are deeply rooted in the past. secretion (including his secretin). The Frederick Ruysch (1638–1731), a Dutch word hormone was derived from a Greek anatomist, was the first to speculate, in phrase meaning “to set in motion”. Thus, 1690, that an organ such as the thyroid secretin was the first hormone to be isolat- pours into the blood substances of physio- ed. The term “endocrine” can be traced to logical importance [1]. The French scien- Starling who differentiated between endo- tist Theophile de Bordeu (1722–76) had a crine and exocrine secretions [1]. similar theory [1]. The Ruysch and Bordeu The history of endocrinology is not speculations were easily criticized by the complete without a mention of the master lack of any experimental proof. But the real of the endocrine glands, the pituitary. The father of endocrinology who set its princi- pituitary gland was named by the Belgian ples as a formal discipline was French anatomist Andreas Vesalius (1514–64) who physiologist Claude Bernard (1813–78). In believed that it secreted mucus through the 1855, Bernard introduced the term “internal nose (derived from the Latin word pituita secretions” when he was studying the role which means mucus) [1]. Later, the Ger- of the liver in sugar metabolism. He stated man physician Conrad Victor Schneider that the external secretions form the bile 25 History of disorders.pmd 460 12/20/2005, 2:39 PM Eastern Mediterranean Health Journal, Vol. 11, No. 3, 2005 461 (1614–80) cast doubt on the mucus secret- gested that it functioned to lubricate the lar- ing function of the pituitary when he first ynx and this view was accepted for a long described the cribriform plate of the eth- time. Wharton in 1656 suggested that the moid [1]. But this view persisted until purpose of the thyroid was to beautify the Pierre Marie (1853–1940) detected two neck by giving it a rounded contour cases of acromegaly with associated pitu- through filling the vacant spaces around the itary enlargement in 1886 and 1888 [3]. larynx [3]. In 1829 Astley Cooper proposed Since then a large body of knowledge has that the thyroid was a lymphatic gland accumulated about the pituitary which led when he noticed lymph passing from it to Langdon Brown in 1935 to describe it as the thoracic duct [1]. Even up to 1880 the the “leader of the endocrine orchestra”. thyroid was proposed as a receptacle of worms or even a vascular shunt to cushion the brain against a sudden increase in blood Anatomy of the thyroid flow. The anatomy of the thyroid gland can be Thomas King (1809–47) first suggested traced back as far as the first century AD the concept of an internal secretary func- when Galen, the famous Greek doctor, tion for the thyroid. King’s idea was that briefly described it in his treatise De voce the thyroid formed and secreted a vital ma- [1]. In 1543 Vesalius gave a full description terial into the circulation at a time of emer- of the organ; he believed that it consisted of gency [4]. This view was supported a few two separate parts [1]. Later, the anatomist years later by Felix Semon [1]. In 1856 Bartolomeo Eustachius recognized the isth- Moritz Schiff (1823–96) of Berne carried mus and considered the thyroid as a single out thyroidectomies on dogs and guinea organ [1]. But the controversy about pigs with fatal results [3]. For 30 years whether the thyroid was a single or double nothing was heard of this work. The thy- organ was finally resolved by Giovanni roidectomy remained generally fatal until Bathista Morgagni (1682–1771) who dem- French physiologist Eugene Gley (1857– onstrated that the gland had two lobes con- 1934) described the parathyroid glands in nected by the isthmus. Thomas Wharton of 1891 [5]. London (1617–73) named the thyroid in In 1882–83, Ludwig Rehn (1849–1930) 1656, from the Greek word thyreos mean- and Jacques-Louis Reverdin (1841–1917) ing “oblong shield” [3]. noticed the appearance of symptoms of The histology of the thyroid was stud- hypothyroidism after thyroidectomy opera- ied from the start of the microscopy era. It tions on patients with Graves disease (see was found to be formed of vesicles con- later) [6,7]. In 1884 Schiff remembered his taining colloid material and lined with cubi- 1856 work and repeated his previous ex- cal cells. The vesicles were thought to be periments on dogs and succeeded in pre- communicating together, but in 1841, Hein- venting the effects of thyroidectomy by rich Bardeleben of Germany (1817–95) re- grafting the thyroid onto another part of the futed this idea [1]. animal body. Unfortunately, the body soon absorbed the gland. Thereafter, the func- tion of the thyroid gland was thought to Physiology of the thyroid neutralize or remove poisons from the body and hence that thyroid deficiency leads to Throughout history, the function of the toxaemia. thyroid has been controversial. Galen sug- 25 History of disorders.pmd 461 12/20/2005, 2:39 PM 462 La Revue de Santé de la Méditerranée orientale, Vol. 11, No 3, 2005 The definite function of the thyroid as a Pituitary and thyroid controller of metabolism was studied and The association between the pituitary gland confirmed by work carried out between and endocrine disease was first recognized 1886 and 1895 by George Murray (1865– by Pierre Marie in 1890 who found that pi- 1939), Hector Mackenzie (1856–1938) and tuitary enlargement was a constant finding Edward Fox (1856–1938) [8]. These stud- in acromegaly patients [3,15].
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