May 5, 2024
The study of the thyroid gland has a rich history dating back centuries.[1] However, it wasn’t until the 16th century that anatomists began to systematically describe the structure of the thyroid gland.[2] Andreas Vesalius, often regarded as the father of modern anatomy, provided one of the first detailed illustrations of the thyroid in his seminal work, De Humani Corporis Fabrica, published in 1543.[3]
Throughout the following centuries, interest in the thyroid gland grew as physicians observed the profound effects of thyroid dysfunction on human health. In the 19th century, clinicians began to recognize the association between goiter, enlargement of the thyroid gland, and iodine deficiency, particularly prevalent in regions with low iodine levels in the soil.[4] This understanding led to the implementation of iodine supplementation programs, which significantly reduced the incidence of goiter and related thyroid disorders in affected populations.[5]
The next era of thyroid research was ushered in during the late 19th and early 20th centuries with groundbreaking discoveries in thyroid physiology and pathology.[6] In 1891, Emil Theodor Kocher, a Swiss surgeon, was awarded the Nobel Prize in Physiology or Medicine for his work on the thyroid gland.[7] Kocher’s studies elucidated the role of the thyroid in metabolism and highlighted the significance of surgical interventions for thyroid disorders.[8]
Figure 2[9]
In 1872, during a pivotal moment in the history of thyroid surgery, Kocher embarked on his inaugural thyroidectomy, employing Billroth’s technique characterized by a vertical incision. However, this initial approach was fraught with challenges, notably a propensity for profuse bleeding within the highly vascular gland, presenting significant risks to patient safety. Undeterred by setbacks, Kocher swiftly pivoted to refine his technique, recognizing the critical importance of meticulous vascular control and nerve preservation.[10]
In a transformative shift, he devised a novel approach that prioritized the careful ligation of major arteries and veins before the delicate identification and isolation of the recurrent laryngeal nerve. This strategic modification not only mitigated the risk of hemorrhage but also safeguarded vital neural structures, thus revolutionizing the landscape of thyroid surgery. By mastering this refined technique, surgeons could now navigate thyroidectomy with enhanced precision, ensuring optimal hemostasis while preserving critical anatomical integrity. Kocher’s visionary innovation not only propelled the safety and efficacy of thyroid surgery to new heights but also heralded a paradigm shift in surgical practice, epitomizing the enduring pursuit of excellence and advancement in the field of medicine.[11]
In the 20th century, advancements in endocrinology and molecular biology further deepened our understanding of thyroid function and regulation.[12] The identification of thyroid hormones, thyroxine (T4) and triiodothyronine (T3), in the early 1900s paved the way for research into their synthesis, transport, and cellular effects.[13] Subsequent discoveries, including the cloning of thyroid hormone receptors and the elucidation of intracellular signaling pathways, have provided insights into the molecular mechanisms underlying thyroid hormone action. Today, the study of the thyroid gland continues to be a vibrant area of research, with ongoing investigations into its role in health and disease. From its ancient origins to its modern-day implications for human health, the thyroid gland remains a subject of enduring scientific interest and clinical significance.
References
[1] Fragu P. Le regard de l’histoire des sciences sur la glande thyroïde (1800–1960) [The history of science with regard to the thyroid gland (1800–1960)]. Ann Endocrinol (Paris). 1999 Mar;60(1):10–22. French. PMID: 10374011.
[2] Lydiatt DD, Bucher GS. Historical vignettes of the thyroid gland. Clin Anat. 2011 Jan;24(1):1–9. doi: 10.1002/ca.21073. PMID: 21120907.
[3] Lamberg BA. Glandula thyreoidea i Anothomia Mundini (1316) [The thyroid gland in Anothomia Mundini (1316)]. Dan Medicinhist Arbog. 2001:142–7. Danish. PMID: 11845798.
[4] Zimmermann MB. Research on iodine deficiency and goiter in the 19th and early 20th centuries. J Nutr. 2008 Nov;138(11):2060–3. doi: 10.1093/jn/138.11.2060. PMID: 18936198.
[5] Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015 Apr;3(4):286–95. doi: 10.1016/S2213–8587(14)70225–6. Epub 2015 Jan 13. PMID: 25591468.
[6] McAninch EA, Bianco AC. The History and Future of Treatment of Hypothyroidism. Ann Intern Med. 2016 Jan 5;164(1):50–6. doi: 10.7326/M15–1799. Erratum in: Ann Intern Med. 2016 Mar 1;164(5):376. PMID: 26747302; PMCID: PMC4980994.
[7] Choong, Emil Theodor Kocher (1841–1917), Journal of Clinical Neuroscience, ISSN: 0967–5868, Vol: 16, Issue: 12, Page: 1552–1554. “Kocher was a surgical pioneer and in 1909 was awarded the Nobel Prize in Physiology or Medicine for his contributions to the understanding and treatment of the thyroid gland.”
[8] Morris JB, Schirmer WJ. The “right stuff”: five Nobel Prize-winning surgeons. Surgery. 1990 Jul;108(1):71–80. PMID: 2193425.
[9] Credit Wikipedia, Emil Theodor Kocher.
[10] Medicine in Stamps Emil Theodor Kocher (1841–1917): thyroid surgeon and Nobel laureate, Tan S Y, MD, JD, Shigaki D, MS*, Singapore Med J 2008; 49 (9):662.
[11] Medicine in Stamps Emil Theodor Kocher (1841–1917): thyroid surgeon and Nobel laureate, Tan S Y, MD, JD, Shigaki D, MS*, Singapore Med J 2008; 49 (9):662.
[12] Balázs Gereben, Elizabeth A. McAninch, MD, Miriam O. Ribeiro, Antonio C. Bianco, Scope and limitations of iodothyronine deiodinases in hypothyroidism, 2 (2015), doi:10.1038/nrendo.2015.155. (“However, with the discovery in 1970 that, in humans, iodothyronine deiodinases produce most of the circulating T3, clinical standards abruptly shifted to align with the assumption that levothyroxine monotherapy would maintain the pool of T4 and that a group of enzymes known as the iodothyronine deiodinases would provide physiologic regulation of the T3 availability to tissues.”)
[13] Elizabeth A. McAninch, MD, New insights into the variable effectiveness of levothyroxine monotherapy for hypothyroidism 1 (2015), doi:10.1016/S2213–8587(15)00325–3. (“Thyroid hormone replacement has been the mainstay of treatments for hypothyroidism since the 19th century.”)
