March 2005 Newsletter: The mechanism of thyrotoxicosis

Tuesday, March 01, 2005

“Exopthalmic goitre” widely known as Graves’ Disease in the English-speaking world was actually first noted by Caleb Hiller Parry in 1786. It was not until 1825 however that his account of eight patients with “enlargement of the thyroid gland in connexion with palpitation of the heart” was published posthumously. In 1835 Robert Graves described three patients with “a newly observed affectation of the thyroid gland in females”, noting palpitations, thyroid enlargement and exophthalmos. Subsequently Basedow, in 1840, described three patients with“exophthalmos due to hypertrophy of cellular tissue in the orbit, goitre and palpitations” and the disorder bears his name in Europe. Graves ascribed the observed thyroid enlargement as being due to overaction of the heart. However a primary role for the thyroid itself was strongly suggested by the effects of surgical operations. In the nineteenth century patients were treated with setons, thyroid artery ligation, or partial thyroidectomy primarily to relieve local pressure effects, however the toxic features were sometimes also noted to be relieved. The significance of this was first appreciated by Ludwig Rehn, of Frankfurt-am-Main in 1884. He reported three cases of Basedow’s disease whose toxic symptoms were cured incidentally when their goitres were removed for relief of dyspnoea. It was he who proposed thyroid overactivity as the primary mechanism of the symptoms manifest in this disorder. Toxic symptoms also subsided after thyroid resection in one of Mikulicz’s patients. Paul Mobius of Leipzig made the same suggestion as Rehn two years later and in 1893 William Greenfield of Edinburgh described primary thyroid hyperplasia in patients with exophthalmic goitre. Berry, the famous English thyroid surgeon, suggested in 1901 that the thyroid secretion in toxic goitre was altered in quantity, although he also proposed that it might be altered in quality and attributed the disease to a specific “thyroid toxin”. It was up to Plummer, a physician from the Mayp Clinic, to demonstrate that excess thyroxine in itself caused all the features of hyperthyroidism excepting exphthalmos.

From: Welbourn RB. The history of endocrine surgery. 1990. Praeger, New York

Find A Surgeon

- select country first to select state

Prediction Tools for Surgeons


Contact Us

Australian and New Zealand Endocrine Surgeons
Suite 202 AMA House
69 Christie Street

Send Email to Australian and New Zealand Endocrine Surgeons

Just Updated

The Alfred General Surgery Meeting 2019

Saturday, April 06, 2019
The Alfred General Surgery Meeting 2019 1 - 2 November 2019 Pullman Melbourne on the Park 192 Wellington Parade, Melbourne, Victoria Early registration closure: 29 September 2019 For more information and to register please visit the meeting website. ( ..Read More

RACS 88th Annual Scientific Congress

Tuesday, February 19, 2019
Save the date for the RACS 88th Annual Scientific Congress 6-10 May 2019 Centara Grand & Bangkok Convention Centre | Bangkok, Thailand  ..Read More

Save the Date: 6th Postgraduate Course in Endocrine Surgery

Thursday, October 29, 2015
Save the date for the 6th Postgraduate Course in Endcorine Surgery 24th and 25th June 2016 Parkroyal Darling Harbour Sydney (Agenda to be published soon)  ..Read More

30th and 31st of October: The Alfred General Surgery Meeting 2015

Thursday, October 29, 2015
 ..Read More

August 2013 - Symposium on the management of central compartment lymph node disease

Friday, August 09, 2013
THE ROLE OF LYMPH NODE SURGERY IN THE MANAGEMENT OF CENTRAL COMPARTMENT NODAL METASTASIS IN PAPILLARY THYROID CARCINOMA The following document summarizes a presentation given by A/Prof Mark Sywak at a Clinical Symposium on the management of central compartment lymph node disease. The symposium was held at the recent International Surgical Week, Helsinki FINLAND in August 2013.  ..Read More

August 2012 Newsletter: James Berry and His Thyroid Clinic

Thursday, August 16, 2012
HISTORICAL NOTE JAMES BERRY AND HIS THYROID CLINIC Berry’s Ligament is certainly the most well known eponymous anatomical structure of relevance to thyroid surgery, tethering the thyroid gland to the trachea and lying, as it does, at the crucial point where the recurrent laryngeal nerve is most likely to be injured. James Berry was a formidable surgeon who established a Thyroid Surgical Clinic ..Read More

July 2011 Newsletter: Rundle and His Curve

Saturday, June 11, 2011
Rundle’s curve is a well known phenomenon, found in many ophthalmology and endocrinology textbooks. It describes the natural history of the orbital changes in Graves’ ophthalmopathy. Whilst all the primary research underlying this observation was undertaken in the London, Rundle was in fact an Australian, and later returned to Sydney to make a significant contribution to the surgic ..Read More

March 2010 Newsletter: Cecil Joll and His Instruments

Monday, September 27, 2010
Joll's thyroid retractor Thyroid surgeons from last century were at the forefront of developing surgical instruments to facilitate safe and effective thyroid surgery. Such instruments remain in widespread use in all forms of surgery today. In this current era of sutureless thyroidectomy, where almost the entire procedure can be performed with a small, hand-held, disposable vessel sealin ..Read More

November 2009 Newsletter: IAES - The International Association of Endocrine Surgeons

Wednesday, January 20, 2010
The IAES owes its origins to Peter Heimann, Professor of Surgery, Bergen, Norway. He was a general surgeon with a particular interest in the thyroid gland, and it was his ambition to polarize the activities of those general surgeons interested in the endocrine system into a special group within the Société Internationale de Chirurgie (SIC). In 1978, Peter Heimann wrote to some of his frien ..Read More

September 2009 Newsletter: A Tale of Two Celts

Wednesday, January 20, 2010
Immunogenic thyrotoxicosis is commonly referred to as Graves’ disease after the Irish physician Robert Graves. That however is a case of mistaken eponymous attribution to the wrong Celt, and the disorder should really be called Parry’s disease after the Welsh physician, Caleb Parry, who was the first to describe the clinical features. Robert Graves was born in Dublin in 1797, the son  ..Read More

Quick Contact

Captcha Image