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 friends that he was dying of gastric carcinoma, and stating his fervent wish that a group of endocrine surgeons should be formed. Scientific papers were invited and a single day program set up during the next meeting of the SIC together with the provision for all those interested to meet and discuss plans for the future.

At 9:00 a.m., Thursday, September 4, 1979, a group met in a room of the SIC congress in San Francisco and elected a president, Selwyn Taylor, a president-elect, Richard Egdahl, a secretary-treasurer, Orlo Clark, and a small international committee.

All those who had indicated that they would be present became the founding members and, since then, the membership has been strictly monitored by surgeons from the applicant's own country, as well as by the committee. The IAES currently counts more than 500 members from around the globe.

The meeting's first scientific session opened at 11.00 a.m. and so keen were other members of the congress to attend, that a larger hall had to be found to house the afternoon session. The standard of presentation and the subsequent discussion was of the highest order and it has remained so ever since. At the conclusion of the next meeting, which was held in Montreux, Switzerland, in 1981, the founding president, Selwyn Taylor, handed over to his successor a badge of office, placing it around his neck, and this ceremony has been carried on ever since at each meeting, the latest being in Adelaide in September this year where Leigh Delbridge received the badge of office. The subsequent list of IAES Presidents includes: Richard Egdahl (USA), Per-Ola Granberg (Sweden), Tom Reeve (Australia), Yoshide Fujimoto (Japan), Norman Thompson (USA), Hans Roher (Germany), Ivan Johnston (UK), Orlo Clark (USA), Charles Proye (France), Jon van Heerden (USA), Shiro Noguchi (Japan), Malcolm Wheeler (UK), Henning Dralle (Germany), and Goran Akerstrom (Sweden). It is heartening that the members' enthusiasm is maintained and even increased. The IAES owes much of the success of its early days to the beneficent sponsorship of the parent organization, the SIC.

The original aims of the IAES were to provide "a forum for the exchange of views of those who are involved in expanding the frontiers of endocrine surgery whether by clinical experience, laboratory investigation or in any other way, not for the general surgeon who occasionally operates on a thyroid or adrenal gland."

The IAES, indeed, fulfils these aims, and is proud of its place in the SIC. The recent IAES meeting in Adelaide demonstrated the valuable contribution by endocrine surgeons around the world. the next biennial meeting of the IAES will be held in Yokohama, Japan, in August 2010. Finally, the World Journal of Surgery regularly devotes a complete issue to the contributions of the IAES.

The IAES always presents a plenary session at the SIC congress, the Peter Heimann lecture, as a prestigious reminder of his contribution.

Adapted from: www.iaes-endocrine-surgeons.com/about/history.shtml accessed 3rd Nov 2009

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 of a clergyman. He graduated in Medicine from Dublin in 1818 and went on to become chief physician at Meath Hospital. In 1835 he published his lectures in which he described three patients with “a newly observed affectation of the thyroid gland in females”, noting palpitations, thyroid enlargement and exophthalmos. In fact, Graves incorrectly attributed the thyroid enlargement as a disorder secondary to overactivity of the heart. Robert Graves' career, as well as his family life, suffered a major downturn when he developed severe depression, probably due to primary hypothyroidism. He died in 1853.

The eponymous term Graves’ disease was first suggested by Trousseau in his Textbook of Medicine, and the name has stuck. However, another Celt, Caleb Parry, clearly described the disease before Robert Graves.

Caleb Parry was born in 1755, also the son of a clergyman. He graduated from Edinburgh University in 1788 and became a physician in Bath, and soon developed a reputation as an expert in disorders of the heart, including angina. John Hunter, who himself suffered from angina, was one of his patients. Parry first noted a case of “exophthalmic goitre” in his writings in 1786 but did not publish it at the time. He was also a renowned fossil collector and Founding Member of the Geological Society. His career ended however when he suffered a stroke in 1816, dying in 1822. His collected writings were published posthumously in 1825. In this he reports 5 cases with goitre, exophthalmos and cardiac arrhythmias. He correctly attributed the disorder as being primarily due to a disorder of the thyroid gland.

Sir William Osler, in his textbook published in 1898, ascribed the name “Parry’s Disease” to the disorder, however this was never accepted and the term “Graves’ disease entered popular usage. Interestingly, in continental Europe, the disorder is referred to as Basedow’s disease, although von Basedow (1799-1844) who graduated from Halle University in Germany, did not publish his report until 1840.

Lecture presented at the International Association of Endocrine Surgeons meeting, Adelaide, 8th September 2009

Thyroid fine needle biopsy is now accepted as the definitive diagnostic procedure in the investigation of thyroid nodules. It was developed at the Karolinska Hospital in Stockholm, Sweden, and many decades passed before the technique was accepted worldwide. Fine needle biopsy (FNB) is more than 100 years old. In 1904 Greig and Gray reported that trypanosomal organisms could be detected in needle aspiration material from lymph nodes in a patient with sleeping sickness. Thyroid fine needle biopsy however had its origins at the Karolinska Hospital in Sweden. In the late 1940s Dr Sixten Franzén, then a young doctor with special interest in the morphology of bone marrow smears, was recruited to the oncology clinic at Karolinska. Dr Franzén started to make aspiration biopsies stained with Giemsa from various tumours and his diagnoses were, already at this time, used in the clinical management of many patients. In 1967 a Fine Needle Biopsy Clinic was opened at the Karolinska Hospital. Drs Zajicek, Löwhagen and Esposti joined the Clinic and, in its heyday, more than 10.000 patients were examined, aspirated and diagnosed each year. The clinical impact of this activity had a dramatic effect, with the number of open thyroid biopsies being reduced substantially. Needless to say, at this time there were many opponents of the use of fine needle cytology as definite diagnostic method. Dr Löwhagen was particularly enthusiastic about teaching the techniques, and several hundred foreign doctors were introduced to fine needle cytology over the years. Although it took several decades for the technique to be accepted worldwide, thyroid fine needle biopsy, as pioneered at the Karolinska Institute, has led to a significant reduction in the number of patients requiring surgery for thyroid nodules.

Adapted from: Lundgren CI, Zedenius J, Skoog L. Fine-needle aspiration biopsy of benign thyroid nodules: an evidence-based eview. World J Surg. 2008;32:1247-52.

Thyroid and parathyroid ultrasound are now part of routine clinical practice, with endocrine surgeons and endocrinologists around the world being encouraged to incorporate clinician-performed ultrasound (CPU) as an extension of clinical examination. What is not commonly appreciated is that thyroid and parathyroid ultrasound, and the technological developments that led to their introduction into clinical practice, were actually an Australian achievement. Ultrasound was originally a modality developed by the US military to detect metal flaws. It was released for general use after World War 2, and in 1951 the technology was first used to describe the acoustic characteristics of breast tumours. During the 1960’s research into breast ultrasound continued in Australia and in 1966 the first ultrasonic breast scanner in the world was installed at Royal North Shore Hospital in Sydney under Tom Reeve’s clinical supervision. It was a bistable machine capable of imaging in linear, sector, and compound scanning modes. The technological developments that enabled this scanner were the development of grey scale imaging techniques by George Kossoff and Jack Jellins at the Commonwealth Acoustic Laboratories in Chatswood, Sydney. The combination of grey scale imaging and focused array techniques enabled grey scale ultrasonography to be applied to all soft tissue lesions. ASUM (Australian Society for Ultrasound in Medicine) was set up in 1970, another world first. In 1974 the breast scanner was then modified and applied to the thyroid, parathyroid and testis. The increasing experience of this group with the clinical application of small parts ultrasound led to the publication in the 1978 of sentinel publications on small parts ultrasound of breast, testicle, thyroid, and parathyroid. The thyroid (1) and parathyroid (2) publications noted below were among the first in the world to utilise the technology, and set the scene for the use ultrasound in endocrine practice for decades to follow.

(1) Crocker EF, Jellins J. Grey scale ultrasonic examination of the thyroid gland Med J Aust 1978;9:244.
(2) Crocker ED, Bautovich GJ, Jellins J. Gray-scale echographic visualisation of parathyroid adenoma. Radiology 1978;126:233-4

The German anatomist and surgeon, Lorenz Heister was born in Frankfurt in 1683 and appointed to the Chair in Surgery and Anatomy in Altdor. In his textbook “Chirurgie” we find some of the earliest descriptions of various medical and surgical approaches for the management of goitre. “In the case of a recent goitre the patient must be given a good diet and suitable sudorific and purgative drugs. It is said to be a beneficial practice if people who are getting a goitre wear a necklet of lead right at the beginning which, while not always successful, at least prevents the goitre from growing any bigger. Many recommend that incipient goitres should be stroked with the hand of a dead man, preferably one that has died of consumption. However in the case of old goitres which cannot be dispersed by drugs but nevertheless remain mobile, it is possible in some cases to remove them completely. Mobile goitres can be removed in three ways:

1. Binding (ie ligation), if they have a thin root which is uncommon.
2. Cutting: if the growth is small, a long incision is made above it; if it is large, a cruciform cut is made, whereupon the lips of the wound are separated and the growth is seized with the hand or tenaculum and it is enucleated like a sebaceous cyst. A needle and strong thread can also be passed through the growth so as to form a handle on which to pull. Helpers should draw apart the wound and dry the blood with swabs. If there is profuse bleeding from the arteries near the root, this must be staunched with a good haemostatic drug, or the arteries are ligated, or a cautery applied to them.
3. Corrosion: Since goitres are growths which cause no pain there are few, particularly among the poor, who want to be operated on. If such people want to be treated without an operation, the growth can be cauterized like other growths by corrosion, but this is reliable only in the case of mobile benign tumours: because otherwise the large arteries and nerves in the throat might be attacked and eaten away with death ensuing, or the goitre may be turned into a cancer”

From Merke FE. History and Iconography of endemic Goitre and Cretinism. MTP Press, Lancaster, 1984: 187.