Thyroid history
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This presentation discusses the historical evolution of thyroid surgery
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Thyroid history
- 1. Thyroid Historic perspective Dr T Balasubramanian
- 3. Initially they did not know that goitre is enlargement of thyroid gland
- 4. It was documented that consuming sea weeds caused remarkable cure in these patients
- 5. It goes without saying that sea weeds contain large amounts of iodine
- 7. Thyroid gland was discovered 200 years before Greeks used this term
- 9. He drew sketches of the gland in great detail
- 10. He used the term laryngeal glands to describe the thyroid
- 11. He also discussed in great detail the vasculature of the thyroid gland
- 13. He also clearly described that this swelling moved up and down when the patient attempts to swallow
- 15. Thyroid is a Greek word to indicate shield shape
- 16. It was coined with the thyroid cartilage in mind as it is shaped like a shield.
- 18. Paracelsus in 1527 was the first to link goitre and cretinism
- 19. Platter in 1562 came out with convincing proof that cretinism was seen in children born of goitrous mothers
- 21. Chinese merchants were the ones who taught the Europeans that consuming sea weed could cure goitre
- 22. Courtois in 1812 discovered that sea weeds contained large quantities of iodine
- 23. Coindet in 1820 popularized iodine treatment for goitre in Sweden
- 25. This work never got the recognition it deserved
- 27. He used thyroid extracts to save dogs in whom he performed total thyroid removal
- 29. It was only after Akron study which was carried out in school children that goitre preventive role of iodine came to be recognised
- 31. His work was not published till much later
- 32. Coindet described the symptoms of thyrotoxicosis without realizing its significance
- 33. Graves in his talk described few of his patients with goitre and palpitation. He initially considered it to be a cardiac malady
- 34. Basedow discussed in detail the symptoms of thyrotoxicosis
- 36. It was approximately during this time surgeons were successful in partially removing this hyperfunctioning thyroid glands
- 38. It was first described in London. The term myxoedema was used because of oedematous skin due to accumulation of myxoid tissue
- 39. Initially it was considered to be a neurologic / skin disease
- 41. He was not beleived at first
- 42. A committee was constituted which concluded 5 years later that his observation was true
- 44. This provoked scientists to try out other organ extracts too
- 45. In 1891 Murray injected sheep thyroid extract which cured a patient with myxoedema
- 47. Baumann identified iodine in the thyroid gland extract
- 48. It was the english man Harrington who indentified the exact molecular structure of thyroxine
- 49. Harrington suspected there could be another hormone in addition to thyroxine
- 51. He successfully synthesized thyroxine
- 52. Since it was a free acid absorption was poor
- 53. Hence until 1960's dessicated thyroid was used in the management of goitre
- 55. He was the first person to associate goitre with exophthalmos
- 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.
- 59. This was practised when the goitre was adherent
- 60. Shoe lace ligature is encircled around the mass and firmly kept tied for 3 hours
- 61. The goitre which had become avascular was sectioned away.
- 64. Heinrichs the IV started this procedure
- 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).
- 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
- 69. Adolf Vogel – circular incision
- 70. Benjamin Gooch – Vertical incision
- 71. Desault – Median longitudinal incision
- 73. He was the first to emphasise ligation of superior / middle / inferior thyroid pedicles before removing thyroid
- 74. His feat was considered unbeleivable
- 76. This allowed for better wound healing during procedures
- 77. He was the first to observe tracheal flattening / distortion
- 79. He first ligated both superior arteries of thyroid gland and this was ineffective
- 80. He ligated both superior and inferior arteries of one side. This provided temporary relief for about 6 months
- 81. He proved that arteries supplying the opposite lobe was not capable of maintaining integrity of opposite lobe
- 83. He used long median incision to expose neck
- 84. Separated strap muscles / fascia – mobilized superior pole using fingers
- 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
- 87. Used midline vertical incision to expose the gland
- 88. Ligated superior and inferior thyroid arteries
- 89. Transfixed and double ligated the isthumus
- 90. Removed the mass completely
- 91. Incisions
- 93. He was the first to report symptoms of thyroid deprivation
- 95. He advised against total thyroidectomy
- 96. He believed total thyroidectomy somehow disturbed blood supply to the brain
- 98. He also beleived ligation of inferior thyroid artery somehow damaged the nerve
- 100. He divided sternohyoid, omohyoid and sternothyroid muscles transversely
- 101. Artery forceps was freely used by Billroth. This facilitated better haemostasis
- 103. He left a sleeve of thyroid gland along the tracheo oesophageal groove in order to protect the recurrent laryngeal nerve from injury
- 104. He insisted that this technique is useful even in treating malignant lesions of thyroid gland
- 106. He attempted to explain the tracheal oedema that followed thyroid surgery by suggesting vascular congestion to be the cause.
- 109. Enucleation
- 111. He was instrumental in disseminating vital knowledge pertaining to thyroid surgery to other surgeons
- 112. His clinic played a vital role in this purpose and still continues to do so
- 113. Thank you