A Century of Hyperthyroidism at Mayo Clinic

Abstract

From the Division of Endocrinology & Metabolism, Mayo Clinic, Jacksonville, FL (R.C.S.); and the Division of Endocrinology & Metabolism, Mayo Clinic, Rochester, MN (J.C.M.). H yperthyroidism was first described by Caleb Hillier Parry (1825), Robert Graves (1835), and Karl von Basedow (1840). At the beginning of the 20th century, the causes were poorly understood and treatment was limited to surgery because antithyroid drugs and radioactive iodine (RAI) were unavailable until the early 1940s. Because of high surgical mortality, treatment was often delayed until the condition was advanced, and a multistage procedure might be required. Initially, hot water was injected into the thyroid, then a thyroid artery was ligated, and subsequently one or both thyroid lobes were resected. Furthermore, critically ill patients who survived surgery risked postoperative death from thyroid storm. Understanding of the etiology, pathology, physiology, clinical manifestations, and management of hyperthyroidism has evolved over the past 100 years, and new insights continue to emerge. Mayo Clinic physicians and scientists, working across disciplines, have contributed importantly to understanding this illness. This review of the Mayo Clinic experience will highlight these achievements, including pathologic clarification of the most common forms of hyperthyroidism, isolation of a crystalline product of thyroid hormone, development of a basal metabolism laboratory, discovery of a method to reduce postoperative mortality, investigation of the kinetics of thyroid hormones using radioisotopes, development and/ or establishing the clinical utility of laboratory tests to diagnose and monitor therapy for hyperthyroidism, clinical characterization of extrathyroidal manifestations of Graves disease, surgical management of severe Graves ophthalmopathy, the role of orbital radiotherapy, and the pathogenesis of Graves ophthalmopathy.