The discovery of thyroid replacement therapy. Part 1: In the beginning.

Abstract

There is a poignant before and after photolithograph of a Victorian lady in the 1878 transactions of the Royal Medical and Chirurgical Society of London ( Figure 1).1 Figure 1 Before (left), aged 21 years in 1870, and seven years later with myxoedema1 This is not the usual celebratory image before and after successful treatment. It is a picture of the woman, aged 21 in 1870, and then seven years later, unrecognizably aged by the effects of undiagnosed and untreated thyroid deficiency. It is poignant because she probably dies of the disease, the introduction in 1891 of effective treatment with subcutaneous injections of thyroid extract by George Murray of Newcastle-upon-Tyne coming too late.2 The images are from a paper by William Ord, physician at St Thomas's Hospital, entitled ‘On Myxoedema, a term proposed to be applied to an essential condition in the “Cretinoid” Affection occasionally observed in Middle-Aged Women’. In this he described a ‘mucous oedema’ of the skin, finding in it an excess of mucin on microscopy and chemical analysis. From this description he coined the term ‘myxoedema’, a name lastingly synonymous with thyroid deficiency. A number of steps led to the discovery of thyroid replacement therapy: the slow understanding that this debilitating disease, myxoedema, was in some way linked to the thyroid; the acceptance of the notion that the thyroid elaborated some important factor with an endocrine function; the emergence of the principle of replacement therapy; and the introduction of replacement therapy in practice. But, contrary to general belief, Murray was not the first to treat myxoedema effectively.