Reminiscences of Working in the Field of Thyroidology
Micahel Turnbridge, Retired Consultant Physician and former Postgraduate Dean of Medicine, Oxford
The invitation from Janis Hickey to record my reflections and experience of thyroid disorders in a short article for the newsletter to mark the 25th anniversary of the BTF is a tall order. It nevertheless encouraged me to reminisce about some of the developments in thyroidology with which I was involved during my career. This is inevitably a personal account as there were many developments in thyroid research besides those recounted here, particularly in the scientific fields of intracellular biochemistry and genetics. Iodine deficiency remains a major problem worldwide and is of particular concern in women of reproductive years, now sadly evident in British schoolgirls too, because of its effects on mental as well as physical foetal development.
After working in Africa for a year in paediatrics and obstetrics I returned to the UK to pursue a career in general internal medicine. It was not until working in the late 1960s in Manchester Royal Infirmary as a Tutor in Medicine with Dr Donald Longson that I developed my special interest in diabetes and endocrinology. I also learnt with expert tuition from Dr Colin Beardwell the then relatively new technique of radioimmunoassay developed by Berson and Yallow in the USA which enabled the measurement of tiny amounts (nanomoles or even less per litre of blood in the circulation) of hormones such as growth hormone and insulin. I applied this technique to set up an assay for TSH in the evenings whilst working during the daytime as a clinical registrar with Prof Russell Fraser in the Endocrine department at the Hammersmith Hospital. I remember the satisfaction of proving with the TSH assay that a child who had been previously diagnosed as suffering primarily from pituitary failure had a sky high TSH and was in fact suffering from primary hypothyroidism and after treatment with thyroxine alone the child grew and went through puberty normally. Measurement of TSH is now a routine tool in every clinical biochemistry laboratory.
The experience of using TSH as a diagnostic tool in a variety of patients with thyroid dysfunction led me to ponder on the natural history of thyroid diseases. This led me to Newcastle as a research fellow in 1972 to work with Prof Reg Hall and colleagues where we undertook the epidemiological study of thyroid disorders in the community which became known as the Whickham Survey. This documented the prevalence (frequency) of thyroid autoantibodies (only discovered by Roitt and Doniach in the UK about a decade earlier) and the whole spectrum of autoimmune thyroid diseases from underactive ( hypo-) to overactive (hyper-) dysfunction as well as goitre in about 3000 people from a cross-section of the community. I was fortunate to remain in Newcastle as a consultant physician long enough to be able to rerun the Whickham Survey twenty years later. In 1992 the repeat study, led by Mark Vanderpump, enabled us to document the incidence (the rate per year) of hypo- and hyper-thyroidism and also to determine the prognostic significance of the markers of thyroid disease such as thyroid antibodies and mildly elevated TSH levels identified 20 years earlier in the same individuals.
The 1970s were a particularly exciting time in endocrinology because not only was it possible to measure hormones accurately but it was also the era when the hypothalamic hormones which regulate the pituitary gland were synthesised in the USA by Guilleman (originally French) and Shalet (originally Hungarian) who shared the Nobel Prize for this work together with Rosalind Yallow (Berson had died) for developing radioimmunoassay. Reg Hall as the doyen of the Newcastle team was invited to test the newly synthesised Thyrotrophin Releasing Hormone (TRH) and later the new Growth Hormone Release-Inhibiting Hormone (GHRIH or Somatostatin) in man, which we did firstly on ourselves as normal subjects before defining their diagnostic and therapeutic place in patients.
Reg Hall, as well as attracting many research fellows from across the world, was also a staunch supporter of the European Thyroid Association (ETA). In 1979 we hosted their 10th anniversary meeting in Newcastle, the first time it had been held in the UK, and it was very successful. The first photo shows the then relatively youthful members of the local organising committee.
It marked the end of an era for Reg Hall who then moved to Cardiff as Professor of Medicine to lead another successful department there. Reg with Bernard Rees Smith and others pursued the holy grail of the cause of Graves’ disease (by Stimulating Antibodies) as well as other autoimmune disorders. Reg also encouraged John Lazarus and colleagues in their ongoing studies of thyroid function in pregnancy. John continues to lead on the importance of correcting iodine deficiency in the UK and Europe.
Endocrinology in Newcastle continued to flourish and we worked in close liaison with our many friends and colleagues in the UK, elsewhere in Europe and worldwide, sharing our common concern for patients with thyroid and other endocrine disorders. In 1991 we organised a meeting to celebrate the centenary anniversary of the publication by Murray of the first successful treatment of myxoedema (severe thyroid failure) with thyroid extract from sheep, strained through a handkerchief! At that meeting the first Murray lecture was given very entertainingly by Dr Nattie Armstrong who was himself a hundred years old and Reg Hall’s predecessor. The vote of thanks was given by Sir Richard Bayliss, a former Physician to the Queen and a founding member of the Thyroid Club, now the British Thyroid Association (BTA), who greeted Dr Armstrong by saying “Dr Murray I presume”! The late distinguished Clark Sawin from USA also gave an illuminating talk on applying the Whickham survey data to a cost analysis of the benefits and disadvantages of screening whole communities for thyroid failure. The balance has come down in favour of the cost benefit of screening women of menopausal age (as well as screening all newborn babies which was well established in the1970s) but not healthy younger women or men because of the relatively low frequency of thyroid disease in these groups in Caucasian communities. The by then somewhat older members of the local organising committee for that meeting are shown in the second photo.
The modest profits from that 1991 meeting were given to the newly established British Thyroid Foundation (BTF) to help get the organisation off the ground financially. It has been a pleasure to see the BTF develop for the benefit of patients and through its close links with the BTA for professionals too, especially in its support for thyroid research. Many members of the BTA have helped to write the leaflets and provide professional advice via the BTF for people with a variety of thyroid disorders. My experience of thyroid disorders over the last four decades was distilled in the book entitled Thyroid Disease – the Facts. The first edition was written in 1982 by Dick Bayliss who kindly invited me to join him in writing the second and third editions and after his death the royalties from the fourth edition, written in 2008 with Mark Vanderpump, were also given to the BTF. I have had as much if not more pleasure from co-authoring this book for patients than from almost all of my scientific publications.
The 125th anniversary of Murray’s discovery was celebrated in Newcastle in the summer of 2016. The meeting, organised by Simon Pearce and Petros Perros, was impressive in the quality of the papers presented about the basic science and genetics underlying thyroid disorders as well as a wide range of other endocrine diseases which augers well for our future understanding of the mechanisms of disease. Hopefully this will lead to improved diagnoses and treatments.
It is all the more important that the BTF continues to flourish in helping patients and their relatives to keep abreast of these developments and providing support for those in need as well as keeping the feet of professionals on the ground! It has been my privilege and pleasure to have worked with so many distinguished colleagues and friends and also to have been involved with the BTF since its inception, subsequently as a Trustee and now a Patron. Congratulations to Janis Hickey who founded the BTF and to the team on reaching its 25th anniversary. May the BTF long continue to flourish.