This Month in Endocrine History
Submitted by Evan Graber, DO
In May 1946, it had already been demonstrated that the thyroid gland utilized iodine more than any other organ in the body and that it’s function was regulated by the concentration of iodine present in the gland. Iodine was used as treatment for thyroid disease and radioactively tagged iodine could be used to trace the physiologic activity of the thyroid. Using this knowledge, Hertz and Roberts sought to demonstrate the use of radioactive iodine to treat hyperthyroidism for the first time. A mixture was developed containing I130 and I131 and was administered orally to 29 patients with hyperthyroidism. Basal metabolic rate, weight, and pulse were determined prior to and after treatment to establish the degree of thyrotoxicosis present. One to 3 days after treatment, nonradioactive iodine therapy was initiated. Of the 29 patients, 20 were permanently cured of their hyperthyroidism. No adverse effects were noted, although the authors admitted that use in patients with ophthalmopathy and large goiters needed to be studied more.
If this procedure sounds familiar, it may be because nothing much has changed since 1946. I131 is used exclusively now that it is easier to produce in large quantities and post-treatment, nonradioactive iodine therapy has been replaced by levothyroxine. Further studies have identified potential side effects including salivary and lacrimal duct damage. But 80 years on, Hertz’s and Robert’s treatment remains an option for children and adolescents with hyperthyroidism who have failed medical therapy.