Sidney H. Ingbar (Editor), Sidney C. Werner (Editor) by Lippincott Williams & Wilkins Publishers
Sidney H. Ingbar (Editor), Sidney C. Werner (Editor) by Lippincott Williams & Wilkins Publishers
Sidney H. Ingbar (Editor), Sidney C. Werner (Editor) by Lippincott Williams & Wilkins Publishers
By OkDoKeY
Werner & Ingbar’s The Thyroid
CONTENTS
Preface
Contributing Authors
Chapter 3 Anatomy
Chapter 6 Thyroid Hormone Transport Proteins and the Physiology of Hormone Binding
Jacob Robbins
Chapter 11 Thyrotropin
Effects of Drugs and Other Substances on Thyroid Hormone Synthesis and Metabolism
Christoph A. Meier and Albert G. Burger
Nonthyroidal Illness
Wilmar M. Wiersinga
Iodine Deficiency
François M. Delange
Chapter 17 Serum Thyrotropin and Thyroid Hormone Measurements and Assessment of Thyroid Hormone Transport
Jan R. Stockigt
Chapter 19 Thyroglobulin
Carole Ann Spencer
Pathogenesis
Terry F. Davies
Ophthalmopathy
Henry B. Burch, Colum A. Gorman, Rebecca S. Bahn, and James A. Garrity
Chapter 76 Clinical Manifestations and Treatment of Nontoxic Diffuse and Nodular Goiter
Ad R. Hermus and Dyde A. Huysmans
Pathogenesis
Arthur B. Schneider and Elaine Ron
Surgical Therapy
Allan E. Siperstein and Orlo H. Clark
Neonatal Screening
Robert Z. Klein and Marvin L. Mitchell
Congenital Hypothyroidism
Thomas P. Foley, Jr.
The first edition of The Thyroid, published in 1955, was the culmination of the vision of Sidney Werner that there was a need for a comprehensive textbook of
thyroidology and his efforts to meet that need. The initial and subsequently the continued success of the book has confirmed the wisdom of his vision. As knowledge
about the thyroid gland, its physiology, and its diseases has grown, the scope and magnitude of the book have increased substantially, and we like to think that The
Thyroid has become a standard textbook of thyroid physiology and disease.
Dr. Werner, who died in 1994, not only conceived the book but also guided it through its first two editions. He was joined by Dr. Sidney H. Ingbar as co-editor for the
third and fourth editions, after which he stepped down as editor. Dr. Ingbar’s role continued through the fifth and sixth editions. The sixth edition was completed two
years before his untimely death in 1988.
Sidney Werner’s vision and skill in creating the book and developing its basic organization of multiple chapters, each written by an expert, was undoubtedly responsible
for its rapid acceptance and continued value. Indeed, the basic organization has changed little from what he created, although chapters and subchapters about
particular topics have been added, and sometimes subtracted, in later editions. Even after stepping down as editor, he continued to contribute to the book as both an
advisor to the editors and an author.
The creation of this book was but one of Dr. Werner’s many contributions to thyroidology. Long interested in Graves’ disease, he carried out many of the early studies
of the therapeutic efficacy and side effects of radioiodine therapy for Graves’ thyrotoxicosis, and was one of the first to question whether it was a pituitary disease, as
many had thought. He was responsible for the first system for classifying and quantitating the ocular manifestations of Graves’ disease, and he carried out many
studies of the pathogenesis and therapy of Graves’ ophthalmopathy. He was a long-time member of the American Thyroid Association, a member of its board of
directors from 1968 to 1974, and its president in 1973. In short, he was a leader in the field of thyroidology for many years.
Dr. Ingbar was equally accomplished. He was at the forefront of thyroid research for over 40 years, and his studies spanned all aspects of thyroidology. He made
seminal contributions, for example, to our understanding of the mechanisms of action of thyroid hormone, the physiology of thyroid hormone secretion, the transport
and metabolism of thyroid hormones, the mechanisms of action of antithyroid drugs, and the diagnosis and treatment of virtually every thyroid disease. He too was a
long-time member of the American Thyroid Association, a member of its Board of Directors from 1971 to 1975, and its president in 1976.
In his preface to the first edition, which is reprinted on the following pages, Dr. Werner commented that the book “is intended for those who must deal with the problems
of thyroid function and thyroid disease in man.” That is our intent now. To be more specific, we would like the book to be useful to anyone who is interested in any
aspect of the thyroid gland and of its products and their actions, in both health and disease. We hope the book is attractive to research and clinical fellows just entering
the field and, we hope, caught up in its excitement, and maybe even to younger students at the time of their first exposure to thyroidology.
This new edition of The Thyroid owes much to its predecessors, but it has been changed too. The authorship is even more international than before. There are new
chapters, and some old ones have been combined. As in the past, we have tried to minimize overlap among different chapters, but some is certainly inevitable and
probably essential. For example, the subjects of iodine metabolism and the effects of iodine deficiency and excess are so central to any understanding of the thyroid
and its diseases and yet so diverse that they must be considered in many chapters. The same is true for the actions of thyroid hormone, and to the many aspects of
thyroid autoimmunity.
Much new has been learned about the thyroid in recent years, as a result of application of a wide array of new research methods, from those of molecular biology to
those of clinical trials. We know much more about the structure and actions of the nuclear receptors for thyroid hormone, and therefore the mechanisms of action of
thyroid hormones than just a few years ago. The gene for the iodine transporter has been closed, and studies of this and other previously cloned thyroid-related genes,
for example those of the thyrotropin receptor and thyroglobulin, have provided much new knowledge about both normal and abnormal physiology. With respect to the
common thyroid diseases, iodine deficiency is still the most common, but the goal of eradicating it now seems within reach. We still do not know much about the
pathogenesis of the thyroid autoimmune diseases or thyroid nodular disease, but at least we now have data from clinical trials to guide treatment of patients who have
some of these disorders.
We thank all the contributors to the book. We requested their contributions in six months. And they did it. They have worked hard to ensure that the chapters are
current and comprehensive, to provide interpretation and guidance in areas of controversy, and to meet our requests for clarification or revision. We tried to guide but
not dictate to them. In this era of ready access to many small bits of information, we think there is a need for comprehensive review and evaluation of what is known
and what is not known—in other words a book, and it has been our goal to provide this review and evaluation. We hope readers will think we reached it.
We also wish to acknowledge the help of Ms. Elizabeth Greenspan, Mr. Raymond E. Reter, and Mr. Thomas Boyce of Lippincott Williams & Wilkins. They have
contributed much to this book, and we thank them.
We are pleased that this new edition of The Thyroid is coming out in the year 2000. We hope that the information herein will provide guidance and even inspiration to
those who seek to increase understanding of the thyroid gland and to treat or prevent its diseases in the new century.
Lewis E. Braverman
Robert D. Utiger
PREFACE TO THE FIRST EDITION
This book is intended for those who must deal with the problems of thyroid function and thyroid disease in man. It is designed for use in the clinic and in the basic
science laboratory connected with the clinic. The information made available has been brought together from widely diverse sources, and in some instances is reported
here for the first time. Many subjects have been presented both in broad outline and in more comprehensive detail to meet differing requirements. It has been planned
to provide sufficient documentation to satisfy most needs and, for more exhaustive requirements, to provide a bibliography adequate enough to initiate a search of the
literature.
The introduction of a book into a field of clinical medicine today requires considerable justification. In the thyroid field particularly, there already is a profusion of books
including the almost classic works of Means in this country and of Joll in England, recently and capably revised by Rundle. Nevertheless, the recent growth of medical
knowledge in general, and about the thyroid in particular, appears to have created need for a new volume constructed on a somewhat different basis from those of
previous works.
Barry Wood has compared the growth of medical information to that of bacteria. Bacteria show a lag at the beginning of growth and then multiply at a logarithmic rate.
Wood considers the growth of current-day medicine to have reached the logarithmic phase. The accumulation of data about the thyroid provides a good example of this
acceleration. One author of a recent review claims to have unearthed 3,000 new references pertaining to the gland and published during the single year before he
wrote his article. The Quarterly Cumulative Index Medicus offers about 7,800 references to the thyroid in the past decade. More than this, the thyroid field is permeated
by contributions from the cardiologist, neurologist, muscle physiologist, and many others, bringing the highly unique techniques of their particular specialties to bear on
the subject.
It is evident that the ability of any one individual to follow progress in all directions at once has all but vanished. As a consequence, marked subspecialization of interest
has developed and advances have come to depend upon the interchange of information among many specialists, each providing his own orientation.
This trend has suggested that the information in a book about the healthy and diseased thyroid should also be subjected to the process of sifting and appraising
through many eyes. The various specialists present material with which they have had direct experience, and the editor functions as the overseer to provide orientation
and preserve the inherent orderliness of the entire subject. The total clinical and research experience made available in this way exceeds that of one person alone.
Each topic can be subjected to the critique of a man who has worked intensively with the problem. Finally, a book of this sort can be readily kept current, because of
the authors' continued contact with investigation and the fact that there are no large sections to be rewritten by any one individual.
Every effort has been made to make available sufficient basic and clinical knowledge to satisfy curiosity about either of these aspects. For example, sections on the
fundamental properties of radioiodine that permit the use of the isotope and on the instrumentation that facilitates such use are presented as well as a discussion of the
clinical application. Most basic sections are separated from the clinical material, but are incorporated with it where this has seemed reasonable.
The fundamental aspects of thyroid function in man and the mechanisms which control the activity of the gland; the biochemistry of the hormone; and histology and
comparative anatomy make up Part I. The mechanisms of action of the anti-thyroid drugs are included because of the intimate relationship of their effects to the
problems of basic physiology.
Part II presents the laboratory methods which supplement the clinical appraisal of thyroid secretory activity. The presentations of the basic principles involved in
radioiodine usage and the instrumentation which is employed are included within the laboratory section and are available here for later reference when the therapeutic
as well as diagnostic use of the isotope are considered.
The diseases of the thyroid are considered in Part III. The disorders first described are those in which the level of thyroid hormone in the circulation and tissues is within
normal limits—euthyroidism. After this come the derangements in which hormone levels are increased—toxic goiter or hyperthyroidism—or decreased—hypothyroidism
or myxedema. The effects of hyperthyroidism and of hypothyroidism upon the individual body systems have been subjected to fairly detailed analysis.
The plan to arrange disease by functional categories breaks down in relation to inflammations of the thyroid including the peculiar composite entity, chronic thyroiditis.
Inflammations of the thyroid tend to inactivate the gland but chronic thyroiditis is almost as often associated with evidence of hyperthyroidism as with hypothyroidism.
The inflammations have been placed under a separate heading on this account.
Before the disease states are presented, several important preliminary subjects are considered in Part III. The normal and abnormal developments of the gland are
described, together with the surgical anatomy and a method of physical examination that is an essential procedure because of the accessibility of the thyroid to this
approach. The pathology is presented in its entirety in the introductory sections and is not dispersed among the various diseases. A concept of change in thyroid
disease emerges in this way which could not otherwise become evident.
A major goal throughout the volume has been to assess the validity of the facts on which current information or procedure is based. Corroborative information is often
documented beyond reasonable doubt, but too often is based only on speculation or custom or is wanting altogether. The fact that a critical appraisal has been
accomplished is a tribute to the contributors. The world today, as in the past, is threatened by prejudice, of which racial, social, and economic prejudices are but a few.
Equally influential, but less well recognized, is the prejudice of “experience,” derived from uncritical or uncontrolled observation, from the word of an “authority,” or from
emotional bias.* Fortunately there are those who are willing to give time and effort to seek out and correct such distortions of the truth.
Considerable aid has come to the editor from several sources. Dr. John Stanbury has been particularly helpful. The members of the Thyroid Clinic at the Presbyterian
Hospital need recognition for their influence upon the formulation of many of the views presented herein. Credit must be given to the patience and forbearance of the
many contributors who tolerated changes in style and length of manuscript in the interest of creating an integrated volume out of a series of individual essays. The
editor's wife has acted as guardian of clarity, upon the thesis that even the layman should be able to read and understand a well-written article. Miss Anne
Powell, of the librarian staff at P. & S., was extremely generous with her time. Finally, Mrs. R. Levine and Mrs. K. Sorenson were more than patient with the secretarial
details.
Sidney C. Werner
New York City
*“Conviction is by no means devoid of emotion but it is a disciplined and differentiated emotion, pointed to the removal of a realistic obstacle. By contrast, the emotion behind prejudice is diffused and
overgeneralized, saturating unrelated objects.”—Gordon W. Allport: The Nature of Prejudice.
CONTRIBUTING AUTHORS
Ad R. Hermus, M.D.
Department of Endocrinology, University Hospital Nijmegen, 6500 HB Nijmegen, The Netherlands