6 - The Rise and Decline of Thyroid Transplantation

Summary

From 1890 on a whole series of reports was published on thyroid transplants. Many of them came from Great Britain; some also originated in France, Portugal, and Switzerland. The usual indication was myxedema, and the organs came mostly from sheep. Most authors observed a positive effect on their patients but were usually not in a position to decide whether the results stemmed from the resorption of the thyroid fluid contained in the transplant or to a genuine survival and functioning of the transplanted tissue.

In 1892, Von Eiselsberg, who could look back upon his experimental autotransplants of feline thyroids, operated on a fifty-four-year-old woman to treat “a case of tetany” after the near-total removal of a cancerous struma, and grafted a small piece of another, freshly extracted hypertrophic thyroid into her abdominal wall. He used exactly the same technique he had used on his cats. Success never materialized and the patient died of tetany. During the autopsy von Eiselsberg found the transplant necrotic and surrounded by pus. He attributed the failure to a breach of asepsis and to the poor state of the transplanted pieces of the organ; never mentioned was the fact that his cats’ transplants had been autogenous whereas his human transplant was allogenic. In conclusion, he recommended transplantation only as a last resort.

That same year, John Macpherson in Edinburgh published a paper on a subcutaneous thyroid transplantation from a live sheep. He attributed the immediate, observable effects on his myxedema patient to the resorption of the transferred active substance but assumed that a large part of the gland tissue he had grafted had taken well in the patient’s body. In his opinion, the transplantation of living tissue was superior to the merely palliative means of treatment via extract. Around the same time, V. Robin in Lyon reported on the initially successful treatment of a cretinous child with injections of thyroid extract from a sheep. As pronounced local side effects occurred, particularly abscesses, Robin changed the therapy and performed a subcutaneous transplant of a thyroid gland from a sheep. He reported good results and emphasized that treating the recipient regularly with injections would increase the transplant’s chances of success.