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Mr President, Mr President Elect, Fellows and Members, Ladies and Gentleman, it is a pleasure to address the Section of Laryngology this morning and deliver the 94th Semon Lecture. I would like to thank the Semon Committee for their kind invitation. My lecture will discuss Sir Felix Semon (the man himself), highlight the history of head and neck surgery, and then discuss the requirements of a modern-day thyroid surgeon. I have no conflict of interest and nothing to declare.

The past half century has seen a number of advances in pathology of thyroid diseases, especially neoplastic lesions. These include the description of new entities, the definition of prognostically important lesions, the incorporation of fine needle aspiration biopsy and its functional risk stratification of diagnoses into the clinical evaluation and therapeutic recommendations of the patient with thyroid nodules and the understanding of thyroid neoplastic development, diagnostic and prognostic parameters by use of molecular analysis so that such techniques are becoming standard of care for patients with thyroid tumors. The histopathologist and cytopathologist have been and continue to be at the forefront in the definition and understanding of these areas of thyroid disease. This review describes many of the most important advances in this area in an attempt bring the practicing pathologist up to date in these developments., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Since the mid-1800s, thyroidectomy has transformed from a procedure associated with high to near-zero mortality. Nonetheless, surgeons must continue to strive to improve patient care. Using historical records and contemporary data, this study compares the practice and outcomes of thyroid surgery at a tertiary institution during two periods, 50 years apart., Methods: 'The Alfred Hospital Clinical Reports' recorded all cases of surgically managed thyroid disease from 1946 to 1959. These historical cases were compared to contemporary thyroidectomy cases at the Alfred Hospital from 2007 to 2016. Cases were compared for surgical indication and post-operative outcomes., Results: There were 746 patients in the historical group (mean age 53 years; 87% female) and 787 patients in the contemporary group (mean age 52 years; 80% female). The most common indication for thyroidectomy in both groups was non-toxic nodular goitre. A greater proportion of the contemporary group were diagnosed with thyroid malignancy (27% vs. 8%; p < 0.001). The contemporary group recorded significantly fewer cases of thyrotoxic crisis (2.1% vs. 0%; p = 0.001), permanent nerve palsy (4.6% vs. 0.4%; p < 0.001) and bilateral nerve palsy (1.2% vs. 0%; p = 0.01). There were no mortalities in the contemporary group, while the historical data recorded three deaths (0.44%)., Conclusions: This study compared thyroid surgery in two cohorts separated by a 50-year period. While it is not surprising that outcomes of thyroidectomy have improved, this study uniquely demonstrates trends of thyroid surgery over time and areas in which further improvements may be made.

Thyroidology is a discipline of Endocrinology which has evolved markedly over the past few decades. However, its historical roots can be seen in the literature of, among others, ancient Greek medicine. In the present article, we present the descriptions of the thyroid gland by ancient Greek physicians and its depiction in ancient Greek art.

Background: Thyroid swellings in the art of the Italian Renaissance are sporadically reported in the medical literature., Methods: Six hundred paintings and sculptures from the Italian Renaissance, randomly selected, were analyzed to determine the prevalence of personages with thyroid swellings and its meaning., Results: The prevalence of personages with thyroid swellings in the art of Italian Renaissance is much higher than previously thought. This phenomenon was probably secondary to iodine deficiency. The presence of personages with thyroid swelling was related to specific meanings the artists wanted to show in their works., Conclusions: Even if the function and the role of the thyroid were discovered only after thyroidectomy was started to be performed, at the beginning of the 19th century, artists of the Italian Renaissance had the intuition that thyroid swellings were related to specific psychological conditions. Artistic intuition and sensibility often comes before scientific demonstration, and it should be a guide for science development., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The history of postpartum thyroid dysfunction (PPTD) dates back almost two millennia, when Soranus of Ephesus, who practiced obstetrics and neonatology, observed swelling in the necks (presumably goiters) of women after pregnancy. The next reference to PPTD appeared in artwork more than 1000 years later, with many portraits illustrating women with goiter while holding infants. In the early to mid-19th century, Caleb Hillier Parry and Armand Trousseau described postpartum hyperthyroidism, while in the late 1800s, Sir Horatio Bryan Donkin reported the first patient with postpartum hypothyroidism. The modern era of PPTD began with the description in the late 1940s by H.E.W. Roberton of women after delivery reporting hypothyroid symptoms and responding to thyroid extract. The immunologic influence on PPTD was recognized initially by Parker and Beierwaltes in the early 1960s, and the clinical variability and natural history were carefully documented by numerous investigators in the 1970s-1980s. The past two decades have seen further refinements in understanding the prevalence, etiology, and treatment of PPTD. Yet to be determined is the role of screening as a cost-effective measure.

This review gives a historical overview about the development of today's understanding of benign thyroid diseases and the possibilities of their treatment.Little was known about the thyroid gland until the nineteenth century: the state of knowledge was (1) that something in food, especially in seaweed, avoided the development of goiters, (2) that goiters seemed to have something to do with cretinism, and (3) that the thyroid gland is an organ consisting of two lobes connected by an isthmus. Shortly after the detection of iodine in 1811, its impact on its ability to avoid the development and the growing of goiters has been realized. The existence of iodine within the thyroid and in human plasma was detected approximately a decade later. The clinical picture of hyperthyroidism including endocrine orbitopathy was described in detail in the middle of the nineteenth century, the etiology of the disease remaining, however, unclear until a century later. In early nineteenth century, surgical goiter exstirpation was the only available form of treatment. Vienna and Berne were the centers leading worldwide in their expertise. Subcutaneous injections of sheep thyroid extracts were developed for treatment of postoperative hypothyroidism as well as congenital myxedema. Another approach suggested by Swiss surgeons was thyroid transplantation. Radioiodine therapy of hyperthyroidism was introduced in the middle of the twentieth century. Thyrostatic drugs are available since about the same time. The different forms of thyroiditis were described at the turn of the twentieth century. The etiology of chronic autoimmune thyroiditis was, however, clarified only some 50 years later independently by two groups of scientists, one in London, UK, and the other in Buffalo, USA. Thyroxine was isolated from bovine thyroid extracts in the beginning of the twentieth century. Its synthesis and correct chemical structure were described some 10 years later. The existence of 3,5,3'-triiodothyronine (T3), the biologically most active thyroid hormone, was detected in the 1950s of the past century by a group in Paris and another in London. The extrathyroidal conversion of thyroxine to T3, as the main source of circulating T3, was suggested shortly thereafter and substantiated in 1970. Finally, the development of the radioimmunoassay method for determination of hormone serum concentrations in 1959 enabled today's exact laboratory diagnosis of thyroid diseases.

At present, physicians and surgeons treating thyroid disorders can rely on highly accurate and precise investigations, modern equipment, and state of the art operating theater to achieve optimum results; however, this was not the case at the beginning of the treatment of thyroid diseases centuries ago. We present a short history of the treatment and understanding of thyroid diseases in the past few decades. Also we present the contributions of the important surgeons who tried to perfect the treatment of thyroid diseases, including surgery, thus making modern day management easier.

Emile Theodor Kocher (1841-1917) studied and spent his entire career as surgeon (since 1866) and professor (since 1872) in his native Berne, apart from a 'grand tour' of surgical institutions in Europe. The discipline of surgery rapidly expanded, not least through the introduction of anaesthesia and antisepsis. Kocher's expertise ranged from ankle fractures to hypophysectomy; he wrote an authoritative textbook on surgical technique. He became most famous through his treatment of goitre, an endemic condition in the mountainous parts of Switzerland. Kocher developed a meticulous technique for thyroidectomy, without major haemorrhage or damage to the recurrent nerve. The 'Kocher clamp' was developed for haemostasis. On discovering that patients might develop cretinism or 'cachexia' many years after total thyroidectomy, he took care to leave part of the gland intact. As the relation with myxoedema became clear, he experimented with thyroid transplantations and attempted to find biochemical function tests. In 1909 he was awarded the Nobel prize for Physiology or Medicine. Five years later thyroxin was isolated.

Thyroid diseases (mainly goiter) have been recognized for more than 3500 years. Knowledge of the nature of these diseases was, of course, limited at that time. Thyroid surgery was conceived by the ancients, but it was limited to rare attempts to remove part of an enlarged thyroid gland in cases of impending death by suffocation or, in very rare cases, of a suppurating thyroid. Like other fields of surgery, thyroid surgery was limited by many problems: the lack of anesthesia and antisepsis, the need for appropriate instruments, mainly artery forceps (many deaths after thyroid surgery were due to severe postoperative hemorrhage or infection). Much of the progress in thyroid surgery occurred in Europe during the second half of the 19th century. During the first half of the 20th century, the evolution of thyroid surgery accelerated significantly, based on the contributions of pioneering European and American surgeons. The present status of thyroid surgery was established during the last quarter of the 20th century, when modern imaging methods and technological advances (including progress in applied molecular biology) brought thyroid surgery into the new millennium.

One hundred years ago, in 1909, Theodor Kocher was awarded the Nobel Prize in Physiology and Medicine for his work on the physiology, pathology, and surgery of the thyroid gland. In the late 19th century, the resection of the thyroid was feared because of its high mortality rate. Kocher's innovative techniques resulted in safe outcomes. His observations that radical resection of the thyroid results in 'cachexia strumipriva' contributed to the recognition that the thyroid is essential for normal growth, development and metabolism. He made many other seminal contributions to the field of surgery and medicine, and his expertise was internationally recognized. Kocher served as the chairman of surgery at the University of Bern in Switzerland, his alma mater, until his death in 1917.

January 9, 2009 commemorates the 100-year anniversary of the Swiss surgeon Emil Theodor Kocher's first performance of the surgical removal of a pituitary adenoma by a trans-nasal approach. He was awarded the Nobel Prize in 1909 for his work on the physiology, pathology and surgery of the thyroid gland. He was the first Swiss citizen and the first surgeon to ever receive such an award. He was a pioneer and a world leader in the surgical revolution of the end of the nineteenth century. Over a period of 45 years, Kocher developed a considerable activity in various fields of surgery leading to worldwide acclaim and renown. Kocher's most significant contribution to medicine concerned the thyroid and pituitary gland. Additionally, he developed or modified many surgical instruments. In total, he published 249 articles and books, the majority based on his own experimental studies. His devotion to his patients, his mentoring of students, his service and loyalty to his university hospital was widely recognized and came to epitomize what society wants and needs in its medical practitioners as well as providing example and motivation to young doctors.

The history of thyroid and parathyroid surgery dates back thousands of years, but the developments leading to the contemporary era began just over a century ago. Pioneers in the field include Billroth, Kocher, Mayo, and Halsted. This article examines the historical progress of operating on the thyroid and parathyroid and the impact of physiology on surgery, surgery on physiology, and recent advances in technologies.

Context: Hürthle cells are eosinophilic, follicular-derived cells that are associated with a variety of nonneoplastic and neoplastic thyroid lesions. The differential diagnosis of Hürthle cell lesions is quite broad., Objective: To review the pathologic conditions associated with Hürthle cells in the thyroid and to discuss pathology of thyroid lesions associated with oncocytic cytology., Data Sources: A variety of thyroid nonneoplastic (autoimmune thyroiditis, multinodular goiter) and neoplastic conditions (Hürthle cell adenoma, Hürthle cell carcinoma) are associated with Hürthle cell cytology. In addition, there are several thyroid neoplasms that should be considered when one observes a Hürthle cell neoplasm in the thyroid (oncocytic variant of medullary carcinoma, several variants of papillary thyroid carcinoma)., Conclusions: Oncocytic cytology is seen in a variety of thyroid conditions that are associated with a broad differential diagnosis and care must be used for accurate diagnosis. Newer molecular-based techniques may be useful for further classification of thyroid neoplasms with oncocytic pathology.

Although several findings of historical writings have been made, the exact role of the thyroid was not known in the ancient times. From the middle of the nineteenth century, the anatomy and the physiological role of the thyroid were gradually elucidated, and diagnostic and therapeutic modalities were developed. It has been 100 years since Theodor Kocher was awarded the Nobel Prize for his work in pathophysiology and surgery of the thyroid. Fifty years have passed since radioactive iodine was first used for the diagnosis and the treatment of hyperthyroidism in Korea. Today, thyroid cancer is one of the most prevalent malignancy in Korean women. However, the detailed history of the thyroid disease has not been introduced in Korea. The aim of this paper is to describe the historical perspectives of the thyroid disease, especially focusing on the development of the treatment. The common thyroid disease were named after their discoverers, such as Graves and Hashimoto. It is meaningful to understand the historical background of the thyroid gland, because the important concepts in the area of endocrinology such as hormone replacement therapy, feedback mechanisms, and the use of isotopes were first established based on the research of the thyroid.

We present a short sketch of how the knowledge of thyroid surgery has evolved throughout decades with pointing out to prominent surgeons who achieved great deeds in the history of thyroidectomy. The progress of thyroid surgery is believed to be of utmost importance because it reflects evolution of surgery itself. Although surgeons of our days can rely on wide range of examinations, modern equipment and endocrinological support, they should remember the rules in medicine, that are obligatory nowadays, have been created throughout decades. The abridged sketch of the history of thyroidectomy reflects how long, difficult and--many a time--dramatic way was surmounted by notable and brave pioneers of endocrinological surgery and how they advanced the surgical treatment of the thyroid from the dark ages into the modern era.

Kraepelin believed that a chronic metabolic autointoxication, perhaps arising from the sex glands, eventually caused chemical damage to the brain and led to the symptoms of dementia praecox. The evolution of Kraepelin's autointoxication theory of dementia praecox is traced through the 5th to 8th (1895 to 1913) editions of his textbook, Psychiatrie. The historical context of autointoxication theory in medicine is explored in depth to enable the understanding of Kraepelin's aetiological assumption and his application of a rational treatment based on it--organotherapy. A brief account of the North American reception of Kraepelin's concept of dementia praecox, its autotoxic basis, and the preferred American style of rational treatment--surgery--concludes the discussion.