history

Let’s play “Would this kill me in the 1800s?”

One of the side effects of being someone who loves history but is also surrounded by people with chronic illnesses and disabilities is that I’m always wondering if they/I/we would survive “back in the day.”

Spoiler: the answer us almost always NO.

So I was rather shocked when I started looking into the history of thyroid disorders and found that people have known about them for a really long time–almost 3000 years. Except…they didn’t know what it actually was. They just happened to stumble on a treatment that worked on one of the possible symptoms.

But let me back up a little.

If your anatomy education started and ended with “Head, Shoulders, Knees and Toes,”  let me give you a basic idea about what this gland does.

The thyroid is a spongy, butterfly shaped tissue at the base of your throat that helps regulate your metabolism. It secretes 2 different hormones, T3 and T4, which our bodies use to convert oxygen and calories into energy.

It works in conjunction with the pituitary gland and the hypothalamus, which are glands at the base of the brain. Depending on what your body needs at a given moment, the pituitary gland will send a message to the hypothalamus, which in turn sends another message to the thyroid and tells it to produce more or less of these hormones.

There are a lot of things that can send these signals out of whack: genetics, age, pregnancy, menopause, cancer, autoimmune disorders, cysts, and nutrient deficiencies just to name a few.

So if all of this is handled by hormones (i.e. stuff in our blood) how did people 3,000 years ago know what it was and how to treat it?

Well, they didn’t…exactly.

You see, in addition to hypo- and hyperthyroid disorders (that would be when your thyroid either doesn’t make enough hormones or goes seriously overboard with them), there’s one other complication they can cause: a goiter.

In most industrialized nations now, goiter is pretty much unheard of. In fact, I had’t heard of it until I was doing some specific Victorian era research. Then I came across it again in Outlander (that would be Voyager or S3 for you fans. Geordie, in particular), and decided to look up what exactly this thing was.

queen_alexandra_2c_th-e8be97
Princess Alexandra of Denmark was famous for her choker-style necklaces, which she single-handedly popularized during the late 1800s. It’s rumored she began wearing them to hide a goiter. Personally, I don’t buy it. For her choker to be tight enough to cover the lump, she wouldn’t have been able to breathe or swallow.

 

A goiter is a lump on the neck. Specifically, it’s an enlarged thyroid gland, but they didn’t actually know that until the mid 1800s. It can be caused by all those lovely things I mentioned above. Sometimes, goiters are relatively small, go away on their own, and don’t cause any symptoms except a strong desire to bring neck ruffles back into style.

As they grow larger, however, they can cause difficulty breathing, swallowing, and talking, but they still might not cause any metabolic issues.

Nowadays goiters are rare and are usually the result of benign cysts forming on the thyroid, or in rare cases thyroid cancer.

Historically, the main cause was an iodine deficiency. The thyroid is the only organ in the body capable of absorbing iodine, and it’s necessary for the production of T3 & T4. Even today, most iodine deficient goiters are found in inland and high altitude places, since most of our iodine intake (naturally, anyway) comes from things like seafood. In the US, our salt has been treated with iodine since at least the 1920s, though experiments in England and the US with treating food and water with iodine began in the 1830s-40s.

But what about those ancients?

Yes, I’m getting there.

About 2700 years ago in China we have our first recorded observation of a goiter and it’s treatment. It’s successful treatment.

We still don’t know how they stumbled on this treatment, or why they thought it would work. We’re not even certain if they knew what exactly they were treating. But starting in ancient China they used seaweed to treat goiter patients.

Seaweed, as it happens, is very high in iodine.

This spread through Asia and the Middle East. But by the 1400s people still weren’t really sure of the connections between the lumps on people’s necks and why eating seaweed often made them go away. In 1500 Leonardo Da Vinci became the first person to draw the thyroid, but he had no idea what it did. Most people until the 1800s assumed that it lubricated the throat and had something to do with the larynx (voice box), since they are very close to each other.

Based on the research I’ve done, it seems that historically people knew more about hyperthyroid than hypothyroid. This is probably for two reasons: First, hyperthyroid can lead to many physical problems that are much easier for outsiders to observe–for example, large appetites, an inability to gain weight, and osteoporosis.

Meanwhile, hypothyroid has many symptoms that mimic depression (lethargy, weight gain) and things that are easily written off by others (like the inability to regulate your body temperature. It’s much easier to just hand someone a blanket than it is to ignore a broken bone).

Another thing that bears mentioning: goiters and thyroid disorders in general are more likely to hit women than men. That’s because HCG (aka the pregnancy hormone) can trigger thyroid problems, though it’s unclear at this time why that’s the case. It’s an unfortunate fact that diseases that impact women more than men, or exclusively, are usually shorted on research time and funds.

So, to sum up: Could someone with a thyroid disorder survive in the 1800s?

The answer is, surprisingly, yes. However, they would probably have a shortened life span due to the stress on their organs and the general ineffectiveness of treatments.

It wasn’t until 1917 that the first effective pharmaceutical was introduced in the US (which, I’ll be honest, is still about 20 years earlier than I expected). Patients could purchase a gram of synthetic T4 for a whopping $350. In today’s currency, that would be $7,580.31!

While I don’t have the proper conversion rates for the dosages, I’m going to take a wild guess based on the weight of my own thyroid medication and say that 1 gram is probably 3 doses–3 days. If we’re being generous (it’s probably more like 1, but I’m assuming my pills have fillers and other things in them besides just pure T4).

Which means a 30 day supply of 1917 thyroxine would cost $75,803.10.  Which, according to this 2015 article on Freakishly Expensive Cancer Drugs , makes it more expensive than the most expensive drug on the list by more than $10,000/month. And that was before health insurance existed!

By comparison, a 30 day supply of my current medication is about $30 without insurance.

With insurance, it’s free.

Now that we all have sticker shock, just a few other notable things to consider:

  • The first thyroid ward/unit in a hospital was created at Massachusetts General Hospital in 1913.
  • Prior to the 1900s, there were a lot of experiments involving removing the thyroid completely, with mixed results. The surgeries themselves were usually successful, but then the patients (usually dogs) would die because they didn’t have the hormones it produced. Having NO T3/T4 leads to a metabolic shutdown.
  • In addition to iodine pills, treated water and food, and eating seaweed, Victorians tried consuming mashed up thyroid glands from other animals. Other than records that it was done, I didn’t see what the outcome of this particular exercise was. I’m assuming it was ineffective,* since the organ itself wouldn’t be doing it’s job once removed and pureed.

As you can probably tell by the length of this post, there are pages and pages of research and historical information available online regarding thyroids and their history in the medical community. If you would like to read up, here are some places where you can do so. I highly recommend the link at the top, which will send you to a timeline on the American Thyroid Association website, from which I plucked the majority of the information in this post:

ATA History Timeline
Goiter info from the Mayo Clinic
Goiter info from the Cleveland Clinic
Thyroidology over the ages
Goiter history

*Since writing this post, I have been corrected. Pig thyroid is actually still used today to treat people who test normal for thyroid function with medication, but still have moderate to severe symptoms, because the body processes it differently. Who knew?


Like what you see? Check out Would this kill me in the 1800s: Gallbladder edition.