Kocher's thyroid surgery

A large goitre could squeeze the windpipe, and surgeons had long removed the thyroid now and then to relieve it, though before antisepsis patients often died of the operation. Theodor Kocher, born in Bern in 1841, had trained under surgeons who included Billroth and Langenbeck, and in 1872 he became professor of surgery and director of the university surgical clinic in Bern. His clinic became a centre for antiseptic surgery, and he was among the first to move on to asepsis.

As the operation grew safer, surgeons removed the whole gland more often. Kocher re-examined as many of his first 100 goitre patients as he could trace, and some 30 of them had developed a distinct syndrome: muscular weakness, swelling of the face and limbs, anaemia, declining intelligence and, in the end, death from exhaustion. It appeared in full only where the entire thyroid had been removed. In April 1883, at the congress of the German Society of Surgery in Berlin, he named it cachexia strumipriva and warned against total excision. The two Reverdins of Geneva had noted similar changes in the autumn of 1882, yet that same April they praised total excision in print.

Confirmation came quickly. The Reverdins linked the syndrome to the myxoedema described by English physicians. At the Clinical Society of London on 23 November 1883 Felix Semon cited Kocher's work, and a committee of the society concluded that myxoedema, sporadic cretinism and probably Kocher's syndrome were the same disease. Victor Horsley showed in monkeys that loss of the thyroid caused it, and the condition was renamed cachexia thyreopriva. Murray's thyroid extract later showed that the missing function could be replaced.

From then on Kocher left a functioning portion of the gland behind. In his Nobel lecture of December 1909 he cited a continuous series of more than 300 goitre operations without a death, and the presentation speech credited him with several thousand patients restored to lasting health. The prize was awarded for his work on the physiology, pathology and surgery of the thyroid. In 1912 he gave his university 200,000 Swiss francs for a research institute. According to a 2017 review, a few weeks before his death in Bern on 27 July 1917 he reported about 5,000 thyroid operations with a mortality of about 0.5 per cent.