Kocher T (1883)

Ueber Kropfexstirpation und ihre Folgen [On goitre removal, and its consequences]. Archiv für Klinische Chirurgie 29:254-337.
In 1883, the Swiss surgeon Theodor Kocher reported his follow-up of patients from whom he had removed goitrous thyroid glands, showing that several of them had developed cretinism.

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“Unfortunately the physiologists know next to nothing about the physiological significance of the thyroid gland, and this may have been the main reason for surgeons tacitly assuming that the thyroid gland had no function at all. Once one had achieved certainty that total removal could be happily performed from a technical point of view, one did not hesitate, in cases of disease of both halves of the thyroid gland, to take out the whole organ (Kocher 1883a, p. 273).”



“I shared this opinion for a long time. It was [the influence of] just one case, on whom I had operated in 1874 – and about whom the doctor had occasionally mentioned that the girl in question had since undergone a complete and substantial change in the nature of her character. Indeed, he had recently informed me that she had become entirely cretinoid. This was so important to me, that I now took all pains to see the girl with my own eyes. This was not easy, because the doctor had died soon after his verbal message. We insisted all the more because [our] colleague Reverdin, in Geneva, mentioned to us that he had seen two cases in whom decreased mental capacity had followed excision of goitre. I was astonished to a great extent by the conspicuous looks of the individual in question [his patient]. In order to fix your views right away, I will pass around among you photographs of the girl with her younger sister before and after the operation [link to photographs]. According to the mother, the two sisters were said to have resembled each other so much at the time of the operation that they were frequently confused for each other. Whilst the younger sister has now grown up to a blossoming young woman of very pretty looks, the sister operated on has remained small and exhibits the ugly looks of a semi-idiot. This having been ascertained … I immediately sent invitations to all my [patients on whom I had] operated for goitre [asking them] to present themselves for examination (Kocher 1883a, pp. 273-4).”




“Of the 34 total excisions…3 patients died as a consequence of the operation, 2 died from unclear causes after good [post-operative] recoveries, and one had a cancerous goitre. Of the remaining 28 we were not able to receive information from 4 cases only; however, 18 patients presented themselves in person, and 6 sent in written reports.”



“Of the 18 patients who presented themselves for examination, only 2 showed unchanged or improved general status compared with earlier (Kocher 1883a, p. 277).”

 Translation by Ulrich Tröhler




Emil Theodor Kocher (1841-1917)