Graves disease

Graves disease (Basedow disease): Autoimmune disease that affects the thyroid. A form of hyperthyroidism manifesting the triad of goitre, exophthalmos and pretibial myxoedema.

Graves ophthalmopathy or Thyroid-associated ophthalmopathy (TAO), is the most common extrathyroidal manifestation of Graves disease

History of Parry-Graves-Basedow disease

The eponymic terms Parry and Graves as applied to exophthalmic goitre illustrate very well the disadvantages of the general use of proper names in classifying diseases.

For many years, in English speaking countries, this type of disease of the thyroid gland has been called Graves disease, following the proposal of Trousseau of Paris. However, in 1897 Sir William Osler called attention to a description of the same condition as noted by Caleb Hillier Parry in 1786 and published in Parry’s posthumous writings in 1825 ten years before Graves’ publication. In Germany the use of the term Basedow disease is generally accepted (Basedow being German).

Parry Disease

1786 – Caleb Hillier Parry (1755–1822) was an English physician whose posthumous publication in 1825 includes detailed description of thyroid enlargement associated with tachyarrhythmias and ocular signs of exophthalmos.

The part swelled was the thyroid gland; the eyes were protruded from their sockets, and the countenance exhibited an appearance of agitation and distress, especially on any muscular exertion, which I have rarely seen equalled.

Parry, 1825; II: 112

The term ‘Parry disease‘ was suggested by Sir William Osler (1898;836-837).

3. EXOPHTHALMIC GOITRE (Parry’s Disease). Historical Note. In the posthumous writings of Caleb Hillier Parry (1825) is a description of 8 cases of Enlargement of the Thyroid Gland in Connection with Enlargement or Palpitation of the Heart…If the name of any physician is to be associated with the disease, undoubtedly it should be that of Parry, the distinguished old Bath physician.

Osler 1898; 3e: 836-837

Graves disease

1835 – Robert James Graves (1796-1853) described a case of exophthalmos associated with an enlargement of the thyroid gland. The term ‘Graves disease‘ was suggested by French physician Armand Trousseau ‘Du Goître Exophthalmique, ou Maladie de Graves.‘ in 1862.

…the eyeballs were visibly enlarged, to such a degree the eyelids were unable to shut during sleep and when trying to close the eye. When the eyes were open the white of the eyes could be seen in the breadth of several lines around all of cornea.

‘1835; 7: 516-517

Basedow disease

1840 – Karl Adolph von Basedow (1799-1854) reported the same group of symptoms with an emphasis on exophthalmos in four cases. The term ‘Morbus Basedowii (Basedow disease)’ was suggested by Georg Hirsch in Klinische Fragmente 1858; 2: 224-225.

There appeared an eminent protrusion of the eye balls, which by the way were absolutely healthy and had a completely full sight. In spite of this the sick woman was sleeping with open eyes and had a frightening appearance.

Basedow 1840: 200 (Madame G)

Associated Persons

• Caleb Hillier Parry (1755–1822)
• Robert James Graves (1796–1853) [Graves disease]
• Karl Adolph von Basedow (1799–1854) [Basedow disease]

Alternative names

• Diffuse toxic goitre
• Exophthalmic goitre
• Graves-Basedow disease
• Basedow disease
• Basedow’sche Krankheit
• Parry disease

Controversies

We have to contend not only with Nationalism but with dates of observation and publication. In regard to descriptions of exophthalmic goitre, the following dates are important. Parry, noted in 1786, published in 1825; Flajani 1802; Demours 1821; Scarpa 1821; Graves 1835; Basedow 1840 and Stokes 1854. Without a doubt other doctors observed the condition many years before any of these men, and it requires only a Trousseau or an Osler to popularize the use of an additional eponym for exophthalmic goitre

Medical Classics (5) 1940

References

• Parry CH. Affections of the heart and thyroid gland. In: Collections from the unpublished medical writings of the late Caleb Hillier Parry. 1825.
• Graves RJ. Newly observed affection of the thyroid gland in females. London Medical and Surgical Journal. 1835; 7: 516-517
• Basedow KA. Exophthalmos durch Hypertrophie des Zellgewebes in der Augenhöhle. Medicinische Blätter: Wochenschrift für die gesamte Heilkunde. 1840; 6: 197-204, 220-228
• Cooper WW. On protrusion of the eyes in connexion with anemia, palpitation, and goitre. London Journal of Medicine. 1849; 1(7): 658-677
• Hirsch G. Cardiogmus Strumosus. In: Klinische Fragmente. 1858; 2: 224-225 [Hirsch: suggests Basedow disease]
• Trousseau A. Du Goître Exophthalmique, ou Maladie de Graves. In: Clinique médicale de l’Hôtel-Dieu de Paris. 1862; 2: 614-654 [Trousseau: suggests Graves disease]
• Osler W. The Principles and Practice of Medicine: 3e. 1898; 836-837 [Osler: suggests Parry disease]
• Major RH. Classic Descriptions of Disease: With Biographical Sketches of the Authors. 3e. Thomas; 1945: 275-286
• Nabipour I, Burger A, Moharreri MR, Azizi F. Avicenna, the first to describe thyroid-related orbitopathy. Thyroid. 2009 Jan;19(1):7-8.
• Wheeler MH. A tale of two celts. World J Surg. 2010 Jun;34(6):1151-6.
• Lindholm J, Laurberg P Hyperthyroidism, exophthalmos, and goiter: historical notes on the orbitopathy. Thyroid. 2010 Mar;20(3):291-300.
• Cadogan M. Eponymythology: Diffuse Toxic Goitre. LITFL 2018
• Cadogan M. Eponymythology: Graves orbitopathy. LITFL. 2018
• Cadogan M. Eponymictionary: Graves Ophthalmopathy LITFL. 2018