Caleb Parry and Hyperthyroidism and Stress

The disease that we commonly call Graves’ disease, or Basedow’s disease in part of Europe, was actually described by Caleb Parry many years before Graves’ published a description of hyperthyroidism and ophthalmopathy. Caleb Parry was a British physician born October 21st 1755, who worked in Bath.

He was a busy General Practitioner, but also found time to make original observations. He is credited for being the first to describe angina and indeed he treated his close friend John Hunter who had severe angina later in life.

Parry first noted the condition of hyperthyroidism in 1786, which he briefly reported in his “Elements of pathology and therapeutics” in 1815 [1], which was reprinted in a volume of “Medical classics” in 1940 [2].

The full descriptions of his first cases were provided by his son in 1825, in “Collections from the unpublished medical writings of C. H. Parry” [3], (Fig. 1).

There has been recent interest in determining who should be credited with the first description of autoimmune hyperthyroidism and on the important role of Caleb Parry in identifying and describing the main features, including exophthalmos.

Figure 1. Collections from the unpublished medical writings of the late Caleb Hillier Parry Face page of the publication by C. H. Parry in “Collections from the unpublished medical writings of the late Caleb Hillier Parry”, which included the first description of hyperthyroidism.

Indeed, it may well be that we now call “Graves’ disease” should be renamed “Parry’s disease”.

In the context of the present volume, we ask the question: did Parry recognized the association of hyperthyroidism with stress?

The Case of Elizabeth S.

The first patient described by Parry was an “Elizabeth S”, who developed hyperthyroidism following acute stress in unusual circumstances; she was, ‘thrown out of her wheelchair when coming down a hill, fast’ [4], (Fig. 2).

At the time she was “very much frightened, though not much hurt, but two weeks later she began to observe a swelling of her thyroid gland”.

The relationship between the unfortunate accident and subsequent development of hyperthyroidism was later discussed by Dr. R. Volpe, Toronto in his Presidential Address to the American Thyroid Association (ATA) in 1981.

Figure 2. The case of Elizabeth S Excerpt from Parry’s publication of the case of Elizabeth S. who, in 1808, developed hyperthyroidism following an acute stress.

It is true therefore, that in this initial case description, probably the first publication of what we call “Graves’ disease”, stress seemed to be a precipitating factor in the development of hyperthyroidism.

However, Parry did not study this relationship, nor did he refer to the possible link in the other cases described in his publications. But he should be credited with noting the association.

In the case of Elizabeth S., the time span of two weeks between the development of signs and symptoms of hyperthyroidism and a stressful incident is consistent with the development of TSH-receptor antibodies in a predisposed patient.

Although we have no proof, Elizabeth S. may have had a family history of this or similar disorders of an autoimmune nature. She would have been predisposed, and the acute stress was sufficient to precipitate her hyperthyroidism.

Generally, the sorts of stress that we link with the development of hyperthyroidism are more prolonged, such as bereavement following death of a loved one, a marital break-up or major ongoing financial concerns.

However, it seems that the stressful incidence, although short lived, was very stressful to Elizabeth S. and we can assume that this did play a role in the subsequent development of her hyperthyroidism. Elsewhere in this Website, studies addressing the relationship between stress and hyperthyroidism will be discussed in greater detail by other workers.

Although Parry was a close friend of Edward Jenner, who presented his findings about vaccination at the Guys Hospital Physical Society, there is no mention in the minutes of the Society’s meetings that he visited as a guest or presented his observations about hyperthyroidism.

Conclusions

In conclusion, it is apparent from this anecdotal observation of a single patient’s stress, that most people with hyperthyroidism do describe a major stressful incident, or a series of events, before the onset of their disease.

Acknowledgements

We thank Prof Malcolm H. Wheeler M.D., F.R.C.S., Emeritus Professor of Endocrine Surgery Department of Endocrine Surgery University Hospital of Wales, Cardiff, Wales for providing a copy of an engraving of Parry which was published in; “A Tale of Two Celts”[5] and the Archivist of Kings College London for checking the minutes of the Guys Hospital Physical Society meetings for any indication that Parry may have participated at one of their meetings.

* The Portrait of Caleb Hillier Parry is from an engraving by Philip Audinet. Reproduced from Caleb Hillier Parry 1755-1822: A notable provincial physician. Hull, G., JRSM 1998; 91:335-338 [6], with permission from The Royal Society of Medicine Press, London.

Author(s) Affiliation

JR Wall – The Department of Medicine, the University of Sydney, Nepean Hospital, Penrith 2751 NSW, Australia
J Lazarus – Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK

References

Parry CH. Elements of pathology and therapeutics etc. 1815; Cruttwell, Bath.
Parry CH. Reprinted in Medical Classics. 1945; 8-30.
Parry CH. Collections from the unpublished medical writings of C. H Parry. London, Underwoods 1825; 2: 11-128.
Parry CH, Enlargement of the thyroid gland in connection of enlargement or palpitations of the heart, posthumous in collections from the unpublished medical writings of C. H. Parry. London, 1825; 111-129.
Wheeler MH. A Tale of Two Celts; Invited historical lecture presented at a meeting of the International Association of Endocrine Surgeons, Adelaide, Australia. 8th Sept 2009.
Hull G. Caleb Hillier Parry 1755-1822: A notable provincial physician. JRSM 1998; 91: 335-338.

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