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Michael Tunbridge
Oxford University and John Radcliffe Hospital, Oxford, UK It has been my privilege to have known George Hennemann since the early 1970's when I was introduced to him by Professor Reginald Hall, with whom I worked in Newcastle upon Tyne. I know that Reg Hall, had he still been alive, would have wished to pay tribute to George for his many contributions to Thyroidology. It is my privilege to do so on behalf of George's many friends and colleagues throughout the UK and elsewhere. I little imagined when I went to Newcastle to conduct the Whickham survey in 1972 that I would still be there twenty years later so we were able to re-run the survey to provide incidence data on thyroid diseases by studying their frequency in the same population over that period. The original survey (1) provided a cross sectional study of the community which documented the prevalence of goitre, hypothyroidism and thyrotoxicosis and the frequency and distribution of thyroid antibodies. The follow-up study (2) conducted by my colleague, Mark Vanderpump and several members of the original survey team provided data which allowed us to determine incidence rates and evaluate the aetiological risk factors and the natural history of the disease states. It is important to bear in mind that all epidemiological studies have their limitations. These include definitions of the diseases being studied, the way in which the survey population is selected, the influence of age, sex and environmental factors and not least the different techniques used for the measurement of thyroid function. The tests have become more sophisticated over twenty years but the principal tests remain the measurement of circulating thyroid hormones and TSH as well as thyroid antibodies. I propose to review the epidemiology of the common autoimmune thyroid diseases ranging from thyrotoxicosis through thyroiditis to hypothyroidism, which are to be found in caucasian communities in many countries (3). I shall not be reviewing the problem of iodine deficiency which remains serious in many parts of the world, not just as a cause of goitre but also as the cause of mental and physical retardation in areas of severe iodine deficiency, where iodine repletion programmes have not been implemented. |
