I Dr. Hans Eggenberger Pioneers in Thyroid AG Unnikrishnan

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Journal of the association of physicians of india • vol 62 • november, 2014
Pioneers in Thyroid
Dr. Hans Eggenberger
AG Unnikrishnan*
The Iodine Story
I
odine is essential for
thyroid hormonestriiodothyronine (T3)
and tetraiodothyronine
(T4) contain 3 and
4 iodine atoms
respectively. The
link between iodine
deficiency and thyroid
diseases was uncovered
long back. Iodine
deficiency, it was found,
could lead to goiter
(enlarged thyroid gland)
and hypothyroidism
at any age. Iodine
deficiency could also
cause neurointellectual
problems in children
(cretinism) and delayed
physical development in
growing children. 1
It was also noted
that persons living in iodine-deficient
areas were most at risk. This included
the Himalayas, Andes and the Alps.
This led to the thought that iodine
supplementation could prevent iodine
defciency disorders. Switzerland was
the pioneering country, which instituted
the iodine supplementation program
in 1922. Whle a number of dedicated
professionals were instrumental for this
program, this article will focus on the
efforts of Dr. H. Eggenberger, a surgeon,
who, with his family led the fight against
iodine deficincy.
A Swiss Odyssey
Chief Endocrinologist and CEO,
Chellaram Diabetes Institute,
Pune
*
T r a ve l s b y s e ve r a l e x p e r t s h a ve
documented that the mountaneous
regions of Switzerland had a significant
burden of people with endemic goiter.
Even the celebrated author, Mark Twin
wrote, “I have seen the principal features
of Swiss scenery—Mount Blanc and
the goiter—and now for home.” It was
eventually the Swiss Army- which used to
classify people as unift because of goiter,
who discovered that the mountaneous
districs of Switzerland had more goiter
than the plains. Soon, studies in the early
1900s were now showing that over 80%
of young men and 60% of school children
had goiters. The relationship between
iodine and the goiter was soon becoming
apparent in studies. Preliminary studies
by Dr O Bayard, a brilliant doctor from
Switzerland- set the stage for an iodine
replacement program. 1
It was at this time that Hans
Eggenberger (1881-1946), a surgeon in
Herisau, Switzerland, decided to do
something about it.
Swiss Time
In country celebrated for its celebration
of time through quality watches, the
timing of Dr. Hans Eggenberger too
could not have been more perfect. He
soon began a campaign to improve
iodine nutrition. And then, going a step
further- he petitioned the government to
introduce iodized salt. It is not known
whether he realized that this petition
would lead to a successful campaignand that iodization of salt would soon
benefit several countries, even Indiain preventing the scourge of iodine
deficiency disorders. The petition by
Hans Eggenberger was succesful, and the
Swiss government in 1922 agreed to allow
the the distribution of salt containing 7.5
mg iodine per kg. 1-3
For Hans Eggenberger, the fight
against iodine deficiency was as much
personal, as it was professional. Indeed,
his entire family would together to
prepare the iodized salt.
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Journal of the association of physicians of india • vol 62 • november, 2014
The Succesful Program
The Movement Spreads
The iodization program was hugely succesful. In a
year’s time, among the families who used iodized salt
regularly - 66% of existing goiter in school children
shrank. After 4 years of iodized salt prophylaxis,
the average size of pre-existing goiters had shrunk
to an invisible or normal level ! The most dramatic
result was that in a few years, there were no cases
of newborn goiters reported ! This led the Swiss
Government to form an advisory council – to take the
program ahead, systematically, countrywide. Though
opposition came from opposing lobbies as well as
an attack of hyperthyroidism- the benefits of iodine
prophylaxis were soon recognized in Switzerland
and other countries of Europe. Further benefits were
noted following the efforts of Dr. Eggenberger- the
prevalence of army recruit goiter reduced, prelanence
of mental deficiency declined and the prooportion of
people with a shorter height (defined as below 156
cm) also decreased. Iodization of salt became the most
cost-effective public health measure ever conducted
succesfully in Switzerland.
Dr. Eggenberger’s contribution is unique, for
this represents a clinician, whose vision and actions
became a harbinger of worldwide change in health.
It also represents the succesful efforts of a doctor
as an advocate for a preventive health program.
The fantastic succces of the program kindled by Dr.
Eggenberger sent ripples worldwide, and theos was
soon felt in India too. Dr Ramalingaswami and Dr
N Kochupillai soon pioneered the iodization of salt
in India. 4 Universal salt iodisation was on its way to
becoming a reality.
References
1.
Papageorgopoulou C, Staub K, and Rüh F. Hypothyroidism in
Switzerland. In: Harbeck M, Von Heyking K, Schwarzberg H, eds.
Sickness, Hunger, War, and Religion. Munich: Rachel Carson Center
for Environment and Society 2012, Pages- 1-90. Link - http://
xn--evolutionremedizin-ttb.ch/wp/wp-ontent/uploads/2012/08/
Papage_Staub_Ruehli_2012.pdf Accessed 10th May, 2014
2.
Eggenberger, Hans. 1922. “Die Verhütung des Kropfes und des
Kropfrecidives.” Schweizerische Medizinische Wochenschrift 53:
245–49.
3.
Hans Eggenberger (1881–1946). http://www.tagblatt.ch/ostschweiz/
stgallen/rheintal/rt-ur/Ein-Segen-fuer-Kropflis;art166,3077080.
Accessed 10th May, 2014
4.
Sooch SS, Deo MG, Karmarkar MG, Kochupillai N, Ramachandran K,
Ramalingaswami V. Prevention of endemic goitre with iodised salt.
Bull WHO 1973;49:307-312.