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I have great pleasure in writing this foreword to Dr Sujata Mitra's book Management of Thyroid Disorders Made Easy. Thyroid is the largest endocrine gland in the human body and thyroid enlargement (“galaganda”) was known to Ayurvedic physicians 2,500 years back but the relationship between goiter and iodine was suggested in 1820 by Coindet, only eight years after the discovery of iodine in 1813. He guessed that iodine was the substance in burned sponge that was used through experiential wisdom to treat goiter for atleast seven centuries. Thyroid hormones are unique among endocrine secretions in their iodine content. J. Dobson in 1998 (Geographic Review 88, 1-28) suggested that the geographic distribution of the environmental supply of iodine and hominid adaptation to it may have played a major role in human evolution. Anatomical characteristics of Neanderthals was remarkably similar to those of modern humans who suffered from cretinism as a result of iodine deficiency. The evolution of the sodium iodine symporter (necessary to transport iodine into the thyroid cell) and pendrin (which permits organification of the iodine for thyroid hormone synthesis) helped the evolution of brain development and bone development of modern humans. Yet NIS and pendrin were discovered only in 1996. New knowledge continues to be accumulated about thyroid function in health and disease as shown by 7800 new references to the thyroid in the past decade in the Cumulative Index Medicus with contributions from cardiologists, neurologists, muscle physiologists, immunologists and many other specialties each providing his orientation. Like insulin, estrogen and Vitamin D 6receptors, thyroid hormone receptors are widely distributed reflecting their action in all tissues. The effects of hyper thyroidism and hypothyroidism upon the individual body systems at the molecular level are much better understood. The striking female preponderance (4-10:1) in all thyroid disorders is attributed to a thyroid growth-promoting factor in estrogen. Genetic factors have been identified which make autoimmune thyroid disease (AITD) the most prevalent among human autoimmune diseases with female preponderance. HLADR3 DR4 and DR5 and CTL antigen 4 are strongly associated with AITD. Dysregulation of immune surveillance and tolerance underlies AITD. This book emphasizes that it is now possible to detect and treat thyroid problems at the subclinical level. Hence the importance of eliciting family history of thyroid disease and estimating antithyroglobulin and anti-TPO antibodies. It also emphasises that for hypethyroidism (Graves' disease, Toxic Multinodular Goitre and Solitary hot nodule) radioiodine therapy is the most cost effective modality of treatment in India and there should be absolutely no apprehension about undesirable radiation effects such as leukemia or malignancy. Is also emphasizes that subacute thyroiditis (presumably viral) is a self limiting disease and does not need neomercazol therapy which is often unnecessarily given to such patients.

Thyroid disorders have emerged as one of the commonest endocrine diseases encountered in clinical practice. As in diabetes, it may present to a whole range of clinical specialty. The gynecologist may come across thyroid disease in the investigation of menstrual disorders or infertility. A patient may present to the surgeon with a thyroid nodule. A pediatrician is concerned about the possibility of neonatal hypothyroidism. An orthopedician may also investigate for thyroid disorder in a patient of carpal tunnel syndrome. The physician, of course, continues to be approached as the primary care giver in a hypothyroid or hyperthyroid patient.

The inspiration for this book came from the late Dr S Dasgupta, who guided us through most of our academic activities at Tata Main Hospital. His spirit continues to lead us even today.