Fagge, assistant physician at Guy’s Hospital, referred to a report of a 14-year-old boy from York County, England with obvious signs of cretinism and a large bronchocele.
The author stated that “in reality, however, this case is the only one on record (so far as I can ascertain) in which cretinism has occurred sporadically, in association with goitre.” He pointed out that he himself had seen patients that differed in as much as though they certainly presented with clinical evidence of cretinism, they had no goiter.
He also observed that in children stunted growth was typical in “sporadic cretinism” and that “it springs up, generally without apparent cause, in the offspring of a healthy father and mother”.
However, Gull had the presence of mind to note “the state is a substantive and definitive one, no one will doubt who has had fair opportunity of observing it”. Thomas Hospital  published a paper in which he coined the term myxoedema and published the first photography of a patient (Figure 1).He was able to confirm the findings of Curling “the thyroid was reduced to about a fourth of its natural size, and, being flattened against the larynx, was hardly felt during life. The thyroid gland evolved from being considered a rudimentary structure to an organ related to specific diseases. The last part of the 19th century was a period of great achievements in medicine and endocrinology.Pathologists have recently been inclined to view the coincidence of these two affections as accidental, or as having no direct relation.” At that time, the term “sporadic cretinism” was used while today the diagnosis would be congenital hypothyroidism.
But the association between the clinical symptoms and the thyroid gland was not appreciated. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.The singular importance of iodine became acknowledged. Surgical treatment evolved with extraordinary speed. Theodor Kocher observed that the clinical picture in patients after total thyroidectomy was similar to the one seen in cretinism.The deposit of fat and the changes in the skin and connective tissues correspond to a languid condition of the venous circulation, but without any tendency to oedema, or any sign of cardiac defect”.It is beyond human imagination how this paper can be constructed as the first description of myxedema.There was virtually no endocrine organ that did not become object of intensive investigation.