John B. Stanbury (May 15,1915–July 6,2015)

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John B. Stanbury died in his sleep on July 6, 2015, in Westwood, MA, seven weeks after his 100th birthday. He was born in Clinton, NC, and went to college at Duke and medical school at Harvard. He married Jean Cook in January 1945 while in the Navy, in which he served during World War II, and raised a family of five in Chestnut Hill, MA. He is survived by Jean, his wife of 70 years, four children (John Jr, Martha, Sarah Stanbury Smith, and David), nine grandchildren, and two great-grandchildren, and was pre-deceased by his youngest daughter, Pamela. Truly both a southern gentleman and a Boston Brahman, John led by discussion and example, and avoided arguments and conflicts. Above all, he loved a family gathering, especially on Isle au Haut, ME. He was an avid tennis player, beekeeper, and gardener.

John became chief resident at the Massachusetts General Hospital (MGH), and his admiration for Fuller Albright influenced his choice for endocrinology. He commenced his own career in medical practice, teaching, and endocrine research when he became Chief of the Thyroid Unit at the MGH in 1949. Teaching was focused in the Thyroid Clinic where trainees and older staff members, including John, saw patients each day. But the main teaching event was the clinic held each Tuesday afternoon, at which several patients were presented in person, and then examined by each of the attendings. Often visitors from clinics around the world were present as well. The discussions that followed by members of medicine, surgery, pathology, and radiology departments were sharp, patient-focused, full of pearls, and provided all present with a living textbook of clinical practice. This model has been emulated in many teaching institutions around the country.

The research environment in the Thyroid Unit was strong at this time, with Jacob Lerman studying immunity to thyroglobulin, Farah Maloof investigating the metabolism of thioureas, and a partnership between Karl Compton, Robley Evans, and Arthur Roberts at the Massachusetts Institute of Technology (MIT), and Saul Hertz, James Howard Means, and Earle Chapman at MGH using the just developed tool of radioactive isotopes of iodine for studying the metabolism of iodine in the thyroid gland. Studies on iodine metabolism in animals were quickly followed by investigations in man, and the first treatment of Graves' disease in 1941. These techniques were soon extended by Rulon Rawson for use in thyroid cancer. The idea of studying endemic goiter using this new technology led John Stanbury to organize a famous expedition to Mendoza, Argentina, along with Gordon Brownell and Douglas Riggs. The research was published in 1954 in a landmark publication “Endemic Goiter: The Adaptation of Man to Iodine Deficiency” (1), which opened this field to modern investigation. John ultimately pursued the “Iodine Trail” around the world with associates and studies in Mexico, Ecuador, Venezuela, Brazil, Thailand, the Congo, and Indonesia during the following years (2). Aside from documenting the extent of known endemic goiter and cretinism, these studies defined for the first time the extent of iodine deficiency–associated mental retardation, a previously unrecognized problem adversely impacting the socioeconomic development of millions of people, through the work of Rodrigo Fierro-Benitez. The research also led to treatment programs using iodinated salt, and injections of iodinated oil, which had and still has a significant impact for inhabitants of countries affected by iodine deficiency. This effort culminated in formation of the International Council for Control of Iodine Deficiency Disorders (ICCIDD, now called the Iodine Global Network; http://ign.org/) sponsored by the World Health Organization (WHO), with John Stanbury as its founding chairman and Basil Hetzel as director. This has led to the near worldwide elimination of iodine deficiency.

The diagnostic use of isotopes continued in the clinic with studies on the treatment of hyperthyroidism and iodine kinetics, and studies of individual patients with unusual hereditary disorders of thyroid function. This led John and his associates to develop a totally new and exciting field: “Inborn Errors of Metabolism” as it related to the thyroid (3). First studies done in 1949 defined the “organification defect” in a young patient and other family members. In 1955, John spent a sabbatical year in Leiden with Andries Querido and pursued research on another remarkable clinical phenotype associated with goitrous hypothyroidism. Their studies documented hypothyroidism due to a generalized lack of the enzyme responsible for the deiodination of iodotyrosines, the first time a human thyroid disorder was coupled with a specific enzyme defect (3). Other personal investigations identified a generalized deficiency in iodide trapping, identified the “coupling defect,” and thyroidal resistance to thyrotropin, at the clinical level. Students and colleagues have carried on this research with identification of the Resistance to Thyroid Hormone (RTH) syndrome, and defects involving thyroglobulin synthesis and formation of abnormal iodinated proteins. This deep interest in “metabolic defects” led in time to publication of a prescient volume edited by John Stanbury, James Wyngaarden, and Donald Frederickson entitled “The Metabolic Basis of Inherited Disease,” which remains a classic (4).

Another research area opened at the Thyroid Unit involved studies on what may be termed “intermediary metabolism” in the thyroid, with Jacques Dumont and others. At that time, knowledge of DNA was little more than the fact that it contains four basic units in long chains and that it is sticky. Moreover, our understanding of the mechanisms governing protein synthesis was non-existent. But studies began on the biochemistry of thyroid hormone synthesis and energy metabolism in the thyroid, and gradually over years developed into what we recognize now as “molecular biology” of the thyroid.

In 1966, John moved to MIT as head of a clinical research center. Over time, the public health problems he had encountered on his “Iodine Trail” led to an interest in problems of overpopulation in Africa and Asia and to a period as director of the Pathfinder Foundation programs (http://pathfindersri.org/).

A very large group of fellows from the United States and abroad were trained over the decades in what was the Mecca for aspiring researchers. “A Constant Ferment: a History of the Thyroid Clinic and Laboratory at the Massachusetts General Hospital: 1913–1990” (5), written by John, is full of memories that bring to life people from those productive years. Many became leaders in thyroidology, including Aldo Pinchera, Leslie DeGroot, Jacques Dumont, Geraldo Medeiros-Neto, Augusto Litonjua, Reginald Hall, Korsgaard Christenson, Rodrigo Fierro Benitez, Eduardo Pretell, John Dunn, and (literally) dozens more.

John's awards included the Prince Mahidol Award from the royal family of Thailand and the Fahrney Medal of the Franklin Institute, honorary degrees from Leiden University, the Netherlands, and the University of Pisa, Italy, and a “Medal of Merit in Public Health” by the Ministry of Public Health of Ecuador. In 2003, John established the Thyroid Pathophysiology Medal, which recognizes outstanding research contributions contributing to a greater understanding of thyroid physiology or the pathophysiology of thyroid disease and is awarded each year at the Annual Meeting of the American Thyroid Association.

John Stanbury was very modest about his contributions to education, research, and human welfare, but his gifts were enormous and richly deserve our recognition.