Retrospective View of Thyroid by Its Former Editors

Jerome Hershman, Editor 1991–1999

How did Thyroid get started? John Wilber, President of the American Thyroid Association (ATA) in 1990, and the ATA Council in collaboration with our publisher, Mary Ann Liebert, Inc. decided to start a journal under the auspices of the ATA even though some ATA members were not in favor of “another specialty journal.” From 1924 to 1956, the organization had published a hard cover volume that included the articles presented at the annual meeting and their discussion under the title “Transactions of the American Goiter Association,” so there was precedent for an ATA publication.

The inaugural issue of Thyroid edited by Leonard Wartofsky was a memorial to the life and achievements of Sidney H. Ingbar written by his former fellows and colleagues; it contained a number of excellent reviews in addition to tributes to Sidney who was a great leader and mentor in thyroid research. Mary Ann Liebert, Inc. provided the initial financial support for Thyroid.

I was selected as the editor and continued in this role for nine years. I was fortunate to have Gregory Brent join me as associate editor with a focus on the molecular biology articles. Thyroid was published quarterly from 1991 to 1994, then bimonthly from 1995 to 1997, and became a monthly journal in 1998 based on an increasing flow of accepted articles. From its inception, Thyroid had many international articles, especially from Japan, Latin America, Italy, and other European centers. The publisher and I were very proud that Thyroid was indexed by Medline after only 1 year of being in publication.

In the early volumes of Thyroid, most articles were in the clinical realm, but there were also very important articles that reported new methods of measurement of thyroid parameters as well as translational and basic studies and case reports. We are fortunate that the publisher digitized the full text of the early volumes in 2009 so that all issues are accessible to readers who are members of the ATA or through subscribing libraries.

I would like to cite a few of the most impressive articles in the years of my editing Thyroid and the principal authors of these articles. There were many studies of thyroid hormone metabolism. Using labeled thyroxine (T4), Hays reported that T4 absorption in humans occurred in the upper small intestine (1). Wu et al. identified T4 sulfate in human serum and amniotic fluid by a new radioimmunoassay (RIA) (2). Gross, who codiscovered triiodothyronine (T3) with Rosalind Pitt-Rivers, described his personal account of this discovery (3).

Studies of hyperthyroidism were prominent. Heufelder et al. identified thyrotropin (TSH) receptor messenger RNA in retro-orbital fibroblasts from patients with Graves ophthalmopathy (4). Tuttle et al. showed that hyperthyroid patients pretreated with propylthiouracil (PTU) before RAI had a higher failure rate than those treated with RAI alone, demonstrating the radioprotective effect of PTU (5); this does not occur with methimazole pretherapy (6). In a prospective study, Conn et al. showed that ∼2% of patients treated with iodinated contrast media developed hyperthyroidism in the next few months (7).

Sawin and Becker wrote a fascinating early history of the treatment of hyperthyroidism with radioiodine (8). They described the controversy involving an eminent Boston hospital and Saul Hertz, who played a key role in initiating and carrying out the therapy in 30 patients. Hertz, who went into the navy in 1943, was not included in authorship of an article reporting a series of RAI therapy from the same center. Eventually there were two articles with different authors reporting separate series from this hospital published in the same issue of JAMA in 1946 (9,10). Vitti et al. reported the clinical features of patients with Graves' disease who had remission or recurrence in a series of 306 patients treated with antithyroid drugs; the features associated with recurrence were age younger than 40 years, large goiter, and very high TSH receptor antibodies (11).

Huysmans et al. showed that ∼2% of patients treated with RAI for multinodular goiter develop autoimmune hyperthyroidism (12). Bogazzi et al. in Pisa found that color flow Doppler ultrasound could differentiate type 1 (high flow) from type 2 (low flow) amiodarone-induced thyrotoxicosis (13). Abalovich et al. showed that hyperthyroidism impairs spermatogenic function (14).

In the area of thyroid nodules and cancer, Danese and Pontecorvi reported that ultrasonography improved the diagnostic accuracy of fine-needle aspiration (FNA) of thyroid nodules by comparison of a series of ∼5000 done with ultrasonography with 5000 done when only palpation of the nodule was the guide for needle placement (15). Kashima et al. noted that patients with papillary thyroid cancer (PTC) who also had chronic thyroiditis had a recurrence rate of 5% compared with 15% of those without chronic thyroiditis (16). Frasoldati et al. showed the utility of measurement of thyroglobulin in FNA of nodes in patients with recurrent thyroid cancer (17). Frank-Raue et al. demonstrated the utility of selective venous catheterization for identifying sites of persistent medullary thyroid cancer (18). Matsuzuka et al. reported a very large series of primary thyroid lymphomas treated at the Kuma Hospital in Japan by radiation and chemotherapy with ∼100% survival (19).

There were several reports of new methods for studies of thyroid disease. Dunn et al. described a simplified method for measuring iodine in urine that was applicable to epidemiologic work in the field (20). Chopra reported a new method for simultaneous measurement of free T3 and free T4 using RIA of the T3 and T4 in the dialysate (21).

The early years included many reviews that were of interest to our readership. The late Delange reviewed the disorders that were induced by iodine deficiency (22). Yoshimura and Hershman reviewed the studies establishing the thyroid stimulating action of human chorionic gonadotropin that resulted in hyperthyroidism in women with hydatidiform moles or choriocarcinoma (23). Weintraub and Szkudlinski reviewed the development of recombinant human thyrotropin (24). After the cloning of the sodium/iodide symporter (NIS) in 1997, there were many studies on its regulation. Spitzweg et al. reviewed the regulation of the NIS gene in cultured rat thyroid cells (25). Brucker-Davis wrote an encyclopedic review of the effects of synthetic chemicals (environmental disruptors) on the thyroid that was the most highly cited article in our early years of publication (26). The July 1999 issue of Thyroid was devoted entirely to an excellent symposium on thyroid disease in pregnancy organized by Robert Smallridge.

Terry Davies, Editor 2000–2008

When I succeeded Jerry Hershman in the year 2000, he arrived at Mount Sinai with a pile of boxes containing all the articles then in play. He was concerned that the first changeover of editors should run smoothly and I was very grateful for his support. In those days, articles were submitted on paper, and I was not fully aware that the digital age was around the corner. I had the good or bad fortune to see the end of real articles being submitted in triplicate and being mailed out for review only to be replaced by a digital file sent through the Internet. The idea of the printed journal being challenged by an online journal was not a concept I even anticipated at that time. However, with the help of the Mary Ann Liebert, Inc. staff, especially Susan Jensen and of course Vicky Cohn, the changeover proceeded quite smoothly from our end, although authors were slow to get the message and mailed articles arrived for some time, especially from international destinations. It was at this time that we also decided that the journal needed a facelift, and it took its still current format with a front cover photo/diagram after overcoming a lot of skepticism that there would not be enough interesting figures long term. I think it is still an attractive way to clothe a journal.

During my tenure I introduced the use of regional editors based abroad to broaden the reach of Thyroid, and this is something we still need to build on. Monthly editorials were also something I loved to write. Some were quite provocative that made Thyroid a talking point. Looking back some of them were a bit wacky and raised some criticism from even my good friends, especially one about spoiling all my slides in very hot weather and trying to rescue the sticky mess in the bathroom, and another on the usefulness of the disabled bathrooms at airports. I still think they livened up the journal, but subsequent editors have not followed my example, not even with a more conservative bent. One of the editorials often quoted explained that reviewing articles is both a privilege and an obligation—something that all editors believe or they would not take on the role (27). We need to keep emphasizing this.

During this time, Thyroid published the first observation only trial for small PTCs by Ito et al. (28), an approach that has now been adopted by several centers although I remain uncomfortable with leaving a cancer in situ. The National Thyroid Cancer Treatment Cooperative Study Group reported that aggressive thyroid hormone suppressive therapy provided a superior outcome in patients with high-risk differentiated thyroid cancer (DTC) but not in low-risk DTC and was the harbinger of our current do less approach to low-risk thyroid cancer patients (29).

The January 2003 issue of Thyroid was entirely devoted to a highly cited series of articles entitled: laboratory medicine practice guidelines; laboratory support for the diagnosis and monitoring of thyroid disease compiled by Baloch et al. (30). Harvey and Williams reviewed the mechanism of thyroid hormone actions with emphasis on action through nuclear thyroid hormone response elements, as well as consideration of a membrane action of thyroid hormone (31). These types of reviews were popular with our readers and it was only then that we realized that such inclusions improved our impact scores. I was sad when my eight years as editor-in-chief were up. I went through quite a severe post-thyroid deprivation syndrome, and I am not sure I ever recovered. Like the loss of a loved one, there remains a hole in my heart for editing Thyroid.

Charles Emerson, Editor, 2009–2012

During the years 2009 through 2012, I served Thyroid as editor-in-chief. Even before my official start date, the task seemed overwhelming as, judging by the relatively large number of articles it was receiving, Thyroid was well established. My first editorial, Thyroid in the 21st Century—Thank You, Terry Davies, was intended as a tribute to the work of my predecessor, Terry Davies. It also spoke of Jerry Hershman's pioneering leadership and the rapidity with which he obtained listing for Thyroid in Index Medicus. I regret that I did not recognize him by name in the title. Conjuring up excuses for not doing so, as I write this memory, the best I can do is plead that including Jerry in the title would have also required the first part to be changed to Thyroid in the 20th and 21st century, something that would have made the editorial no longer as hallowed as “recent publications”! Fortunately, the journal did not suffer from this omission as Jerry was one of the most prolific and dependable reviewers during my tenure.

My vision for Thyroid was to produce a journal with outstanding material and a standardized segmented format, with expert and dedicated reviewers. I looked for final articles to be rich in data but free of opacity, ambiguity, and redundancy. Readers, even if they only saw the title and abstract, should be able to rapidly grasp the importance and validity of the article's conclusions. Uniformity of abstracts with sections divided into objective, methods, results, and conclusions was introduced, authors were asked to include one or two sentences of background at the start of the objective section, and were encouraged to state their objective as a hypothesis. The table of contents for the original studies was segregated into the major thyroid fields, including thyroid cancer and nodules; epidemiology; immunology, autoimmunity and Graves' ophthalmopathy; iodine and endemic goiter; pregnancy and fetal development; thyroid dysfunction; thyroid economy; thyroid radiology and nuclear medicine; and thyroid surgery. Placing thyroid cancer in the first section reflected the plurality of articles in this field.

During this period, Thyroid published guidelines dealing with pregnancy and the postpartum, thyrotoxicosis, and hypothyroidism. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum by Stagnaro-Green et al. was published in 2011 (32). Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and the American Association of Clinical Endocrinologists by Bahn et al. was also published in 2011 (33) and Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association by Garber et al. was published in 2012 (34). These three guidelines were all highly cited, being the 4th, 9th, and 20th most cited in Thyroid, respectively, since its inception. Probably the most important guideline article, however, was the Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer by Cooper et al., appearing in November 2009 (35). This is now the most cited publication in Thyroid. That issue also contained Consensus Statement on the Terminology and Classification of Central Neck Dissection for Thyroid Cancer by Carty et al. (36) and The Bethesda System for Reporting Thyroid Cytopathology by Cibas and Ali (37), both of which are also among the top 50 cited publications in Thyroid.

In that same issue, I wrote an editorial entitled Guidelines for Guidelines: Content, Accountability, Peer Review, and Intellectual Ownership. This recognized the inherent strength and legitimacy of journals published by nonprofit medical organizations, and also emphasized the balance that the journal must try to achieve in publishing content, initiated by a society, to ensure that the material is original, intellectually owned by the authors, and not unduly subject to the dictums or agenda of the sponsoring medical society (38).

In addition to guidelines and consensus statements, a number of influential original studies were published in Thyroid during the years 2008 through 2012. Among these were Delayed Neurobehavioral Development in Children Born to Pregnant Women with Mild Hypothyroxinemia During the First Month of Gestation: The Importance of Early Iodine Supplementation by Berbel et al. (39), Estimation of Iodine Intake from Various Urinary Iodine Measurements in Population Studies by Vejbjerg et al. (40), and Estimating Risk of Recurrence in Differentiated Thyroid Cancer After Total Thyroidectomy and Radioactive Iodine Remnant Ablation: Using Response to Therapy Variables to Modify the Initial Risk Estimates Predicted by the New American Thyroid Association Staging System, by Tuttle et al. (41). Two of these articles and other original studies were among the top 50 cited in Thyroid and the one by Tuttle et al. (41) has had an enduring influence on the development of staging and prognostic systems for DTC.

It is impossible to write a memory of Thyroid without acknowledging the strong support and editorial freedom offered by Mary Ann Liebert, Inc. and the ATA in this endeavor. Even deeper, or at least as much, thanks goes out to my associate editors, members of the editorial board, and reviewers from all over the world. This includes my successor, Peter Kopp, who dealt with many of the thyroid function and thyroid economy articles. One regret I have, which has been admirably corrected by Peter, is to expand the editorial board allowing inclusion of more members, all of them deserving.

Peter Kopp, Editor, 2013–2019

From 2013 to 2019, I had the honor and privilege to serve as editor-in-chief of Thyroid. Starting with a strong foundation created by previous editors, I strived to consolidate the position of Thyroid as one of the strongest subspecialty journals. This resulted in the rise of its impact factor to 7.786 and of the Scopus CiteScore to 6.69 for the year 2018; based on the latter, Thyroid was ranked at position 6 and the 97th percentile of the journals focused on endocrinology. The submission of articles has significantly increased and reached 807 submissions in 2017. This rise and the space limitations have led to an acceptance rate that is now ∼25%.

The downloads of content published in Thyroid is remarkable. In 2012, there were 239,850 downloads of articles published in Thyroid, and this has risen to 838,379 in 2018. The number of downloads is of course much higher than the number of citations for a given publication. As illustrated by Sawka et al. (42), the downloads are particularly high for the guidelines published by the ATA. For example, the 2015 Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer were downloaded almost half a million times (473,758) in 2017, and was cited 1132 times in other publications that same year (42). Very importantly, the use of this content is truly global (Bouillard D, Kopp P; unpublished analysis). For 2019, use of the content has been distributed as follows in different regions of the world: United States 33%, Asia 32%, Europe 19%, Latin America 9%, Canada 4%, and Australia 3%.

The guidelines and position statements published by the ATA during the last few years have a significant impact on practice trends. The majority of these guidelines focus on clinical management and include, among others, recommendations for the management of Thyroid Nodules and Differentiated Thyroid Cancer (2016) (43), Thyroid Disease During Pregnancy and the Postpartum (2017) (44), Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) (45), Medullary Thyroid Carcinoma (2015) (46), Hypothyroidism (2014) (47), and Thyroid Nodules and Differentiated Thyroid Cancer in Children (2015) (48). Currently, the Guidelines for the Management and Therapy of Anaplastic Thyroid Cancer published in 2012 (49) are being revised and a new version, including the significant developments in the molecular diagnosis and therapeutic options for anaplastic thyroid cancer, is anticipated for 2020. In addition to these clinical guidelines, the Guide to Investigating Thyroid Hormone Economy and Action in Rodent and Cell Models has for the first time formulated recommendations for laboratory procedures related to thyroid research to standardize experiments and improve comparability and reproducibility of experimental findings (50).

Many original research articles published in Thyroid during the past few years have provided fundamental novel insights into thyroid pathophysiology and the clinical management of a wide spectrum of thyroid disorders. To discuss them here would result in a lengthy compilation with a substantial selection bias and omission of many relevant contributions.

Of course, the strength, vitality, and visibility of a journal are dependent on the submission of quality work by authors. However, many elements need to be in place behind the scenes. I wish to express my gratitude to all associate editors, editorial board members, and ad hoc reviewers, who serve the review process, which is essential for keeping the selection process alive and for assuring that the content is of high quality. The Editorial Assistant, Sharleene Cano, more recently assisted by Carrie Prewitt, provides a key role in the office of the ATA for handling of the articles and multiple queries by authors and reviewers. At our publisher, Vicki Cohn, Executive Vice President of Mary Ann Liebert, Inc., merits special thanks for her unwavering and generous support for Thyroid during the tenure of all editors. Vicki has always been available with wise and thoughtful advice. Sophie Mohin Reisz will replace Vicki as editorial director, and will be our equally committed and able partner. Numerous collaborators with our publisher, including Susan Jensen, Patricia Meravy, Paige Casey, and Larry Bernstein, also need to be acknowledged. Also, we have been superbly supported by our Production Editor, Amanda Montes de Oca, at Westchester Publishing Services.

A bibliographic analysis by Cooper and Anton examined the trends in the publication of clinical thyroid disease-related research articles between 2006 and 2015 (51). This analysis has revealed that the number of published articles is rising rapidly and, impressively, that there are >1000 articles in the thyroid field per year. Not surprisingly, the number of contributions varies depending on the topic area within thyroidology, with the majority of articles focused on thyroid nodules and cancer. I think it is particularly important that Thyroid continues to cover the whole spectrum of thyroidology, with a clear focus on novel information that has an impact on the understanding of the pathophysiology of thyroid disease and clinical practice. With the ongoing support of creative authors and the team compiled by our incoming Editor-in-Chief, Electron Kebebew, I am confident that Thyroid will remain the leading resource in our field, and the exclusive source for the authoritative ATA guidelines for managing thyroid disease.