Milestones in European Thyroidology (MET)
Donald Alexander (1928-2007)
William Donald Alexander, Academic Physician, Endocrinologist, and a major figure in international thyroid research in the 1960’s and 1970’s. He died aged 79 on the 9th of May 2007.
Donald Alexander was born in 1928 into a family with a strong academic tradition; his father was Professor of English at the University of Glasgow. He was educated at the Glasgow Academy, and at the University of Glasgow, where he graduated after a distinguished undergraduate career with the Cullen medal in 1951. His early clinical training was in the Western Infirmary and in the MRC Rheumatic Fever Unit (which subsequently became the Atheroma Unit). His potential at that stage was recognised by Edward Wayne, the Regius Professor of Medicine at the University of Glasgow and he quickly developed an academic interest in clinical and experimental aspects of thyroid disease.
At that time Glasgow was a major centre for thyroid research and Donald worked alongside Wayne, Jim Crooks (latterly Professor of Medicine in Dundee), and international Fellows such as Dimitri Koutras from Athens. His early research culminated in the production of a book with Wayne and Koutras on clinical disorders of iodine metabolism – This was a landmark publication which described methods of iodine estimation as well as documenting iodine metabolism in different thyroid states and also non toxic goitre. Detailed isotope studies led to the elucidation of thyroidal iodine clearance as well as values for absolute iodine uptake and plasma inorganic iodine in an iodine deficient Scottish population. The principles elucidated in this monograph continue to form the basis for our current understanding of iodide trafficking in the thyroid.
Following this initial research training Donald Alexander moved to the National Institutes of Health in Bethesda to work, as an MRC Travelling Fellow, with Jan Wolff on experimental aspects of iodine metabolism – At that time Wolff was primarily interested in the mechanism and physiology of iodide transport and Donald participated enthusiastically in this, contributing to papers on iodine metabolism that were published in Archives of Biochemistry and Biophysics and in Endocrinology.
In 1964 he returned to Glasgow as a Senior Lecturer in the Department of Medicine in the Western Infirmary; he spent the rest of his professional career there, being promoted to Reader in 1970, providing leadership in clinical and experimental aspects of thyroid disease and as a general internal Physician. He spent other periods of sabbatical study in the United States during the 1960’s and 1970’s, culminating in a six month attachment as a visiting Professor with Sidney Ingbar in Boston in 1975. He greatly valued these links to colleagues in the United States, and maintained close contacts with them in subsequent years.
During this period of time he developed a series of important studies on aspects of antithyroid drug action and metabolism that still inform the clinical use of these agents today. –These studies were initiated in collaboration with Ted Astwood of Tufts Medical centre Boston and used for the first time 35S labelled methimazole to investigate the overall metabolism of the drug. Donald went on to supervise studies with this isotope to evaluate thyroidal concentration of antithyroid drug, biliary excretion, effects of other drugs on absorption and other studies. During these studies Donald pioneered the use of a “block and replace” regimen for management for Graves’ Disease; this allowed the use of thyroid iodine uptake measurements be carried out to follow the underlying course of the disorder and provided some estimate of the risk of relapse. This therapeutic approach has entered routine clinical practice, although the use of iodine uptake as a predictor of relapse has not been shown to have practical utility. Subsequently when measurement of drug by HPLS was available, studies in breast milk were performed. The observations made still are pertinent to current clinical thyroidology; for example, the use of propylthiouracil as a drug that can be taken by breast-feeding women is based on those original data. The whole series of experiments in humans and animals resulted in around 27 publications.
Donald Alexander retired in 1994. However, he found enforced unemployment to be uncongenial and developed a second career as a Medical Adviser to the Abbey National in Glasgow; he took final retirement from this position at the end of 2006.
Donald Alexander was a shy and very private man who was unduly modest about his own achievements. He was widely read and highly articulate and was, in private, an excellent raconteur. He took great pride in the successful careers of those whom he had mentored – trainees included the late Donald McLarty; John Lazarus and John Connell. Throughout his career Donald valued and maintained close contacts with colleagues in thyroid research in the United States and in Continental Europe. He was an early supporter of the development of the European Thyroid Association and was instrumental in ensuring that early meetings of that organisation were scientifically productive. He greatly enjoyed attending the meetings of the European Thyroid Association and his contributions were much appreciated.
His main interest outside his professional life lay with his family; as a student he won the national rifle championships at Bisley for two successful years and in later life dabbled, without conviction, in golf. He and his wife Ann had three daughters (Ann, Gillian and Elspeth) and Donald’s main interest was in their substantial professional, sporting and domestic achievements. He was a warm and much loved father and grandfather who will be greatly missed by his extended family.