Milestones in European Thyroidology (MET)
Julián Podoba (1916-2005)
Julián Podoba was an internationally recognized representative of the Slovak scientific community. He was the founder of the Institute of Endocrinology in Bratislava and of the Slovak Endocrine Society at a time when Slovakia was still part of Czechoslovakia. He was a member of the Executive Committee of the European Thyroid Association between 1968 to 1972.
Julián Podoba was born in 1916 in a small rural village in western Slovakia. His father was a farmer. He had been the mayor of his village for 20 years and a member of the Czechoslovak Parliament in Prague during the first Czechoslovak Republic. From 1934 to 1940, Julián Podoba studied medicine at the Medical School of Comenius University in Bratislava. In 1943, he joined the team of Prof. Ladislav Dérer, the founder of modern internal medicine in Slovakia. He had to resign from the University Hospital as a result of his disagreement over the alliance of the Slovak State with the Nazi Germany. He then became Head of the Department of Internal Medicine at the Hospital of the Workers Social Security Alliance in Bratislava.
After World War II, Prof. Dérer regained his responsibilities as Head of the Department of Internal Medicine at Comenius University Medical School in Bratislava. He advised Podoba a study sojourn at the 3rd Clinic of Internal Medicine with Prof. Pelnar and later, with Prof. Josef Charvát of Charles University in Prague where he acquired a large amount of experience in endocrinology (1945-48). Prof. Charvát was considered as a founder of modern endocrinology in the renewed Czechoslovakia. After these years passed with Josef Charvát and also with Prof. Karel Šilink, Head of the Institute of Endocrinology in Prague, Julián Podoba became permanently involved with endocrinology and above all, with thyroid diseases and iodine deficiency disorders (IDD). He first joined the team of Prof. Šilink and started field studies on endemic goiter in the Czech lands(1). On the basis of this experience, he then organized the same field program in Slovakia during the years 1949-1953.
It is worth remembering these years after World War II. The development of modern endocrinology in Czechoslovakia had started in the period of forced obedience of the country to the Soviets, as other countries of Central and Eastern Europe. From 1948 to 1989, the iron curtain was separating the Eastern countries from Western Europe. During that period, all private or independent medical activities were forbidden. All the State affairs including the healthcare services were put under the strict control of a government firmly dominated by the Communist Party. Postal and telephone contacts with the western world were under surveillance and any personal relationship with western people were heavily curtailed and mostly reserved for the members of the Communist party. Julián Podoba was not a member of the communist party and to some extent, was also suffering from the fact that one of his brothers, a political prisoner, had succeeded to escape to Canada in 1948.
During these difficult years, the attendance to foreign congresses and the acceptance of invitations to visit or to stay abroad in scientific centers were strictly limited. As a consequence of this situation, the intellectual exchanges and the transfer of medical and technical expertise became almost impossible. The resources remained very limited and the lack of foreign currencies prevented the import of modern technologies (equipment, specific chemicals, etc). A continuous aggravation of the medical and scientific gap between the Eastern and Western Countries was unavoidable. Such a situation did not prevent the efforts of the czechoslovakian scientific community to keep going on with research. One example has been endemic goiter present in the country. Podoba investigated the etiological factors responsible for the disease, particularly iodine deficiency and systematically organized adequate campaigns in order to eradicate the disease. The support of the state public health organizations undoubtedly reinforced his action.
Around the 1950s, Šilink and coworkers examined 215,019 individuals in 156 districts of Bohemia and Moravia(2) while in Slovakia Podoba and his team examined 157,865 subjects of all age groups(3) . In several slovak regions, the prevalence of goitre in women reached 80% and that of endemic neurological cretinism 3%. A severe degree of iodine deficiency was confirmed in the majority of the regions. The urinary iodine excretion averaged 25–50 mcg/24 hrs and in the most severely affected areas an ioduria below 25 mcg/day was observed. The survey had some original features: (a) 5% of the population was examined, (b) the survey covered uniformly all the country, (c) ioduria was measured in a statiscally representative part of the population and (d) the role of naturally occurring goitrogens was investigated. Podoba also investigated the role of genetic factors in the development of endemic goiter(4). Using perchlorate and phenylthiocarbamide tests and analyzing the consanguinity in sibships, the importance of genetic factors was also demonstrated (5).
The prophylaxis of IDD with iodinated salt was introduced in Slovakia in 1951 (7 mg KI/kg). Since 1965, the salt contains 25 mg KI/kg (15 – 35 mg/kg) and since 1990s, iodate progressively replaced iodide in the salt. As a result, the iodine intake increased 3-4-times and endemic goitre and cretinism disappeared. The legalization of iodine prophylaxis in 1965 allowed to develop an example of what preventive medicine can achieve. Several local and international studies have later confirmed the sufficiency of the iodine intake as confirmed by the European Thyromobil campaign carried out in 1994-95 under the auspices of WHO.
With his team, Julián Podoba also investigated the role of environmental goitrogens, particularly of the Brassica plants. With one of his young coworkers Pavel Langer, he extended these investigations and pointed out the role of enhanced thiocyanates levels in the blood(6), as later confirmed in Africa.
The preliminary promising data of IDD surveys in Slovakia resulted in the foundation of the Institute of Endocrinogy in 1951 by the Ministry of Health. Julián Podoba became its first director. The research team of the Institute completed the field surveys on IDD as initiated in 1949 and kept the responsibility of supervising the iodine prophylaxis program until 1969. In 1954, the Institute of Endocrinology was incorporated in the newly founded Slovak Academy of Sciences (SAV). In 1967, It was renamed as Institute of Experimental Endocrinology (IEE) and was several times appraised as the best institution among all the other scientific institutes of the Slovak Academy of Sciences. The Institute of Experimental Endocrinology became a center of excellence for the studies performed on the negative effects of the environmental factors as the stress conditions and the nutritional status on the thyroid function. The experience of the Institute was acknowledged in 2000 by the European Commission.
It is very impressive to see that while facing difficult working conditions, Julián Podoba was able to develop epidemiologic studies on IDD in Slovakia and to successfully plan a large program of iodine prophylaxis in Slovakia, even if all the political and economical problems were against him.
From the start, Julián Podoba had been the drive of the Institute of Endocrinology. He resigned from his responsbilities in 1969. He then served as Head of the Endemic Goitre Laboratory until his retirement in 1987.
Modestly but perseveringly, Julián Podoba worked to help his country meet all the problems related to the difficult living conditions during and after World War II and during the Communist regime. One of his cconcerns was the education and training of young scientists. He managed to send to international research centers including the USA, many of his students and young colleagues who later reached important positions in national and international scientific organizations or universities as Knopp, Langer, Lichardus, Macho, Štrbák, Vigaš and others. He launched an international journal "Endocrinologia experimentalis" which enabled many scientists from the eastern countries to publish their results. He was the author of several monographies and wrote many chapters in textbooks dealing with internal medicine and endocrinology. He directed more than 100 publications in national and international journals, mainly related to IDD and its prophylaxis.
This extensive work brought to Julián Podoba the acknowledgement of his work not only in Czechoslovakia but also abroad, at many international symposia and conferences. He became associated professor at Comenius University in 1968. He was also President of the Slovak Endocrine society (1967 - 1975) and Vice-president of the Czechoslovakia Society of Endocrinology. He was elected as a member of the European Thyroid Association (ETA) Executive Committee (1968 - 1972) and hosted in Prague the 8th meeting of the ETA in 1974 with the Czechoslosvak Medical Society J.E. Purkyne, the Czechoslovak Society of Endocrinology and other colleagues
The life-long work of Julián Podoba was esteemed with the highest state and scientific prizes, as the czechoslovakian state medal "For merit of building" (1964), the Golden medal of Jan Evangelista Purkyne (1966), the Golden medal of the Slovak medical society (1976), the Golden medal of the Slovak Academy of Sciences (1983) and the Cross of the President of the Slovak Republic (2003).
The wife of Julián Podoba was a medical doctor, specialist in internal medicine. She spent all her professional life in the Department of Internal Medicine of the Comenius University Medical School. They have 2 sons. The eldest is a medical doctor continuing his father’s work as Head of the Department of Clinical Endocrinology at the St Elisabeth Cancer Institute in Bratislava while the youngest is an ethnographer at the Institute of Ethnography of the Slovak Academy of Sciences.
1. Šilink K. : Goitrogens in foods and endemic goiter. in Podoba and Langer P. (eds), Bratislava, Slovak Academy of Sciences, pp 247-269, 1964.
2. Šilink K. and Reisenauer R. Geographical spread of endemic goiter and problems of his maping. in Šilink K. and Cerny K.,(eds). Endemic goiter and allied diseases. Bratislava, Slovak Academy of Sciences, pp 33-47, 1966.
3. Podoba J. Endemic goiter in Slovakia (in Slovak), Bratislava, Slovak Academy of Sciences, 1962, pp.187 .
4. Podoba J., Štukovský R. and Kovacs R. Iodine deficiency, environmental goitrogens and genetic factors in the etiology of endemic goiter. Acta Endocrino. (Suppl.) (Kbh), 1973, 179 ; 36-37.
5. Podoba J., Štukovský R. and Kovác R. Thyroid function in sibships in endemic goiter region. J. Clin. Endocrinol. Met., 1970, 31 : 134-139.
6. Langer P. Serum thyocynate level in large sections of the population as an index of the presence of naturally goitrogens in the organism. in Podoba J. and Langer P. (eds). Naturally occuring goitrogens and thyroid function. Bratislava, Slovak Academy of Sciences, pp 281-296, 1964.
7. Langer P., M., Podoba J.jr, Koštalová L. and Gutekunst R. Thyroid volume and urinary iodine in schoolchildren and adolescents after 40 years of iodine prophylaxis. Exp. Clin. Endocrinol., 1994, 102 ; 394-398.