Nadezhda Krupskaya, was the wife of the founding father of the Soviet Union, Vladimir Lenin, and in her own right an important figure in pre- and post-revolutionary Russia. She was an outspoken opponent of Stalin and was made a political pariah after the death of her husband. She suffered from Graves’ disease and experienced exacerbations whilst exiled from Imperial Russia for revolutionary anti-Tsarist activities. Graves’ disease and its treatment were poorly understood, and after trialing a series of unsuccessful contemporary medical treatments, she underwent thyroid surgery in 1913, performed by Swiss surgeon, Theodor Kocher. Kocher, already internationally renowned, was awarded the Nobel Prize in Physiology or Medicine in 1909 for his work on thyroid physiology and surgery for goitre. He was the pre-eminent authority on thyroid disease, being widely published. Generations of surgeons were influenced by his “Textbook of Operative Surgery”. This documented, amongst many other subjects, his methodologies in anaesthesia and the practice of thyroid surgery. Through letters written by Lenin and Krupskaya, we learn of their experience of Graves’ disease treatment in the early twentieth century and how the “first lady” of the socialist revolution came to be treated by the celebrity surgeon, the father of thyroid surgery.