The ionosphere's total electron content (TEC) is a parameter widely used in studies of the near-Earth plasma environment. The scientific use of TEC appeared early in the artificial satellite era, and among its many contributions were fundamental insights into how the ionosphere responds to geomagnetic storms. While many excellent reviews of solar-terrestrial disturbances exist in the literature, none have concentrated on the TEC parameter per se. With new TEC data sets increasingly available from the Global Positioning System (GPS), a comprehensive summary of pre-GPS storm studies is needed to set the base for progress in the GPS era. This review summarizes past case studies, describes statistical occurrence pattern, and identifies responsible mechanisms validated via modeling. It presents a new set of results of TEC disturbance patterns during 180 geomagnetic storms to describe seasonal and solar cycle effects. It concludes with a set of open questions that require additional study.