Thyroid and Parathyroid Glands

As per:
Competency based Undergraduate
curriculum
AN 35.2
• Describe and demonstrate location, parts, borders,
surfaces, relations, and blood supply of thyroid gland
AN 35.8
• Describe anatomically relevant clinical features of
thyroid swellings
 As per:
Competency based Undergraduate
curriculum
AN 43.2
• Identify, describe, and draw microanatomy of …,
thyroid and parathyroid glands, ….
AN 43.4
• Describe development and developmental basis of
congenital anomalies of …, thyroid gland, …

Medical Council of India, Competency based Undergraduate curriculum for the Indian Medical Graduate,
2018. Vol. 1; pg 1-80.
 THYROID
GLAND
• Largest endocrine gland
• Brownish-red, highly vascular shield-like gland
Functions
• Secretes triiodothyronine (T3), tetra-iodothyronine (T4), or
thyroxine and calcitonin
• Regulates basal metabolic rate
• Promotes psychosomatic growth of body
• Modulates calcium metabolism
 THYROID
GLAND
Peculiarities of Thyroid Gland
• Strong hormones: Only endocrine gland can store,
secretions and releases as per requirement
• Location: Only superficially located endocrine gland
and therefore can be physically examined
• Dependency on iodine: Only endocrine gland depends
on external environment for supply of iodine (raw
material) for hormone synthesis
• High vascularity: One of organs with richest blood flow
 THYROID
Parts GLAND
• H-shaped (thyreos = shield in Greek) and consists of
following parts
• Two lobes – right and left
• Isthmus – connects two lobes
• Pyramidal lobe – occasionally present, projects
upward from isthmus, usually to left of body
 Location and External
Features
• Located in lower part of front and
sides of neck
• Vertebral level: Lies against C5–C7
and T1 vertebrae
• Lobe: Each lobe of gland extends
upward to oblique line of thyroid
cartilage and below up to 4th to 5th
tracheal ring
• Isthmus: Extends from 2nd to 4th
tracheal rings
 Location

 Situated in lower part of

front of the neck anterior to
lower part of larynx and
upper part of trachea.
 Vertebral Level: C5 – T1
 Location and External
Features
Weight and Dimension
• Weight: Weighs about 25 gm
• Size:
• Lobe – 5 cm long, 3 cm
transverse, 2 cm
anteroposterior thickness (3 × 3
× 2 cm)
• Isthmus – 1.25 cm × 1.25 cm
(flat)
 Some Interesting
Facts
• Thyroid gland in females – larger than in males.
• Size increases during menstruation and pregnancy
Pyramidal lobe
• May arise from isthmus or any one of lobes
• Variable in length
• Derived from thyroglossal duct
• Levator glandulae thyroideae – fibrous or fibromuscular band
sometimes present and connects pyramidal lobe to body of
hyoid bone
 Capsules of Thyroid
GlandInner true
• Has two capsules:
capsule and outer false capsule
• True capsule: Derived from
condensation of fibrous stroma of
gland
False capsule
• Surrounds true capsule
• Derived from splitting of
Pretracheal fascia
 Some Interesting
Factslies deep to true
• Dense capillary plexus
capsule
• Hence, to avoid postoperative
hemorrhage in thyroidectomy, thyroid
gland should be removed along with true
capsule
• In prostatic surgeries, venous plexus lies
between two capsules
• Hence, prostate should be removed,
leaving behind both capsules
 Some Interesting
Facts
Features of false capsule of thyroid gland
• Thin along posterior border of lateral
lobe
• Thicker on medial surface of lateral
lobe
• Suspensory ligament of Berry: Thickened
part of pretracheal fascia (false capsule)
connects lobes of thyroid gland with
cricoid cartilage
 Clinical
Integration
• As capsule of thyroid gland – thin along posterior
border, swelling more commonly extends backward
rather than forming visible swelling in neck
• Swallowing and thyroid movements: Thyroid moves up
and down during swallowing as attached to cricoid
cartilage by ligament of Berry
 Clinical
Integration
• Ligation of thyroid arteries in thyroidectomy
• Superior thyroid artery and external laryngeal nerve
diverge from each other near apex of thyroid lobe
• Hence, superior thyroid artery should be ligated near
apex of gland to avoid damage to nerve
• Inferior thyroid artery and recurrent laryngeal nerve
approach lower pole (base) of thyroid lobe
• Hence, inferior thyroid artery should be ligated away
from gland to avoid damage to nerve
 Parts and Relations of Lobes of Thyroid
• Gland
Each lobe of thyroid gland –
pyramidal or conical in shape and has
• Apex
• Base
• Three surfaces: Lateral, medial, and
posterolateral
• Two borders: Anterior and
posterior
Apex
• Directed upward and laterally
• Extends up to oblique line of thyroid
cartilage
 Parts and Relations of Lobes of Thyroid
Gland
Relations
• Laterally – sternothyroid
• Medially – inferior constrictor of
pharynx
Base
• Lowest part of thyroid lobe
• Extends up to 5th to 6th tracheal ring
• Relations: Closely related to
• Inferior thyroid artery
• Recurrent laryngeal nerve
 Parts and Relations of Lobes of Thyroid
Glandor superficial surface
Lateral
• Convex and covered by
• Sternocleidomastoid (only anterior border of this
muscle)
• Sternohyoid
• Superior belly of omohyoid
• Sternothyroid
Medial surface
• Related to
• Two tubes: Trachea and esophagus
Parts and Relations of Lobes of Thyroid
Glandsurface
Medial
• Related to
• Two muscles: Inferior constrictor and
cricothyroid
• Two cartilages: Cricoid and thyroid
• Two nerves: External laryngeal and
recurrent laryngeal nerves
Posterolateral surface
• Related to carotid sheath
• Overlaps common carotid artery
 Borders of thyroid lobe
Anterior border
• Thin
• Separates superficial and medial
surfaces
• Related to anterior branches of
superior thyroid artery
Posterior border
• Thick and rounded
• Separates medial and posterolateral
surfaces
 Borders of thyroid lobe
Posterior border
• Related to
• Inferior thyroid artery
(in lower part)
• Anastomosis between
superior and inferior
thyrohyoid arteries
• Parathyroid glands
• Thoracic duct on left
side
Parts and Relations of Isthmus of Thyroid Gland
• Horizontal, flat part of gland connect
two lobes
• Has
• Two surfaces: Anterior and
posterior
• Two borders: Superior and inferior
Anterior surface: Related to
• Sternohyoid
• Sternothyroid
• Anterior jugular veins
Parts and Relations of Isthmus of Thyroid Gland
• Posterior surface: Related to 2nd – 4th
tracheal ring
• Superior border: Related to
anastomosis between anterior
branches of right and left superior
thyroid arteries
Inferior border
• Inferior thyroid veins emerge from
inferior border of isthmus. If present,
thyroidea ima artery enters this
border
Blood Supply, Lymphatic Drainage and
Innervation
• Arterial supply
• Supplied by
Superior thyroid artery
• Branch of external carotid artery
• Near apex of gland, divides into
anterior and posterior branches
• Inferior thyroid artery – branch from
thyrocervical trunk of first part of
subclavian artery
Blood Supply, Lymphatic Drainage and
Innervation
Thyroidea ima artery (in 30%
cases)
• Occasionally present
• Branch of brachiocephalic trunk
or arch of aorta
• Enters isthmus of thyroid gland
• Accessory thyroid arteries: They
arise from tracheal and
esophageal arteries
 Some Interesting
Superior thyroid arteryFacts
• Arises from external carotid artery
• Runs downward and forward along with external laryngeal nerve
• Passes deep to superior belly of omohyoid, sternohyoid, and
sternothyroid muscles
• As artery approaches gland, nerves move away from artery
• Superior thyroid artery divides into anterior and posterior
branches after piercing pretracheal fascia at apex of gland
• Anterior branch: Descends on anterior border of thyroid lobe and
anastomoses with fellow artery along upper border of isthmus
• Posterior branch: Descends along posterior border of thyroid lobe
and anastomoses with inferior thyroid artery
 Some Interesting
Inferior thyroid arteryFacts
• Branch of thyrocervical trunk of first part of subclavian artery
• Ascends in front of scalenus anterior and turns medially between
vertebral vessels posteriorly and carotid sheath anteriorly
• On left, artery – crossed by thoracic duct anteriorly
• Near lower pole of thyroid gland, artery – approached by
recurrent laryngeal nerve
• Divides into 4–5 glandular branches which pierce pretracheal fascia
and supply lower two-thirds of lobe and lower half of isthmus of
thyroid gland
• Ascending branch anastomoses with posterior branch of superior
thyroid artery and supplies parathyroid glands
 Venous
drainage
Drained by following veins
• Superior thyroid vein: Emerges at
upper pole of the gland and
opens into internal jugular vein
Middle thyroid vein
• Short and wide vein
• Emerges at middle of thyroid
lobe and opens into internal
jugular vein
 Venous
Inferior thyroid veindrainage
• Emerges at inferior border of isthmus
• Forms plexus in front of trachea and
finally drains into brachiocephalic
veins
Fourth thyroid vein (Kocher’s vein)
• Occasionally present
• Emerges between middle and
inferior thyroid veins and drains into
internal jugular veins
 Lymphatic
• Drain into following nodes
drainage
• Prelaryngeal nodes
• Upper deep cervical or
jugulodigastric nodes
• Pre- and para-tracheal nodes
• Lower deep cervical nodes
• Retrosternal or brachiocephalic nodes
Nerve supply
• Receives vasomotor nerve supply from
superior, middle, and inferior cervical
sympathetic ganglia
 Histology of Thyroid
• Covered by Gland
thin connective
tissue
• Septa arising from capsule
divide gland into number of
lobules
• Made-up of follicles lined by
simple cuboidal epithelium
(ranges from squamous to low
columnar) with rounded
nuclei
 Histology of Thyroid
Gland
• Lumen of follicle contains pink
homogeneous colloid material
consists of thyroglobulin
• Few parafollicular cells (C-cells) –
present in relation to follicles
• C-cells secrete calcitonin reduces
blood calcium level
• In between follicles, rich vascular
connective tissue is present
 Follicular cells and activity of thyroid
gland
• Secrete thyroid hormones (T3
and T4)
• Shape of follicular cells
depends on activity of cells
Resting/inactive cells
• Squamous
• Inactive follicles contain large
quantity of colloid
 Follicular cells and activity of thyroid
gland
Secretory/active cells
• Under influence of thyroid-
stimaulating hormone, follicular
cells become cuboidal or low
columnar with large vesicular
nucleus (even tall columnar
epithelium is also seen)
• Active follicles contain less
colloid
 Follicular cells and activity of thyroid
gland
Scalloping of colloid
• Moth-eaten edges or
scalloped colloid indicator
of active thyroid gland
• Mostly seen in Grave’s
disease (hyperthyroidism)
 Clinical
Integration
• Irrespective of cause,
enlargement of thyroid gland is
called goiter
• Hyperthyroidism/thyrotoxicosis:
Excess production of thyroid
hormones causing increased
metabolism
• Causes of hyperthyroidism: Grave’s
disease (most common cause),
multinodular goiter, toxic thyroid
adenoma (tumor), long-acting
thyroid stimulator antibodies
 Clinical
Hypothyroidism Integration
• Inadequate production of thyroid hormone or tissue
resistance for activity of thyroid hormone
• Hypothyroidism during infancy or childhood causes
cretinism, whereas in adulthood causes myxedema
(mental and physical sluggishness, edema of
connective tissue)
Causes of hypothyroidism
• Iodine deficiency (most common cause) and
Hashimoto’s thyroiditis (autoimmune disorder)
 Development of Thyroid
Gland
• Develops from following two
sources
• Follicles from thyroglossal
duct
• Parafollicular cells from
ultimobranchial body (a
part of caudal pharyngeal
complex)
Fig. 15.14: Development of
thyroid gland
 Development of Thyroid
Gland pharynx,
• In floor of primitive
over first arch in midline, there
– swelling called tuberculum
impar
• By 24th day, just behind
tuberculum impar, pharyngeal
epithelium forms depression
(diverticulum) called
thyroglossal duct Fig. 15.14: Development of
thyroid gland
 Development of Thyroid
Gland
• Opening of thyroglossal duct
in pharynx is represented by
foramen caecum
• By end of third month (12th
week), follicular cells start
producing thyroid hormones
• First gland develops after
fertilization
Fig. 15.14: Development of
thyroid gland
 Anomalies of thyroid gland
• Sometimes, isthmus or one lobe of
thyroid gland may be absent or
small
Anomalies of location
• Thyroid gland may lie at any
position at passage of thyroglossal
duct Fig. 15.15: Anomalies of the position of
the thyroid gland
• May be lingual, intralingual,
suprahyoid, or infrahyoid thyroid
gland
 Anomalies of thyroid gland
Ectopic thyroid tissue
• Presence of thyroid tissue in
locations other than usual
(normal) thyroid gland
locations
• Mostly found in larynx,
trachea, esophagus,
pericardium, and ovaries Fig. 15.15: Anomalies of the position of the
thyroid gland
 Thyroglossal cyst and
• Thyroid glandfistula
develops from thyroglossal
duct (parafollicular cells from ultimobranchial
body)
• Usually, thyroglossal duct regresses
• Remnant of thyroglossal duct may form
thyroglossal cyst or fistula anywhere along
course of thyroglossal duct
• Thyroglossal cyst – irregular mass or lump in
midline of neck
Fig. 15.15: Anomalies of the position
• Occasionally, thyroglossal cyst ruptures of the thyroid gland
externally, resulting in draining sinus called
thyroglossal fistula
• Rarely, forms thyroglossal cyst carcinoma
 Clinical
Integration
• Thyroidectomy – surgical removal of thyroid gland
• Subtotal thyroidectomy: Involves removal of thyroid gland
leaving behind posterior part of thyroid gland to spare
parathyroid glands and to prevent postoperative
hypothyroidism
• Tumors of thyroid gland: They may compress adjacent
structures such as
• Trachea – causing dyspnea (difficulty in breathing)
• Esophagus – causing dysphagia (difficulty in swallowing)
• Recurrent laryngeal nerve – dysphonia (hoarseness of voice)
 PARATHYROID
GLANDS
• Are two pairs (superior and inferior) of small
endocrine glands
• They are essential for life
Morphology
• Small yellowish brown, ovoid or lentiform glands
• Measurements
• Length – 6 mm
• Width – 34 mm
• Thickness – 12 mm
• Weight – 50 mg
 PARATHYROID
Functions GLANDS
• Chief cells secrete parathyroid hormone (PTH) increases blood calcium
level
• PTH acts at following sites:
• Bone resorption: PTH activates osteoclasts and enhances bone
resorption
• Increases calcium reabsorption by kidney
• Increases conversion of 25-OH vitamin D3 to active 1,25-(OH)2
vitamin D3
• Increases calcium absorption in intestine
• Increases phosphate excretion by kidney
• Note: PTH and calcitonin have opposite roles in regulation of blood
calcium levels
 Locatio
n
• Superior parathyroid gland –
more constant in position
• Lies at middle of posterior
border of lobe of thyroid gland
• Lies dorsal to recurrent laryngeal
nerve
• Inferior parathyroid gland is
variable in position
 Locatio
n
• May lie at following sites
• Within true capsule of thyroid
gland, below inferior thyroid
artery, near lower pole of
thyroid gland
• Behind lower pole, outside true
capsule of thyroid gland, just
above inferior thyroid artery
• Inferior parathyroid glands
usually lie ventral to recurrent
laryngeal nerve
 Some Interesting
Facts superior and inferior thyroid
• Anastomosis between
arteries – used as guide to locate parathyroid glands,
as they lie along anastomosis
 Blood
supply
• Are highly vascular
Superior parathyroid artery
• Branch of anastomotic artery joins superior and
inferior thyroid arteries
• Supplies superior parathyroid gland
Inferior parathyroid artery
• Branch of inferior thyroid artery
• Supplies inferior parathyroid gland
 Blood
supply
Inferior parathyroid artery
• Thyroid plexus veins drain parathyroid glands
• Lymphatic of parathyroid glands drains along of
thyroid and thymus
Innervation
• Parathyroid activity – controlled by blood calcium
levels
• Low calcium level increases and high calcium level
reduces activity of parathyroid glands
 Histolog
y or sheets of cells
• Parathyroid gland shows cords
separated by numerous capillaries
• Shows two types of cells: (1) chief and (2) oxyphil
cells
• Chief cells – more in number, small in size, and
consist of spherical nucleus with small amount of
cytoplasm
• They secrete PTH hormone
• Oxyphil (eosinophilic) cells – less in number, larger
in size, and small intense-staining nucleus with
eosinophilic cytoplasm
• They do not secrete any hormone. Oxyphilic cells
appear just before puberty
 Development
• Two superior parathyroid glands are
derived from 4th pharyngeal pouch,
whereas two inferior parathyroid glands
are derived from 3rd pharyngeal pouch
• Dorsal part of third pouch grows and
loses contact with pharynx and then
descends caudally along with thymus
• Finally, loses contact with thymus and
forms inferior parathyroid gland
(parathyroid III)
 Development
• Dorsal part of fourth
pharyngeal pouch grows and
loses contact with pharynx
• Later descends caudally to
form superior parathyroid
gland (parathyroid III)
 Clinical
Hyperparathyroidism Integration
• Excessive production of parathyroid
hormone
• Results in high blood calcium levels
Hypoparathyroidism
• Decreased secretion of parathyroid
hormone
• Results in low blood calcium levels
cause tetany, paresthesia, Chvostek’s
sign (tetany on tapping facial nerve),
and Trousseau sign of latent tetany
(occlusion of brachial artery with
blood pressure cuff elicit tetany)
Thank you…