ENDOCRINE GLANDS

THE ENDOCRINE GLANDS

Endocrine glands are the ductless glands which pour
their secretion directly to the blood. Secretion
of these glands is called hormones.
Endocrine system is very important in
maintaining the homeostasis
Homeostasis: Maintenance of a dynamically stable
state between the different systems of the
body and environment
The different endocrine glands and tissues of the
body are:
- Hypophysis cerebri or pituitary gland
- Thyroid and parathyroid glands
- Suprarenal or adrenal gland
- Pineal gland
- Islets of Langerhan’s in the pancreas
- Interstitial cells of Leydig in the testis
- Graafian follicles and corpus luteum of the ovary
- Also found in the kidney, placenta and in the wall of
GIT
- Hypothalamus
 THE ENDOCRINE GLANDS
Endocrine glands are the ductless glands which
pour their secretion directly to the blood.
Secretion of these glands is called
hormones.
The endocrine glands of the body are:
• Hypophysis cerebri or pituitary gland
• Thyroid and parathyroid glands
• Suprarenal or adrenal gland
• Pineal gland
• Islets of Langerhan’s in the pancreas
• Interstitial cells of Leydig in the testis
• Graafian follicles and corpus luteum of
the ovary
• Also found in the kidney, placenta and in
the wall of GIT
• Hypothalamus
 THE ENDOCRINE SYSTEM
Definition:
• This is the body system partly
responsible for coordination and
integration of all the body systems.
• It operates in conjunction with the
Nervous system in the execution of
these functions.
Component Parts:
• The system is composed of glands
which synthesis and secrete
chemical substances (messengers)
referred to as Hormones.
• Hormones may be transported to
target organ via the blood stream or
could act locally via the
microcirculations.
Origin and Organization:
• Endocrine glands are epithelial derivatives which invade the underlining connective
tissue of the epithelium.
• They derive their copious blood supply from the surrounding connective tissue.
• The fibrous components of the latter also support the glands.
• The secretory cells are organized in various geometrical structures (spherical, chords
and clusters)
 Thyroid gland
(thyreos [Gr] – oblong shield; edios [Gr] – shape)
• Largest and highly vascular endocrine gland
• Situated in front and sides of trachea
• Extends from C5 – T1
The hormones secreted by the gland include
triiodothyronine (T3) and tetraiodothyronine (T4
or thyroxine) and calcitonin, which sub-serve the
following functions:
• Its secretion regulate the basal metabolic rate
• Stimulates the psychosomatic growth of the
body
• Calcitonin plays an important role in calcium
metabolism
Special features of the thyroid gland:
• It is the only endocrine gland which is located
superficially in the body, hence accessible for
physical examination
• It is the only endocrine gland that depends on
external environment for the raw material, the
iodine, to synthesize its hormones
• It is the only endocrine gland which does not
pour its hormones into blood immediately
after its formation, stores them and then
releases them into blood for use as required
• Possesses richest blood flow, comparable to
adrenal and kidney
External features:
• It consists of right and left lobes that are
connected across the median plane by the
isthmus
• Each lobe extends from the middle of the
thyroid cartilage to the 4th or 5th tracheal ring
• Pyramidal lobe when present, projects from
the upper border of the isthmus
• Isthmus lies in front of 2nd to 4th tracheal rings
• Levator glandulae thyroideae – a fibro-
musculo-glandular band descends from the
hyoid bone to the isthmus or to the apex of the
pyramidal lobe
Measurements
• Larger in females than in males
• Further increases in size during menstruation and pregnancy
• Each lobe measures about
length – 5cm
breadth – 3cm
thickness – 2cm
• Weight – about 25gms
• Isthmus is 1.2cm in length and 1.2cm in breadth
Coverings or capsules of the gland:
• Inner true capsule – formed by the condensation of connective tissue
• Outer false capsule – derived from pre-tracheal layer of deep cervical fascia
- It is thin along the posterior border
- Thick along the inner surface – suspensory ligament [ligament of Berry]:
extends from the gland to the cricoid cartilage
- This attachment explains why the gland moves up and down with deglutition
- Space between the true and false capsule is occupied by – parathyroid
glands and trunks of the blood vessels.
Deep to the true capsule is a dense venous plexus
• During thyroidectomy to avoid much haemorrhage, the thyroid is removed along
with the true capsule
• In case of prostate gland, the venous plexus lies between the true and false
capsules, and therefore, during prostatectomy both the capsules are left behind to
avoid much haemorrhage
Presenting parts:
Each lobe is roughly pyramidal in shape
Each lobe consists of:
- apex
- base
- 3 surfaces – antero-lateral or superficial
medial
postero-lateral
- 2 borders - anterior
posterior
Relations
Apex - directed upwards and laterally
- upward extension is limited by the
attachment of sterno-thyroid to the
oblique line of the thyroid cartilage
- hence the thyroid enlargement cannot
extend above
- the superior thyroid artery and
external laryngeal nerve diverge
from each other close to the apex
- artery runs superficial and the nerve
passes deep to the apex

The base - extends up to 4th or 5th tracheal ring

- related to inferior thyroid artery and
recurrent laryngeal nerve
Superficial surface or antero-lateral surface
Overlapped from within outwards by: - sternothyroid
- sternohyoid
- superior belly of omohyoid
- anterior border of sternocleidomastoid
Postero-lateral or posterior surface
Related to carotid sheath and its contents - common carotid artery
- internal jugular vein
- vagus nerve
Medial or deep surface
Related to 2 tubes, 2 muscles and 2 nerves
2 tubes – trachea and oesophagus
2 muscles – inferior constrictor and cricothyroid muscle
2 nerves – external laryngeal nerve and recurrent laryngeal nerve
The recurrent laryngeal nerve passes upwards in the tracheo-oesophageal groove and
usually lies behind the ligament Berry. Sometimes it may pass through or in front of
the ligament
Borders
Anterior border – - separates the superficial surface from the medial surface
- related to anterior branch of superior thyroid artery
Posterior border - - separates the medial surface from the postero-lateral
surface
Related to: - inferior thyroid artery
- anastomosis between superior and inferior
thyroid arteries
- superior and inferior parathyroid glands
- thoracic duct on the left side
Isthmus – connects both the lobes across the median plane
- measures 1.2 cm vertically and transversely
- sometimes it is absent
It consists of 2 surfaces and 2 borders
Anterior surface or in front it is related to:
- skin
- superficial fascia
- anterior jugular vein
- investing layer of deep cervical fascia
- sternohyoid and sternothyroid muscle
Posterior surface or behind it is related to:
- 2nd to 4th rings of trachea
Upper border
• Related to anastomosis between the anterior
branches of two superior thyroid arteries
• Pyramidal lobe occasionally extends
upwards from the isthmus, close to the mid
line
• Rarely a fibro-musculo-glandular band, the
levator glanduli thyroidae extends from
the hyoid bone to the isthmus or pyramidal
lobe
The striated muscle fibres of this
band is supplied by external
laryngeal nerve or C2, C3 via ansa
cervicalis
Lower border
• Inferior thyroidal veins leave the gland at
this border
• Thyroidea ima artery, when present is
related to this border
Blood supply of thyroid gland:
Arterial supply
Superior thyroid artery –
• First ventral branch of external
carotid
• Runs downwards and forwards to
reach the upper pole of the gland
with external laryngeal nerve
• Close to the gland the nerve deviates
from the artery
• At the upper pole it divides into
anterior and posterior branches
- anterior br. anastomoses with
the similar branch from
the opposite side along the
upper border of isthmus
- posterior branch descends
along the posterior border and
anastomoses with the
ascending branch of inferior
thyroid artery
Inferior thyroid artery
• Branch of thyrocervical trunk of
subclavian artery
• Runs upwards, medially and then
downwards to reach the lower pole of the
gland
• In its course it passes behind the carotid
sheath, middle cervical sympathetic
ganglion and in front of vertebral vessels
• Near the gland it is intimately related to
recurrent laryngeal nerve
• It gives an ascending branch and 4-5
glandular branches
• Ascending branch unites with posterior
branch of superior thyroid artery
Thyroidea ima artery:
• Present in 3% of cases
• Branch of brachiocephalic trunk or
arch of aorta
• Supplies the isthmus
Accessory thyroid arteries:
• Numerous glandular branches are
derived from oesophageal and
tracheal arteries supplying the gland
from the medial or deep surface
Area of distribution:
• Superior thyroid artery supplies the
upper 1/3 of the lobe and upper ½ of
the isthmus
• Inferior thyroid artery supplies the
lower 2/3 of the lobe and lower ½ of
the isthmus
• But due to anastomoses between the
superior and inferior thyroid arteries
there is considerable overlapping in
the region of distribution
Median thyroid with only superior
thyroid artery supplying it
Int. J. Morphol., 25(1):121-124,
2007.
Venous drainage:
Superior thyroid vein – run along the lateral border of superior belly of omohyoid and
opens into internal jugular vein
Middle thyroid vein – follows the medial border of superior belly of omohyoid and
opens into internal jugular vein
Inferior thyroid veins – emerge from the lower border of isthmus and open into left
brachiocephalic vein
Fourth thyroid vein (Kocher’s vein) – emerge near the lower pole and drain into
internal jugular vein
Lymphatic drainage:
• From the upper part drains into upper deep cervical lymph nodes
through prelaryngeal and jugulo-digastric lymph nodes
• From the lower part drains directly into lower deep cervical lymph
nodes and also through pretracheal and paratracheal nodes

Nerve supply:
Supplied by sympathetic and parasympathetic nerves
• Parasympathetic nerves are derived from vagus and recurrent
laryngeal nerve, their functions are not known
• Sympathetic nerves are derived mainly from middle cervical
sympathetic ganglion and partly from superior and inferior cervical
sympathetic ganglion
They are vasoconstrictor in function
 Microscopic structure
Consists of number of lobules, each lobule contains 40-60 thyroid follicles
Thyroid gland contains 3 millions of thyroid follicles
Secretes Tri-iodothyronin (T3) & Tetra-iodothyronin (T4)

An enlarged follicle
Thyroid gland
• Functional unit of the gland is called the follicle
• Simple cuboidal epithelium that lines the follicle when the gland is resting and when it is secretory it is lined by
columnar epithelium
• The cavity of the follicle contains the stored iodine containing hormones (tri-iodo thyronine[T3] and thyroxine [T4] –
which regulate the basal metabolic rate) called the colloid.
• Colloid is an inactive precursor of T3 and T4. It is made up of a glycoprotein called thyroglobulin, made by the
epithelial cells, which is bound to iodine.
• The clear cells or parafollicular cells secrete calcitonin - which regulates blood calcium levels. Secretion of calcitonin
causes blood calcium levels to drop, and its secretion is directly dependent on blood calcium levels.
The parathyroid gland: are embedded in the capsule of the thyroid gland.
• It contains two types of cells - chief or principle cells and oxyphil cells.
• Chief cells are small and eosinophilic staining. They secrete parathyroid hormone (PTH).
• Parathyroid hormone acts on osteoclasts, and on the epithelial cells of the renal tubule, to increase plasma calcium by
promoting bone resorption and increasing renal calcium resorption.
Para Follicular cells (C-cells/clear cells)
• secrete “thyrocalcitonin”.
• This hormone regulates the calcium metabolism
• It tends to withdraw the serum calcium level by depositing it in the bone
• Development – neural crest cells and ultimobranchial body (5th pharyngeal
pouch) become incorporated secondarily into the thyroid gland and form the
parafollicular cells or C cells.
Development of thyroid gland:
• Develops as an endodermal thickening in the midline of the floor of the pharynx,
behind the tuberculum impar, during 3rd week of intrauterine life
• This thickening is soon depressed below the surface to form – thyroglossal duct, which
grows caudally
• The duct passes through the substance of the tongue in front of the body of the hyoid bone
• On reaching the upper part of the trachea the duct forms a bilobed mass
• The lower bifid end of the thyroglossal duct proliferates to give thyroid gland
Development of thyroid gland……
• The foetal thyroid follicles start iodide trapping at about 12th week
• Foetal functioning of thyroid begins between 18th & 22nd week
• The ultimobranchial bodies from the 5th pharyngeal pouch and the neural crest cells
become incorporated secondarily into the thyroid gland and form the parafollicular
cells or C cells.
Developmental anomalies:
– Thyroglossal cyst or fistula
– Ectopic thyroid
• Thyroglossal cyst
– Persistent part of thyroglossal
duct
– 1cm size.
– Should be excised because
infection is inevitable.
• Thyroglossal fistula
– Discharges the mucus
– Recurrent attacks of
inflammation
Thyroid gland may be found at an
abnormal position anywhere along the
course of thyroglossal duct:
a. At the base of the tongue (lingual
thyroid)
b. Above or below the hyoid bone
Lingual thyroid
• Failure of migration
• Present in the posterior 1/3 of the tongue
 One of the lobe may be absent
 Isthmus may be absent
Ectopic thyroid
Present in the posterior triangle of the neck or retro-
sternal region [retrosternal-thyroid]
Accessory thyroid
Thyroid tissue may be situated away from the normal
course of the thyroglossal duct:
In relation to:
• Carotid sheath
• In the mediastinum
• In the pericardium
 One of the lobe of the thyroid may be absent
 Isthmus may be absent
 Median thyroid
Hypothyroidism causes cretinism (foetal or infantile hypothyroidism)
in infants, and myxoedema in adults.
Causes of hypothyroidism:
• Thyroiditis – inflammation of the gland
• Goiter – where the gland grows abnormally
• Destruction of gland by radiation
• Surgical removal of gland
Hashimoto’s disease (chronic lymphocytic thyroiditis or autoimmune thyroiditis)
• Named after the first doctor who described this condition, Dr. Hakaru Hashimoto,
in 1912.
• A form of chronic inflammation of the thyroid gland
• The inflammation results in damage to the thyroid gland and reduced thyroid
function or “hypothyroidism
• Hashimoto’s disease is the most common cause of hypothyroidism in the United
States
Cretinism
• In fetal life, infancy or childhood.
• Failure of body growth with mental retardation
 Myxedema
Myxedema or Myxoedema - A disease
caused by decreased activity of the thyroid
gland, it is characterised by
• Low BMR.
• Hair is coarse and sparse
• Dry and yellowish skin
• Poor tolerance for cold
• Husky and slow voice
• Poor memory
• Carpal tunnel syndrome
Enlargement of thyroid gland (goitre)
 In goitre thyroid gland can enlarge backwards or downwards
 It cannot enlarge upwards due to the attachment of its fascial sheath and
sternothyroid muscle to the thyroid cartilage
Backward enlargement is common since the thyroid capsule is relatively thin
posteriorly
• In posterior enlargement the gland buries itself around the sides of trachea and
oesophagus
This results in three characteristic symptoms [3D]
 Dyspnea (difficulty in breathing) – due to pressure on the trachea
 Dysphagia (difficulty in swallowing) – due to pressure on oesophagus
 Dysphonia (hoarseness of voice) – due to pressure on the recurrent laryngeal nerve
Downward expansion behind the sternum – retrosternal goitre
• It compresses the trachea leading to dangerous dyspnea
• It can also cause severe venous compression leading to venous congestion
 Hyperthyroidism (thyrotoxicosis)
• Symptoms: Causes:
– Exophthalmos
– Excitability Grave’s disease
– Intolerance to heat
– Increased sweating
– Weight loss
– Diarrhea
– Tremor of the hands
– Muscle weakness
– Nervousness.
– High BMR

Benign tumours may compress or also displace the neighbouring structures

whereas malignant growth tends to invade surrounding structures
 PARATHYROID GLAND
• It is yellowish brown lentiform body (size
of a split pea) and essential to life
• Usually (in 80%) 4 in number and
arranged in superior and inferior pairs.
• Their secretion is called parathormone
Measurements
length - 6mm
breadth – 3mm
thickness – 1-2 mm
weight – 50mg
The superior pair of parathyroid is also called
parathyroid IV
• Fairly constant in position
• Develops from endoderm of fourth pharyngeal
pouch
• The position of the superior parathyroid is constant
and is placed along the middle of the posterior
border of the lobe of thyroid gland (at the level of
cricoid cartilage)
• Lies between the true and false capsules of the
thyroid gland and dorsal to the recurrent laryngeal
nerve
The inferior pair of parathyroid is also called
parathyroid III
• Develops from endoderm of third
pharyngeal pouch
• Position of inferior parathyroid is
variable
• It can be placed close to the base of the
thyroid gland (inside or out side the false
capsule) or within the substance of thyroid
gland ventral to recurrent laryngeal nerve
Fallacy of identification:
• Lymph nodes, fat lobules or accessory
thyroid tissue are occasionally mistaken for
the parathyroid glands
• In such cases histological demonstration is
the only diagnostic clue
TRUE CAPSULE
Blood supply –
• Mostly supplied by inferior thyroid artery or
from the anastomosis between superior and
inferior thyroid arteries
• Venous blood and lymphatics accompany
those of thymus and thyroid gland
Sympathetic fibres from superior and middle
cervical ganglia convey mainly the
vasomotor fibres to the gland
The secretary activity of the glands are
controlled by the concentration of the
calcium level in the blood
• Low level of calcium stimulates and high
level inhibits the gland secretion
Microscopic structure
Principal cells (chief cells):
• secrete parathyroid hormone
Oxyphil cells:
• Strongly acidophilic cytoplasm
• function not known
Function of parathormone
Increases the serum calcium level by:

 Increasing bone resorption through osteoclasts.

 Increasing calcium reabsorption from renal tubules.
 Enhancing calcium absorption of the gut.
Hyper parathyroidism –
• Seen in the tumours of the parathyroid glands
• Removes excessive calcium from bone, which makes the bone soft – generalised
osteitis fibrosa
• Increases calcium level in blood results in increased urinary excretion of calcium,
which may cause formation of stones in the kidney.

Hypoparathyroidism –
• May occur spontaneously or due to inadvertent removal of parathyroid gland
during thyroidectomy
• Results in low blood calcium level, due to which there is increased neuromuscular
excitability causing muscular spasm (tetany) and convulsions
STUDY WELL