THE THYROID AND

PARATHYROID GLANDS
 EMBRYOLOGY

 The thyroglossal of the duct develops from the median bud of the
pharynx.
 The foramen caecum at the base of tongue is the vestigial remnant of
the duct.
 The parathyroid glands develop from the 3rd and 4th pharyngeal
pouches.
 The thymus develops from the 3rd pouch.
 The developing thyroid lobes amalgamate with the structures arising
in the 4th pharyngeal pouch i.e. the superior parathyroid gland and
ultimobrachial body.
 Parafollicular cells ( C cells ) from the neural crest reach the thyroid
via ultimobrachial body.
 SURGICAL ANATOMY OF THYROID

 The normal thyroid gland weighs

20-25 g.
 The functioning unit is the lobule
supplied by a single arteriole and
consisting of 24-40 follicles lined
with cubidal epithelium.
 The follicle contains colloid in
which thyroglobulin is stored. The
arterial supply is rich and
extensive anastomosis occur
between the main thyroid arteries
and branches of the tracheal and
esophageal arteries.
 There is an extensive lymphatic
network within gland.
 SURGICAL ANATOMY OF PARATHYROID GLAND

 The normal parathyroid gland weighs

upto 50 mg.
 These are orange/brown in colour.
 Most adults have 4 parathyroid glands.
 The superior parathyroid is more
consistent in position than the inferior.
 The superior gland is commonly found
in fat above the inferior thyroid artery
and close to the cricothyroid articulation
 PHYSIOLOGY

The hormones T3 and T4 are bound to the thyroglobulin

with in the colloid .
Synthesis with in the thyroglobulin complex is controlled
by several enzymes in distinct steps:
- Trapping of inorganic iodide from the blood.
- Oxidation of iodide to the iodine.
- Binding of iodine with tyrosine to form iodotyrosines.
- Coupling of monoiodotyrosines and di-iodotyrosines to
form T3 and T4
 The metabolic effects of the thyroid hormones are due to
unbound freeT3 and T4.
 T3 and T4 are 0.3% and 0.03% of the total circulating
hormones respectively.
 T3 is more important physiological hormone. It is quick
acting( with in few hours) where as T4 acts more slowly
( 4-14 days )
 PARATHYROID HORMONE

 It is 84-amino acid peptide.

 It controls the level of serum calcium or high serum magnesium level.
 It activates osteoclasts to resorb bone and increases calcium
reabsorption from urine and renal activation of vitamin D.
 CALCITONIN

 Parafollicular cells of thyroid are neuroendocrine origin and arrive in

the thyroid via ultimobrachial body.
 These produce calcitonin which is serum marker for recurrence of
medullary thyroid cancer.
 THE PITUITARY –THYROID AXIS

 The synthesis and liberation of

thyroid hormones from the thyroid is
controlled by TSH from anterior
pituitary gland.
 Secretion of TSH depends upon the
level of circulating thyroid hormones
and is modified in a classic negative
feedback manner.
 Regulation of TSH secretion also
results from the action of TRH
produced in the hypothalamus.
 TESTS OF THYROID FUNCTION

SERUM TSH:
 Normal value: o.3-3.3 mU/L.
 In euthyroid state T3,T4 and TSH levels will all be within normal
range.
 Incipient or developing thyroid failure is characterised by low normal
values of T3 and T4 and elevation of TSH.
 In toxic states the TSH level is suppressed and undetectable.
SERUM T3 and T4:
 Normal values:T3=3.5-7.5 mic mol/L T4=10-30 n mol/L.
 Highly accurate radioimmunoassay of free T3 and T4 are now routine.
 CHEST AND THORACIC INLET RADIOGRAPHY

 It shows presences of significant retrosternal goiter.

 It is clinically important for degree of tracheal deviation and
compression.
 Pulmonary metastasis may also be detected.
 ULTRSOUND SCANING

- It gives good anatomical

images of the thyroid and
surrounding structures.
- It permits more targeted
sampling, allowing the
identification of parathyroid
adenomas and nodes involved in
thyroid cancer.
 ISOTOPE SCANNING

 It distinguish benign from malignant lesions.

 80% of cold swellings are benign and 5% functioning or warm
swellings are malignant.
 Localization of overactivity in the gland will differentiate between a
toxic nodule with suppression of the remainder of the gland and toxic
multinodular goitre
 FINE NEEEDLE ASPIRATION CYTOLOGY

 It is the investigation of choice for

discrete thyroid swellings.
 It is simple and quick to perform.
 Ultrsound guided FNAC is perfomed to
achieve more accurate sampling.
 HYPOTHYROIDISM
CLASSSIFICATION OF HYPOTHYROIDISM:
 Autoimmune thyroiditis

Non-goitrous: primary myxoedema

Goitrous: Hashimoto’s
 Iatrogenic

After thyroidectomy
After radioiodine therapy
Drug induced( anti thyroid drugs,para aminosalicylic acid and iodides in
excess)
 Dyshormonogenesis

 Goitrogens

 Secondary to pituitary or hypothalamic disease

 Thyroid agenesis

 Endmic cretinism

Often goitrois and due to iodine deficiency.

 CRETINISM

 It is the consequence of inadequate

thyroid hormone production during
fetal and neonatal development.
 “Endemic cretinism” is due to dietary
deficiency, where as sporadic are due to
inborn error of thyroid metabolism or
complete or partial agenesis of the
gland.
CLINICAL FEATURES:
 A hoarse cry

 Macroglossia

 Umbilical hernia

TREATMENT:
 Thyroxine with in few days of birth are essential to prevent
damage in utero progressing and if physical and mental
development are to be normal.
 ADULT HYPOTHYROIDISM

SYMPTOMS:
 Tiredness
 Mental lethargy
 Cold intolerance
 Weight gain
 Constipation
 Mental disturbance
 Carpal tunnel syndrome
SIGNS:
 Bradycardia
 Cold extremities
 Dry skin and hair
 Periorbital puffiness
 Hoarse voice
 Bradykiesis, slow movements
 Delayed relaxation phase of ankle jerks
INVESTIGATIONS:
 T3 and T4 are decreased.
 TSH is increased.
TREATMENT:
 Oral thyroxine (0.10-0.20 mg) as a single daily dose is
curative.
 In elderly and cardiac patients replacement dose is
commenced at 0.05 mg daily and increased cautiously.