THYROID-PARATHYROID-

ADRENALS
ANATOMY

Dr. Rene Lastimoso

General Surgery

Cebu City Medical Center

Southwestern Medical
Center – Department of
Surgery
DISCLOSURE

• None
SOURCES

• Moore – Clinically Oriented Anatomy (Keith L.

Moore) 8th – 10th edition
CONTENTS
• Thyroid

• Parathyroid

• Adrenals
INTRODUCTION
• Cervical viscera are disposed in three layers,
name for their primary function

• ENDOCRINE LAYER (Thyroid and Parathyroid)

• RESPIRATORY LAYER (Larynx and Trachea)

• ALIMENTARY LAYER (Pharynx and Esophagus

THYROID GLAND
SURFACE ANATOMY
SURFACE ANATOMY
ENDOCRINE LAYER
• Endocrine System
• Ductless
• Hormone-secreting
glands
• Thyroid gland -
Thyroid hormone;
Calcitonin
• Parathyroid gland -
Parathormone
THYROID
• Lies deep to the
sternothyroid and
sternohyoid muscles
• Located anteriorly
• C5-T1 vertebrae
• Right and Left lobes
• Anterolateral to the
larynx and trachea
• Fibrous capsule
THYROID
• Isthmus – unites the
lobes over the trachea;
anterior to the 2nd and
3rd tracheal rings
BLOOD SUPPLY
• SUPERIOR THYROID
ARTERIES

• First branches of the

external carotid
artery

• Descend to the
superior poles of the
gland
BLOOD SUPPLY
• SUPERIOR THYROID
ARTERIES

• Divide into anterior

and posterior
branches

• Mainly supply the

anterosuperior
aspect of the gland
BLOOD SUPPLY
• INFERIOR THYROID
ARTERIES

• Largest branches of
the thyrocervical
trunk arising from
the subclavian
arteries

• Postero-inferior
aspect of the gland

• Inferior poles
BLOOD SUPPLY
• INFERIOR THYROID
ARTERIES

• Run superomedially
posterior to the
carotid sheath to
reach the posterior
aspect of the thyroid
gland

• Potential collateral
circulation between
the subclavian and
external carotids
BLOOD SUPPLY
• THYROID IMA ARTERY

• May arise from the

following:
Brachiocephalic
trunk, aorta, right
common carotid,
subclavian or
internal thoracic
arteries
BLOOD SUPPLY
• THYROID IMA ARTERY

• 10% of people
• Unpaired artery
• Anterior surface of
the trachea
• Continues to the
isthmus
BLOOD SUPPLY
• SUPERIOR THYROID
VEIN
• Accompany the
superior thyroid
arteries
• Drain the superior
poles of the thyroid
BLOOD SUPPLY
• MIDDLE THYROID
VEINS
• Run essentially
parallel courses with
the inferior thyroid
arteries
• Drain the middle of
the lobes
BLOOD SUPPLY
• INFERIOR THYROID
VEINS
• Run essentially
parallel courses with
the inferior thyroid
arteries
• Drain the middle
and inferior part of
the lobes
LYMPHATICS
• Lymphatic vessels run
in the interlobular
connective tissues
usually near the
arteries
• Lymphatic vessels
along the superior
thyroid veins pass
directly to the inferior
deep cervical lymph
nodes
LYMPHATICS
• Others may drain into
the brachiocephalic
lymph nodes or the
thoracic duct
LYMPHATICS
• PRELARYNGEAL LYMPH
NODES
• Drain to the
superior deep
cervical lymph
nodes

• PRETRACHEAL and
PARATRACHEAL LYMPH
NODES
• Drain to the inferior
cervical lymphnodes
INNERVATION
• Derived from the
superior, middle and
inferior cervical
(sympathetic) ganglia
• Reach the gland
through cardiac,
superior, inferior
thyroid peri-arterial
plexuses
• Usually accompany the
thyroid arteries
INNERVATION
• Vasomotor
• Constriction of blood
vessels
• Endocrine secretion is
hormonally regulated
by the pituitary gland
PARATHYROID GLANDS
PARATHYROID
• Small flattened, oval
shaped
• External to the thyroid
capsule
• Medial half of the
posterior surface of each
lobe
• 4 glands in most cases
PARATHYROID
• SUPERIOR
PARATHYROIDS
• Located more than 1cm
superior to the point of
entry of the inferior thyroid
arteries
• More constant in position
than the inferior ones
• At the level of the inferior
border of the cricoid
cartilage
PARATHYROID
• INFERIOR
PARATHYROIDS
• Located more than 1cm
inferior to the point of entry
of the inferior thyroid
arteries
• Near the inferior poles but
may lie in various positions
BLOOD SUPPLY
• Primarily by the Inferior
thyroid arteries
• May also be supplied by
the branches of the
following:
• Superior thyroid arteries
• Thyroid ima
• Laryngeal arteries
• Tracheal arteries
• Esophageal arteries
BLOOD SUPPLY
• Venous drainage is
towards the thyroid
plexus of veins of the
thyroid gland and
trachea
LYMPHATICS
• Lymphatic drainage is
towards deep cervical
lymph nodes and
paratracheal lymph
nodes
INNERVATION
• Vasomotor
• Derived from the
thyroid branches of the
cervical (sympathetic)
ganglia
ADRENAL GLANDS
ADRENAL GLANDS
• Suprarenal glands
• Yellowish in living persons
• Superomedial aspects of
the kidney and diaphragm
• Enclosed by renal fascia
which are attached to the
crura of the diaphragm
(major attachment)
• Each gland has a hilum
(veins and lymphatic
vessels exit)
• Arteries and nerves enter
at multiple sites
ADRENAL GLANDS
• Medial borders are 4-5cm
apart
• R->L (IVC, R crus, celiac
ganglion, celiac trunk,
SMA, L crus)
• Each gland has 2 parts:
Suprarenal cortex and
suprarenal medulla
(different embryological
origins and different
functions
ADRENAL GLANDS
• SUPRARENAL CORTEX
• Mesoderm
• Secretes corticosteroids
and androgens

• SUPRARENAL MEDULLA
• Neural crest associated
with sympathetic nervous
system
• Chromaffin cells –
catecholamines
• Epinephrine (adrenaline)
and Norepinephrine
(noradrenaline)
ADRENAL GLANDS
• RIGHT ADRENAL
• Pyramidal
• More apical relative to the
left kidney
• Anterolateral to the right
crus of the diaphragm
• In contact with the IVC
anteromedially
• In contact with the liver
anterolaterally
ADRENAL GLANDS
• LEFT ADRENAL
• Crescent shaped
• Medial to the superior half
of the left kidney
• Related to the spleen,
stomach, pancreas and left
crus of the diaphragm
BLOOD SUPPLY
• SUPERIOR
SUPRARENAL
ARTERIES – inferior
phrenic arteries

• MIDDLE SUPRARENAL
ARTERIES– abdominal
aorta

• INFERIOR SUPRARENAL
ARTERIES – renal
arteries
BLOOD SUPPLY
• RIGHT SUPRARENAL
VEIN -> IVC

• LEFT SUPRARENAL
VEIN -> Joined by the
INFERIOR PHRENIC
VEIN -> LEFT RENAL
VEIN
LYMPHATICS
• SUPRARENAL
LYMPHATIC VESSELS –
arise from the deep
capsule and from one
in its medulla

• Drains into the LUMBAR

LYMPH NODES
INNERVATION
• CELIAC PLEXUS

• ABDOMINOPELVIC
splanchnic nerves
INNERVATION
• IML (Intermediolateral
cell column)
• Exclusive to the
suprarenal medulla
• Where the Myelinated
presynaptic sympathetic
is derived from ->
chromaffin cells in the
suprarenal medulla
• T10-L1 spinal cord
segments
END