Surgical anatomy of the parathyroid glands
- Melanie L Richards, MD, MHPE
Melanie L Richards, MD, MHPE
- Professor of Surgery
- Mayo Clinic College of Medicine
- Tracy S Wang, MD, MPH
Tracy S Wang, MD, MPH
- Associate Professor of Surgery
- Chief, Section of Endocrine Surgery
- Medical College of Wisconsin
- Julie Ann Sosa, MD, MA
Julie Ann Sosa, MD, MA
- Professor of Surgery and Medicine
- Chief, Section of Endocrine Surgery
- Leader, Endocrine Neoplasia Diseases Group
- Duke University Medical Center
The parathyroid glands were first identified by Sir Richard Owen in the Great Indian Rhinoceros in 1850 . They were identified in humans by Ivar Sandstrom, a Swedish medical student, in 1880 . The first parathyroidectomy was reported by Felix Mandl in 1929, 30 years prior to the isolation of human parathyroid hormone .
The success of the surgical management of parathyroid disease is based on accurate biochemical diagnosis and the surgeon's understanding of the significant embryologic variations in parathyroid anatomy. An expert knowledge of the unusual anatomic locations for enlarged parathyroid glands is crucial to operative success during both initial and reoperative parathyroid surgical exploration. The wide range of parathyroid anatomic variations may make it difficult to predict a patient's anatomy preoperatively.
Parathyroid anatomy is discussed here. The indications for parathyroidectomy, treatment of multiglandular disease, and surgical techniques are discussed elsewhere. (See "Primary hyperparathyroidism: Management", section on 'Candidates for surgery' and "Parathyroid exploration for primary hyperparathyroidism", section on 'Focused parathyroid exploration'.)
The parathyroid glands are usually in close approximation with, but function independently of, the thyroid gland. The parathyroid glands produce parathyroid hormone (PTH) which is one of the two major hormones modulating calcium and phosphate homeostasis; the other hormone is calcitriol (1,25-dihydroxyvitamin D). PTH also stimulates the conversion of calcidiol (25-hydroxyvitamin D) to calcitriol in renal tubular cells, thereby stimulating intestinal calcium absorption. The function and regulation of PTH and the diagnosis and management of hyperparathyroidism are discussed in detail elsewhere. (See "Parathyroid hormone secretion and action" and "Primary hyperparathyroidism: Diagnosis, differential diagnosis, and evaluation" and "Primary hyperparathyroidism: Management".)
The parathyroid glands arise from endodermal epithelial cells, in conjunction with the thymus (figure 1). The superior parathyroid glands are derived from the fourth branchial pouch. These glands are closely associated with the lateral lobes of the thyroid and have a short line of embryologic descent .
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