SpringerLink
Log in

Parathyroid Glands: Anatomy, Physiology, Pathophysiology, and Ultrasound

  • Chapter
  • First Online:
Endocrine Surgery Comprehensive Board Exam Guide

  • 1012 Accesses

Abstract

Parathyroid gland function is essential to serum calcium regulation, which is critical for bone strength, neuromuscular activity, and other physiologic processes. Surgical management of the parathyroid glands requires intimate familiarity with their anatomy, including their relationship to the thyroid and other structures in the neck, in order to optimize functional outcomes. This chapter will address in detail the anatomy of the parathyroid glands, which is closely linked to their embryologic development and migration. Patterns of abnormal migration leading to ectopic parathyroid location will be addressed. The normal physiology of the parathyroid glands will be reviewed. Pathophysiology of the parathyroid glands, including conditions of hyperparathyroidism and hypoparathyroidism, will be briefly discussed. Lastly, this chapter will address the clinical application of US in evaluation of the parathyroid glands.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (Brazil)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (Brazil)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (Brazil)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Kazaure HS, Zambeli-Ljepovic A, Oyekunle TM, Roman SA, Sosa JAM, Stang MT, et al. Severe hypocalcemia after thyroidectomy: an analysis of 7366 patients. Ann Surg.

    Google Scholar 

  2. Stack BC, Tolley NS, Bartel TB, Bilezikian JP, Bodenner D, Camacho P, et al. AHNS series: do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons. Head Neck. 2018;40(8):1617–29.

    PubMed  Google Scholar 

  3. Zajac JD, Danks JA. The development of the parathyroid gland: from fish to human. Curr Opin Nephrol Hypertens. 2008;17(4):353–6.

    Article  CAS  PubMed  Google Scholar 

  4. Pradhan R, Agarwal A, Lombardi CP, Raffaelli M. Applied embryology of the thyroid and parathyroid glands. In: Randolph GW, editor. Surgery of the thyroid and parathyroid glands. 3rd ed. Elsevier; 2021. p. 15–25.e4.

    Chapter  Google Scholar 

  5. Peissig K, Condie BG, Manley NR. Embryology of the parathyroid glands. Endocrinol Metab Clin N Am. 2018;47(4):733–42.

    Article  Google Scholar 

  6. Wang C. The anatomic basis of parathyroid surgery. Ann Surg. 1976;183(3):271–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mohebati A, Shaha AR. Anatomy of thyroid and parathyroid glands and neurovascular relations. Clin Anat N Y N. 2012;25(1):19–31.

    Article  CAS  Google Scholar 

  8. Akerström G, Malmaeus J, Bergström R. Surgical anatomy of human parathyroid glands. Surgery. 1984;95(1):14–21.

    PubMed  Google Scholar 

  9. Palestini N. Surgical anatomy of the parathyroid glands. In: Gasparri G, Camandona M, Palestini N, editors. Primary, secondary and tertiary hyperparathyroidism: diagnostic and therapeutic updates. Springer; 2015.

    Google Scholar 

  10. Delattre JF, Flament JB, Palot JP, Pluot M. Variations in the parathyroid glands. Number, situation and arterial vascularization. Anatomical study and surgical application. J Chir (Paris). 1982;119(11):633–41.

    CAS  Google Scholar 

  11. Edis AJ, Purnell DC, van Heerden JA. The undescended “parathymus”. An occasional cause of failed neck exploration for hyperparathyroidism. Ann Surg. 1979;190(1):64–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Fraker DL, Doppman JL, Shawker TH, Marx SJ, Spiegel AM, Norton JA. Undescended parathyroid adenoma: an important etiology for failed operations for primary hyperparathyroidism. World J Surg. 1990;14(3):342–8.

    Article  CAS  PubMed  Google Scholar 

  13. Wheeler MH. Clinical anatomy, developmental aberrations and endocrinology. In: Arora A, Tolley N, Tuttle RM, editors. Practical manual of thyroid and parathyroid disease. Wiley; 2009.

    Google Scholar 

  14. Doppman JL, Marx SJ, Brennan MF, Beazley RM, Geelhoed G, Aurbach GD. The blood supply of mediastinal parathyroid adenomas. Ann Surg. 1977;185(4):488–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Fukumoto A, Nonaka M, Kamio T, Kamura E, Ozu C, Baba S, et al. A case of ectopic parathyroid gland hyperplasia in the pyriform sinus. Arch Otolaryngol Head Neck Surg. 2002;128(1):71–4.

    Article  PubMed  Google Scholar 

  16. Wheeler MH, Williams ED, Wade JS. The hyperfunctioning intrathyroidal parathyroid gland: a potential pitfall in parathyroid surgery. World J Surg. 1987;11(1):110–4.

    Article  CAS  PubMed  Google Scholar 

  17. Thompson NW, Eckhauser FE, Harness JK. The anatomy of primary hyperparathyroidism. Surgery. 1982;92(5):814–21.

    CAS  PubMed  Google Scholar 

  18. Proye C, Bizard JP, Carnaille B, Quiévreux JL. Hyperparathyroidism and intrathyroid parathyroid gland. 43 cases. Ann Chir. 1994;48(6):501–6.

    CAS  PubMed  Google Scholar 

  19. Lappas D, Noussios G, Anagnostis P, Adamidou F, Chatzigeorgiou A, Skandalakis P. Location, number and morphology of parathyroid glands: results from a large anatomical series. Anat Sci Int. 2012;87(3):160–4.

    Article  PubMed  Google Scholar 

  20. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg. 1998;22(7):718–24.

    Article  CAS  PubMed  Google Scholar 

  21. Numano M, Tominaga Y, Uchida K, Orihara A, Tanaka Y, Takagi H. Surgical significance of supernumerary parathyroid glands in renal hyperparathyroidism. World J Surg. 1998;22(10):1098–102; discussion 1103.

    Article  CAS  PubMed  Google Scholar 

  22. McHenry C, Walsh M, Jarosz H, Henkin R, Tope J, Lawrence AM, et al. Resection of parathyroid tumor in the aorticopulmonary window without prior neck exploration. Surgery. 1988;104(6):1090–4.

    CAS  PubMed  Google Scholar 

  23. Arnault V, Beaulieu A, Lifante J-C, Sitges Serra A, Sebag F, Mathonnet M, et al. Multicenter study of 19 aortopulmonary window parathyroid tumors: the challenge of embryologic origin. World J Surg. 2010;34(9):2211–6.

    Article  PubMed  Google Scholar 

  24. Curley IR, Wheeler MH, Thompson NW, Grant CS. The challenge of the middle mediastinal parathyroid. World J Surg. 1988;12(6):818–24.

    Article  CAS  PubMed  Google Scholar 

  25. Buell JF, Fraker DL, Doppman JL, Shawker TH, Skarulis MC, Spiegel AM, et al. High cervical intravagal hypercellular parathyroid gland as the etiology of severe persistent primary hyperparathyroidism. Am Surg. 1995;61(11):943–6.

    CAS  PubMed  Google Scholar 

  26. Pawlik TM, Richards M, Giordano TJ, Burney R, Thompson N. Identification and management of intravagal parathyroid adenoma. World J Surg. 2001;25(4):419–23.

    Article  CAS  PubMed  Google Scholar 

  27. Henry JF, Defechereux T, Raffaelli M, Lubrano D, Iacobone M. [Supernumerary ectopic hyperfunctioning parathyroid gland: a potential pitfall in surgery for sporadic primary hyperthyroidism]. Ann Chir. 2000;125(3):247–52.

    Google Scholar 

  28. Takimoto T, Okabe Y, Ito M, Umeda R. Intravagal parathyroid adenoma. J Laryngol Otol. 1989;103(7):704–6.

    Article  CAS  PubMed  Google Scholar 

  29. Isono H, Shoumura S, Emura S. Ultrastructure of the parathyroid gland. Histol Histopathol. 1990;5(1):95–112.

    CAS  PubMed  Google Scholar 

  30. Ritter CS, Haughey BH, Miller B, Brown AJ. Differential gene expression by oxyphil and chief cells of human parathyroid glands. J Clin Endocrinol Metab. 2012;97(8):E1499–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Tominaga Y. Surgical management of secondary and tertiary hyperparathyroidism. In: Randolph GW, editor. Surgery of the thyroid and parathyroid glands. 3rd ed. Elsevier; 2021. p. 564–575.e4.

    Chapter  Google Scholar 

  32. Carpentier A, Jeannotte S, Verreault J, Lefebvre B, Bisson G, Mongeau CJ, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content. J Nucl Med. 1998;39(8):1441–4.

    CAS  PubMed  Google Scholar 

  33. Tu C-L, Chang W, Shoback DM. Chapter 23 – Biology of the extracellular calcium-sensing receptor. In: Bilezikian JP, Martin JT, Clemens TL, Rosen CJ, editors. Principles of bone viology. 4th ed. Elsevier Health Sciences; 2020. p. 539–71.

    Chapter  Google Scholar 

  34. Brown EM. Role of the calcium-sensing receptor in extracellular calcium homeostasis. Best Pract Res Clin Endocrinol Metab. 2013;27(3):333–43.

    Article  CAS  PubMed  Google Scholar 

  35. Shifrin A. Brief overview of calcium, vitamin D, parathyroid hormone metabolism, and calcium-sensing receptor function. In: Shifrin AL, editor. Advances in treatment and management in surgical endocrinology. Elsevier; 2020. p. 63–70.

    Chapter  Google Scholar 

  36. Christensen SE, Nissen PH, Vestergaard P, Mosekilde L. Familial hypocalciuric hypercalcaemia: a review. Curr Opin Endocrinol Diabetes Obes. 2011;18(6):359–70.

    Article  CAS  PubMed  Google Scholar 

  37. Nussey S, Whitehead S. The parathyroid glands and vitamin D. In: Endocrinology: an integrated approach. BIOS Scientific Publishers; 2001.

    Google Scholar 

  38. Applewhite MK, White MG, Tseng J, Mohammed MK, Mercier F, Kaplan EL, et al. Normohormonal primary hyperparathyroidism is a distinct form of primary hyperparathyroidism. Surgery. 2017;161(1):62–9.

    Article  PubMed  Google Scholar 

  39. Bilezikian JP. Primary hyperparathyroidism. J Clin Endocrinol Metab. 2018;103(11):3993–4004.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Silverberg SJ, Bilezikian JP. Primary hyperparathyroidism: pathophysiology, surgical indications, and preoperative workup. In: Randolph GW, editor. Surgery of the thyroid and parathyroid glands. 3rd ed. Elsevier; 2021. p. 486–493.e2.

    Chapter  Google Scholar 

  41. Ahadi MS, Gill AJ. Surgical pathology of the parathyroid glands. In: Randolph GW, editor. Surgery of the thyroid and parathyroid glands. 3rd ed. Elsevier; 2021. p. 597–604.e6.

    Chapter  Google Scholar 

  42. Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med. 2000;343(25):1863–75.

    Article  CAS  PubMed  Google Scholar 

  43. Kebebew E, Hwang J, Reiff E, Duh Q-Y, Clark OH. Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg Chic Ill 1960. 2006;141(8):777–82; discussion 782.

    Google Scholar 

  44. Lim JY, Herman MC, Bubis L, Epelboym I, Allendorf JD, Chabot JA, et al. Differences in single gland and multigland disease are seen in low biochemical profile primary hyperparathyroidism. Surgery. 2017;161(1):70–7.

    Article  PubMed  Google Scholar 

  45. Schneider DF, Burke JF, Ojomo KA, Clark N, Mazeh H, Sippel RS, et al. Multigland disease and slower decline in intraoperative PTH characterize mild primary hyperparathyroidism. Ann Surg Oncol. 2013;20(13):4205–11.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Tominaga Y, Tanaka Y, Sato K, Nagasaka T, Takagi H. Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol. 1997;13(2):78–86.

    Article  CAS  PubMed  Google Scholar 

  47. Paschoalin RP, Torregrosa J-V, Sánchez-Escuredo A, Barros X, Durán CE, Campistol JM. Cinacalcet treatment for stable kidney transplantation patients with hypercalcemia due to persistent secondary hyperparathyroidism: a long-term follow-up. Transplant Proc. 2012;44(9):2588–9.

    Article  CAS  PubMed  Google Scholar 

  48. López V, Toledo R, Sola E, Gutiérrez C, Sujan S, Rodríguez MA, et al. Treatment with cinacalcet in 29 kidney transplant patients with persistent hyperparathyroidism. Transplant Proc. 2009;41(6):2394–5.

    Article  PubMed  Google Scholar 

  49. Fatourechi MM, Hay ID, McIver B, Sebo TJ, Fatourechi V. Invasive fibrous thyroiditis (riedel thyroiditis): the Mayo clinic experience, 1976–2008. Thyroid. 2011;21(7):765–72.

    Article  PubMed  Google Scholar 

  50. Brown EM. Anti-parathyroid and anti-calcium sensing receptor antibodies in autoimmune hypoparathyroidism. Endocrinol Metab Clin N Am. 2009;38(2):437–45, x.

    Article  CAS  Google Scholar 

  51. Shoback D. Clinical practice. Hypoparathyroidism. N Engl J Med. 2008;359(4):391–403.

    Article  CAS  PubMed  Google Scholar 

  52. Kobrynski LJ, Sullivan KE. Velocardiofacial syndrome, DiGeorge syndrome: the chromosome 22q11.2 deletion syndromes. Lancet Lond Engl. 2007;370(9596):1443–52.

    Article  CAS  Google Scholar 

  53. Lindstrand A, Malmgren H, Verri A, Benetti E, Eriksson M, Nordgren A, et al. Molecular and clinical characterization of patients with overlap** 10p deletions. Am J Med Genet A. 2010;152A(5):1233–43.

    Article  PubMed  Google Scholar 

  54. Björses P, Halonen M, Palvimo JJ, Kolmer M, Aaltonen J, Ellonen P, et al. Mutations in the AIRE gene: effects on subcellular location and transactivation function of the autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy protein. Am J Hum Genet. 2000;66(2):378–92.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Pearce SH, Williamson C, Kifor O, Bai M, Coulthard MG, Davies M, et al. A familial syndrome of hypocalcemia with hypercalciuria due to mutations in the calcium-sensing receptor. N Engl J Med. 1996;335(15):1115–22.

    Article  CAS  PubMed  Google Scholar 

  56. Al-Azem H, Khan AA. Hypoparathyroidism. Best Pract Res Clin Endocrinol Metab. 2012;26(4):517–22.

    Article  CAS  PubMed  Google Scholar 

  57. Shindo M. Parathyroid ultrasonography. In: Orloff LA, editor. Head and neck ultrasonography: essential and extended applications. 2nd ed. Plural Publishing; 2017. p. 137–53.

    Google Scholar 

  58. Zafereo M, Yu J, Angelos P, Brumund K, Chuang HH, Goldenberg D, et al. American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism. Head Neck. 2019;41(7):2398–409.

    Article  PubMed  Google Scholar 

  59. Steward DL, Danielson GP, Afman CE, Welge JA. Parathyroid adenoma localization: surgeon-performed ultrasound versus sestamibi. Laryngoscope. 2006;116(8):1380–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA

    Marika D. Russell

  2. Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Gregory W. Randolph

  3. Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Gregory W. Randolph

Authors
  1. Marika D. Russell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory W. Randolph
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory W. Randolph .

Editor information

Editors and Affiliations

  1. Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ, USA

    Alexander L. Shifrin

  2. Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Marco Raffaelli

  3. The Claire and John Bertucci Endowed Chair in Thyroid Surgical Oncology, Harvard Medical School, Boston, MA, USA

    Gregory W. Randolph

  4. Department of Surgery, Linkö** University, Linkö**, Sweden

    Oliver Gimm

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Russell, M.D., Randolph, G.W. (2021). Parathyroid Glands: Anatomy, Physiology, Pathophysiology, and Ultrasound. In: Shifrin, A.L., Raffaelli, M., Randolph, G.W., Gimm, O. (eds) Endocrine Surgery Comprehensive Board Exam Guide. Springer, Cham. https://doi.org/10.1007/978-3-030-84737-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-84737-1_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-84736-4

  • Online ISBN: 978-3-030-84737-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation