Parathyroid and Thyroid Glands + salivary glands

Superficial parts

Parathyroid glands normal anatomy:

paired, two on the superior pole of the thyroid, two on the inferior pole

normally four but can have 3-5

on the posterior side of the thyroid

More common parathyroids to see

inferior ones

Normal gland size

< 4 mm

Parathyroid functions

regulate serum calcium in the blood

Stimulus to PTH secretion to decrease/increase the level of blood calcium

MOST COMMON referral for a parathyroid sonography

unexplained hypercalcemia

PTH acts on these systems to enhance calcium absorption

bone

kidney

intestines

Hypocalcemia symptoms

hyperirritability

fatigue

anxiety

numbness around the mouth

tingling or numbness in the extremities

muscle cramps

dementia

depression

psychosis

seizures

Hypercalcemia symptoms

weight loss

anorexia

dyspepsia

peptic ulcer

pancreatits

nausea

Parathyroid normal size

5 mm x 3 mm x 1 mm

Primary hyperparathyroidism

occurs when increased amounts of PTH produced by adenomas, primary hyperplasia, or rarely carcinoma

Who is more likely to get primary hyperparathyroidism 2-3x

women

Primary hyperplasia

defined as hyperfunction of all parathyroid glands with no apparent cause

MOST COMMON CAUSE of primary hyperparathyroidism

adenoma

associated with radiation exposure

Parathyroid adenoma normals

hypoechoic, vast majority solid

usually > 3 cm

Parathyroid carcinoma has _______ vascularity

increased

Secondary hyperthyroidism

chronic hypocalcemia caused by renal failure, vitamin D deficiency, or malabsorption syndromes

Major salivary glands

Parotid

submandibular

sublingual

Largest salivary gland

parotid

superficial portion os subcutaneous and located in front of the external ear and deeper portion lies behind ramus of the mandible

Whartin’s duct

the submandibular duct that saliva is excreted by

located at the posterior portion of the floor of the mouth, medial to the mandible and wrapping around the posterior border of the mylohyoid

Sublingual gland

smallest of the major glands

located at the anterior part of the floor of the mouth and mylohyoid muscle

Sialadenitis

inflammation or enlargement of one or more salivary glands

MOST COMMON in newborns and elderly

Sialolithiasis

salivary stones

MOST COMMON in submandibular gland duct (Whartin’s duct)

A salivary duct mass is MOST COMMON IN

the parotid gland

MOST COMMON benign mass of the salivary glands

pleomorphic adenomas and whartin tumors

Sjogren’s disease

chronic autoimmune disorder where the immune system attacks tear and salivary producing glands

more common in females

LOOKS LIKE SWISS CHEESE

First endocrine gland to develop

thyroid

Pyramidal lobe

arises from the caudal portion of the thyroglossal tract, small and normally a cephalic extension of the isthmus

more commonly seen in peds patients

arises more commonly from the left side

Who has a slightly larger thyroid

women

but male volumes are more

Thyroid volume

18.6 +- 4.5 ml

Strap muscles

sternothyroid

sternohyoid

omohyoid

What muscle is directly posterior to the thyroid?

Longus colli muscle

Inferior thyroid veins drain:

into the innominate vein

superior thyroid veins drain:

into the internal jugular veins

Thyroid function

maintains normal body metabolism, growth, and development by synthesis, storage, and secretion of thyroid hormones

Follicular cells

absorb iodine

MOST COMMON thyroid disease

hypothyroidism

Grave’s disease

associated with hyperthyroidism

low TSH → high T4 and T3

hyperthyroidism

high TSH → low T3 and T4

hypothyroidism

low TSH → low T3 and T4

pituitary gland issue or mass like an adenoma

hot nodules

benign

cold nodules

more likely to be malignant

More common cause of thyroid nodules

multinodular goiter

MOST COMMON thyroid abnormality

nodular hyperplasia (goiter)

caused by iodine deficiency

toxic goiter

hyperthyroid condition resulting from hyperactivity of the thyroid gland

Thyroid inferno conditions

multinodular goiter

Graves disease

primary hypothyroidism

Hashimotos (in acute phase)

Adenomas are MORE COMMON in

females (7:1)

MOST COMMON thyroid malignancy

papillary carcinoma

A solidary thyroid nodule in presence of cervical adenopathy on the same side suggests:

malignancy

SECOND MOST COMMON thyroid malignancy

follicular carcinoma

Subacute thyroiditis (De Quervain’s)

caused by a viral infection of the thyroid

decreased vascularity

MOST COMMON form of thyroiditis

Hashimoto’s thyroiditis

destructive autoimmune disorder which leads to chronic inflammation of thyroid

LOW T3 and T4 but ELEVATED TSH