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Thread: Parathyroid Gland, Panoramic 2 picture - Endocrine Histology Atlas

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    Default Parathyroid Gland, Panoramic 2 picture - Endocrine Histology Atlas

    The thyroid gland: Pace-setter for the entire body


    “The thyroid gland is the body’s engine,” explains George Kahaly, chief of the endocrine outpatient clinic at the Gutenberg University Medical Center in Mainz, Germany. “It is important for the metabolism and for burning calories.” As an endocrine organ, it produces the hormones thyroxine (T4) and triiodothyronine (T3), and for this process it needs the trace elements iodine and calcitonin. It secretes these messenger substances directly into the blood. For this reason, it is up to 100 times better supplied with blood vessels than for example the arm or leg muscles. In addition, it has a small depot in which it stores hormones containing iodine in order to balance out short-term deficiencies.

    T3 and T4 are primarily important for regulating the body’s metabolism and its growth and development processes. They are involved in the regeneration of bone mass and the formation of nerves, they influence the processing of carbohydrates, proteins, and fats, and they regulate the physical and mental maturation of a fetus. The tiny thyroid gland is the pace-setter for a broad range of physical processes ranging from the consumption of oxygen in the cells to the regulation of body temperature and the maintenance of emotional well-being.

    Hyperactivity or hypoactivity: The body is out of balance

    Thyroid cancer and autoimmune diseases can also interfere with the thyroid gland’s production of hormones and cause its dysfunction. Hyperactivity, known medically as hyperthyreosis, produces excessive amounts of T3 and T4 in the body, which force the body into a state of permanent peak performance. “Profuse sweating, restlessness, high blood pressure, and heart disease are the result,” explains Kahaly. By contrast, insufficient amounts of T3 and T4 cause the body to operate at a low gear.

    “In this case, there is too much sugar in the blood because the body is burning too few calories,” Kahaly says. This impaired function, which is known as hypothyreosis, causes fatigue, depression, and lethargy. It is regarded as a risk factor for Alzheimer’s disease. In pregnant women, it can damage the fetus. Both hyperactivity and hypoactivity of the thyroid gland can cause men and women to become infertile. Therefore, if a couple is unable to conceive, physicians should examine both partners’ thyroid function as a possible cause of the problem. Both forms of thyroid gland dysfunction can be treated with medicine as soon as the causes of the condition have been determined.

    Summary
    Targeted endoscopic parathyroidectomy without gas insufflation is a relatively non-invasive means of discovering and resecting parathyroid adenomas in sporadic primary hyperparathyroidism. This standardized technique depends on the quality of the preoperative imaging: cervical ultrasound and sestamibi scintigraphy, and can be optimized by preoperative insertion of an ultrasound-guided “harpoon” and rapid peroperative parathyroid hormone analysis. Failure rates range between 1.7% and 4%.
    Parathyroid Gland, Panoramic picture Endocrine attachment.php?s=1cca527df164c4282c9188eba93ebb89&attachmentid=1318&d=1439062648

    Introduction
    Sporadic primary hyperparathyroidism (SPH) is a common endocrine disorder characterized by inappropriate parathyroid hormone (PTH) secretion by one or several parathyroid glands. The most frequent clinical and biological symptoms involve bone tissue (osteoporosis, bone pain) and kidneys (lithiasis, impaired creatinine clearance), but diagnosis is increasingly made on discovery of asymptomatic hypercalcemia. Incidence of such cases is estimated at one in 500 females and one in 1500 males

    Complete resection after precise identification of the pathologic tissue is the only treatment enabling symptom resolution and long-term cure and. Parathyroid surgery, however, is often difficult: the main cause of failure is non-detection of a single adenoma with unusual or even ectopic topography. The second cause of failure is overlooking multi-gland involvement with hyperplasia or double adenoma: a pathologic gland is diagnosed, but inappropriate PTH secretion persists or recurs, indicating residual pathologic parathyroid tissue

    SPH involves a single adenoma in 89% of cases, double adenoma in 4%, hyperplasia in 5.5% and parathyroid adenocarcinoma in less than 1%and The rate of multi-gland parathyroid pathology ranges from 2.4% to 16% [2] and [4]. This high rate of benignity and histopathologic variability lead to two requirements: preoperative topologic analysis by cervical ultrasound and sestamibi scintigraphy [2], [3] and [5], and relatively minimally invasive surgery – the latter presently consisting mainly in the endoscopic parathyroidectomy procedure first described by Paolo Miccoli, associated for some authors to rapid peroperative PTH assay and [7]. This targeted strategy is increasingly replacing traditional exploration of the parathyroid migration areas by bilateral cervicotomy

    Surgical technique
    Endoscopic parathyroidectomy without gas insufflation is performed under general anesthesia, with the patient in dorsal decubitus with the head in slight hyperextension as for thyroid surgery. A medial transverse skin incision of 2 cm is made two finger-widths from the superior edge of the jugular notch of the sternum. An endoscopy exploration tunnel is performed, with opening of the median cervical line and identification of the trachea, sternothyroid muscle and also the isthmus of the thyroid gland. Once these have been identified, long (8 cm) Langenbeck retractors are positioned, with a medial retractor for the thyroid gland positioned toward the medial line and a lateral retractor for the sternocleidomastoid and sternothyroid muscles toward the exterior; the panoramic endoscope (3.5 mm diameter, 30° angle) can now be introduced in Cunéo and Loré’s “spider's web” space, medially between the visceral axis and the common carotid artery, beating and clearly visible laterally. The principal surgeon stands to the patient's right if right-handed, with the endoscope in his or her left hand and the active instrument in the right hand; the first assistant stands at the patient's head, holding the Langenbeck retractors; the second assistant stands to the left, with the aspirator; all must have a free view of the video-screen. Three areas are successively explored: the first is at the base of the thyroid lobe, around all its facets, especially the inferior and lateral, but at all events forward of the presumed trajectory of the recurrent laryngeal nerve, which has yet to be located (Fig. 1). The parathyroid adenoma is usually purplish brown, with a light yellow fatty “cap”; easily detached from the thyroid tissue, in an extracapsular position, generally about 1 cm in size and more than 50 mg in weight (compared to a normal parathyroid gland of 5 mm and 50 mg).

    References:
    Endoscopic surgery of the parathyroid glands: Methods and principles
    A look at the thyroid gland - M - The Explorer Magazine











    Last edited by Medical Photos; 08-08-2015 at 07:37 PM.

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