Thyroid gland and parathyroid glands


The thyroid gland is a butterfly-shaped endocrine gland located inferior to the larynx and anterior to the trachea. The thyroid gland develops from the fusion of the median thyroid anlage with the two lateral thyroid anlages, which are derived from the pharyngeal pouches. The thyroid gland receives its arterial supply from the superior and inferior thyroid arteries and drains into the superior, middle, and inferior thyroid veins. The thyroid gland secrets thyroid hormones, which regulate body metabolism and growth, and calcitonin, which lowers serum calcium and phosphate through inhibition of osteoclasts. Hormone synthesis occurs in the epithelial lining of the thyroid follicles. The epithelial lining consists of follicular (thyroid epithelial) cells, which synthesize thyroid hormone, and parafollicular (C) cells, which synthesize calcitonin.

The parathyroid glands are four, oval-shaped endocrine glands located on the posterior surface of the thyroid gland. They are derived from the third and fourth pharyngeal pouches. The parathyroid glands receive their arterial supply from the inferior thyroid arteries and drain into the thyroid venous plexus. The parathyroid chief cells secrete parathyroid hormone, which maintains serum calcium and phosphate homeostasis and, furthermore, antagonizes the effect of calcitonin by increasing serum calcium and decreasing serum phosphate. The recurrent laryngeal nerves, parathyroid glands, sympathetic trunks, and the nerves of the carotid sheath are at risk of injury during thyroid surgery.

Thyroid gland


Damage to the recurrent laryngeal nerves, parathyroid glands, sympathetic trunks, and even the nerves of the carotid sheath is possible during thyroidectomy because of the thyroid's location in the anterior neck.

Gross anatomy

Gross anatomy

  • The thyroid gland is made up of a left lobe and a right lobe connected by an isthmus.
  • An ascending pyramidal lobe is present in ∼ 50% of the population.
  • The thyroid gland is encapsulated by:
    • Pretracheal fascia (false/surgical capsule)
    • Internal capsule: An inner connective tissue covering that cannot be separated from the gland (true capsule).
      • Forms septae, dividing the gland into lobes and lobules.

Vasculature and innervation

Vessel Supplies
Arterial supply
Venous drainage

The inferior thyroid artery runs close to the recurrent laryngeal nerve and the superior thyroid artery close to the superior laryngeal nerve. Both nerves are at risk during thyroid surgery!

Microscopic anatomy

Lobules of thyroid gland

Cell type Characteristics Function

Thyroid epithelial cell (= follicular cells)

C cells (parafollicular cells)


The thyroid gland produces thyroid hormones, which stimulate metabolism and growth, as well as calcitonin, which decreases bone resorption and is involved in plasma calcium homeostasis.


Thyroid hormones

Thyroid hormone synthesis

The thyroid hormones T3 (triiodothyronine) and T4 (thyroxine, tetraiodothyronine) are synthesized by thyrocytes in the thyroid follicles.

  1. Thyroglobulin, an iodine-free hormone precursor, is stored in the follicular lumen.
  2. Iodide is actively taken up by thyrocytes and transported into the follicular lumen.
  3. Here, thyroid peroxidase catalyzes the iodination of tyrosine residues of thyroglobulin, creating precursors monoiodotyrosine (MIT) and diiodotyrosine (DIT) and eventually the thyroid hormones.
  4. To release T3 and T4, the iodinated thyroglobulin must be taken up again by thyrocytes, where it is broken down by lysosomes, thus releasing attached T4 and T3.
  5. T4 and T3 are then transported out of the thyrocyte into the blood.

Detailed steps of thyroid hormone synthesis

Steps Description Site

1. Synthesis of thyroglobulin (TG)

  1. Thyroglobulin (TG) is produced in the rough ER of the follicular cells.
  2. TG is packed in vesicles in the Golgi apparatus.
  3. TG is released into the follicular lumen via exocytosis.
Thyrocytefollicular lumen

2. Uptake of iodide

  1. Basolateral transport
    • Na+/I-symporter: Uptake of iodide by thyrocytes
  2. Apical transport
Blood vessel → thyrocytefollicular lumen

3. Iodination of thyroglobulin

In follicular lumen

4. Storage

In follicular lumen

5. Release

  1. Reuptake of iodinated TG in thyrocytes via endocytosis
  2. Fusion of endocytosis vesicles with lysosome
  3. Proteolytic enzymes cleave TG to release T3, T4, DIT, and MIT
  4. T3 (∼ 20%) and T4 (∼ 80%) are released into the blood (via the MCT8 transporter)
  5. Deiodinase removes the iodine from the MIT and DIT
    • Iodine is then redistributed to the intracellular I- pool (iodine salvage).
Thyrocytefenestrated capillary network

Thyroxine hormone is produced from tyrosine and iodine.

TPO is stimulated by TSH and inhibited by propylthiouracil, methimazole, and excess iodine (Wolff-Chaikoff effect), resulting in high or low levels of thyroid hormones, respectively.

Transport and degradation

Thyroid hormones are lipophilic; most of the circulating thyroid hormones are inactive and bound to transport proteins. Only a very small fraction (∼ 0.3%) is unbound and biologically active.


In general, thyroid hormones increase the metabolic rate: oxygen and energy consumption as well as thermogenesis increase under their influence. See thyroid hormones in the general endocrinology article for more information regarding their functionality.

Target organ Effect
Skeletal muscle
  • Increased development of type II muscle fibers (fast-twitch muscle fibers), which are capable of fast and powerful contractions
Growth during childhood
  • Thermogenesis


Like the adrenal steroid hormones, the thyroid hormones are under the control of the hypothalamic-pituitary axis.

Thyroid-stimulating hormone (TSH) from the pituitary gland stimulates the basolateral uptake of iodine, as well as the biosynthesis and release of thyroid hormones.

TSH levels are very sensitive to thyroid hormone dysfunction. If thyroid hormone levels are very high, TSH can fall below detection limits and if they are very low, TSH increases markedly. Therefore, serum TSH is an important parameter for assessing thyroid function and is usually the first step in thyroid diagnostics.


During embryological thyroid migration, remnants of thyroid tissue can remain in the tongue (lingual thyroid) or along the migration path. Ectopic thyroid should always be considered when performing surgical procedures involving thyroid tissue.

Follicular cells arise mainly from the median thyroid anlage!
Parafollicular C cells arise mainly from the lateral thyroid anlage!


Clinical significance

Parathyroid glands


Microscopic anatomy


  • See calcium homeostasis (PTH increases serum calcium and decreases serum phosphate)
    • High extracellular calcium → activation of calcium-sensitive receptors → PTH excretion
    • Low extracellular calcium → inhibition of calcium-sensitive receptors → PTH excretion


DiGeorge syndrome is a congenital T-cell immunodeficiency that is caused by microdeletion at chromosome 22 (22q11.2). The deletion leads to defective development of the third and fourth pharyngeal pouches, resulting in aplastic parathyroids and hypocalcemia due to PTH deficiency.

Clinical significance

Surgery of the thyroid and parathyroid glands can result in destroyed or removed parathyroid glands due to their variable position. This may result in hypoparathyroidism and hypocalcemia.

last updated 09/17/2020
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