Parathyroid glands characteristics. Functions and diseases of the parathyroid gland. History of the discovery of the parathyroid glands

The parathyroid glands are an endocrine organ located on the posterior surface of the thyroid capsule. 80% of people have 2 pairs, the rest have from 3 to 6 pairs.

They produce parathyroid hormone (parathyroid hormone). When their work is disrupted, the hormonal balance changes, leading to the development of a number of pathologies.

Representatives of the fairer sex are susceptible to them 3 times more often than men. Let's look at the symptoms of parathyroid gland diseases in women.

Parathyroid hormone is a polypeptide hormone that controls the balance of calcium in the blood. Regulation is carried out according to the feedback principle. On the surface of the parathyroid glands there are receptors that determine the level of calcium ions in the blood serum. When it decreases below 2.25 mmol/l, the synthesis of parathyroid hormone is activated.

The following effects are observed:

• The excretion of calcium in the urine decreases due to an increase in its absorption in the kidney tubules.
• The hydroxylation of vitamin D in the kidneys increases, resulting in an increase in the level of its active form (calcitriol), which is involved in the production of a protein that ensures calcium absorption.
• Osteoclasts are stimulated - bone tissue cells that are responsible for its resorption (destruction), as a result of which calcium is actively released into the blood.

Failures in the functioning of the parathyroid glands lead to endocrine pathologies that provoke disturbances in phosphorus-calcium metabolism. There are two main diseases - hypoparathyroidism and hyperparathyroidism - conditions caused by deficiency and excess of parathyroid hormone, respectively.

Dysfunction of the parathyroid glands in women negatively affects the condition of bone tissue, kidneys, cardiovascular, nervous systems, and the gastrointestinal tract.

Before the functions of this endocrine organ were established, people who underwent surgery to remove the thyroid gland and did not receive hormone replacement therapy died after prolonged seizures.

Hypoparathyroidism: causes and symptoms

Hypoparathyroidism is a condition in which an insufficient amount of parathyroid hormone is produced or there is a decrease in the sensitivity of tissue receptors to it. As a result, the level of calcium in the blood decreases and the concentration of phosphates increases.

Causes

The main causes of hypoparathyroidism in women:

• removal of the parathyroid glands alone or together with the thyroid gland;
• neck injuries leading to hemorrhage into the endocrine organ;
• autoimmune inflammatory diseases in which the body produces antibodies to glandular cells - adrenal insufficiency, polyendocrine syndrome;
• primary dysfunction of the parathyroid glands as a result of their congenital underdevelopment;
• inflammatory pathologies;
• metastasis of malignant tumors;
• chronic lack of vitamin D – relevant for women during pregnancy and lactation;
• impaired absorption of calcium in the intestine;
• poisoning with lead, carbon monoxide, strychnine, ergot;
• radioactive radiation.

Symptoms

A decrease in calcium levels during hypoparathyroidism leads to an increase in neuromuscular excitation and other manifestations.

Symptoms of the initial stage:

• spasms in the limbs;
• feeling of numbness, tingling, “crawling”;
• chills followed by a rush of heat to the hands or feet.

Signs intensify during physical activity, during stress, as a result of overheating or hypothermia, and during illness.

As hypoparathyroidism progresses, the following are observed:

• symmetrical painful cramps;
• atrophy of the muscles of the limbs;
• weakness, irritability, decreased memory and intelligence;
• headache;
• photophobia;
• tachycardia;
• sweating;
• abdominal pain, diarrhea;
• ophthalmological pathologies – cataracts, keratoconjunctivitis.

Chronic lack of parathyroid hormone in women is accompanied by:

• peeling of the skin;
• baldness;
• brittle nails;
• destruction of tooth enamel.

Autoimmune hypoparathyroidism is often complemented by hypothyroidism, disorders of the adrenal glands and gonads, inflammation of the liver, fungal infections of the skin and mucous membranes.

In severe cases of hypoparathyroidism, disturbances in the functioning of the respiratory system (laryngospasm), as well as convulsive seizures similar to epileptic ones, may occur. These conditions require urgent help.

Hyperparathyroidism: symptoms of the phenomenon

Hyperparathyroidism is a condition characterized by increased activity of the parathyroid glands or individual parts thereof. Excess parathyroid hormone leads to an increase in the concentration of calcium in the blood - hypercalcemia. At the same time, the trace element is washed out of the bones, significantly reducing their strength. As a result, parathyroid osteodystrophy develops.

Causes

Depending on the mechanism of development, primary and secondary hyperparathyroidism are distinguished.

Factors that provoke the primary form of the disease in women:

• hyperplasia of the parathyroid glands;
• adenoma is a benign tumor of glandular cells;
• carcinoma (malignant neoplasm or cancer) of the parathyroid glands;
• hereditary endocrine disorders.

Secondary hyperparathyroidism occurs due to prolonged calcium deficiency. Causes:

• insufficient intake of vitamin D and calcium;
• rickets;
• Fanconi syndrome – disruption of the kidney tubules;
• gastrointestinal diseases leading to deterioration of calcium absorption;
• chronic renal failure;
• long-term treatment with anticonvulsants.

Did you know that disruption of the endocrine system can lead to infertility? Hypofunction of the thyroid gland if left untreated can cause such a complication. Here is everything about this pathology and methods of its treatment.

Symptoms

Hyperparathyroidism leads to damage to the musculoskeletal system, kidneys, gastrointestinal tract, cardiovascular system and central nervous system.

Signs:

• musculoskeletal system - softening of bones, fractures during normal movements, pain in the limbs and back, muscle weakness, fibrocystic osteitis, radiculitis;
• kidneys – formation of stones, increased urine output (has a whitish color), severe thirst;
• Gastrointestinal tract - loss of appetite and weight, abdominal pain, nausea, vomiting, pancreatitis, stomach and intestinal ulcers as a result of increased production of hydrochloric acid;
• heart and blood vessels – vascular calcification, hypertension, angina pectoris;
• CNS – depression, nervous excitability, memory loss;
• others – loss of hair, teeth, sallow-gray skin tone.

Depending on the prevailing symptoms, bone, gastrointestinal, renal and other forms of the disease are distinguished.

Hypo- and hyperparathyroidism are diagnosed based on a biochemical blood test, which determines the level of calcium in the serum, as well as by detecting the level of parathyroid hormone. In addition, X-rays are taken to show changes in bone tissue.

Ways to restore the body

Treatment of hypoparathyroidism

An acute attack of hypoparathyroidism, accompanied by painful cramps, is relieved by slow intravenous administration of a calcium solution in the form of chloride or gluconate. Infusions are repeated several times a day.

In parallel with this, injections of parathyroidin are prescribed - a drug that contains an extract of the parathyroid glands of animals. It is not advisable to use it for a long time, since the body becomes resistant and an autoimmune reaction occurs as a result of the production of antibodies to parathyroid hormone.

In the period between attacks with hypoparathyroidism, the following are prescribed:

• vitamin D;
• calcium preparations;
• aluminum hydroxide (to reduce phosphorus levels);
• magnesium sulfate;
• antispasmodics;
• sedatives.

Dosages and duration of treatment are selected individually. The concentration of calcium, phosphorus and magnesium in the blood is constantly monitored.

Therapy for hyperparathyroidism

During a hypercalcemic crisis in women, therapy is carried out aimed at reducing calcium levels in the blood. Preparations:

• sodium chloride solution intravenously in large quantities in combination with potassium and furosemide (a diuretic) for forced diuresis;
• magnesium sulfate intramuscularly;
• sodium citrate intravenously to bind calcium;
• phosphates intravenously or in tablets;
• mithramycin is an antibiotic that inhibits the activity of osteoclasts;
• glucocorticoids to reduce calcium absorption in the kidneys;
• calcitonin to reduce calcium leaching from bones.

Dairy products and vitamin D are excluded from the patients’ diet.

After relief of the symptoms of the crisis, primary hyperparathyroidism is treated surgically: neoplasms in the parathyroid glands are removed or part of the glands is resected. In the secondary form of the disease, therapy is aimed at eliminating the underlying diseases.

Previously, it was believed that diseases of the parathyroid glands were a rare phenomenon. But thanks to modern diagnostic methods, it has become obvious that many mature women suffer from dysfunction of this endocrine organ. Excess or deficiency of parathyroid hormone negatively affects the condition of the entire body. The success of treatment is determined by the timely detection of the problem.

Video on the topic

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Everyone has heard about the thyroid gland, which, like a butterfly, is located on the neck. But few people know that behind each lobe of the thyroid gland there is a small paired parathyroid gland - its hormones take an active part in phosphorus-calcium metabolism and are also very important for the body. What is this organ and what biological role does it play? Let’s try to figure it out using the results of the latest medical research, photos and videos in this article.

Parathyroid glands (other names: parathyroid, parathyroid) are four small endocrine formations that are located on the posterior wall of the thyroid gland, in pairs at the lower and upper poles of the organ.

Glandulae parathyroideae are found on both lateral lobes of the thyroid gland, and in some cases they are all localized on one side. The parathyroid glands are immersed in loose tissue, which fills the space between the fascial sheath and the fibrous capsule of the thyroid gland; there are cases of their location outside the boundaries of the vagina.

Some anatomical characteristics of the organ are indicated in the following table:

The level of location of the upper pair of parathyroid glands, as a rule, is the border of the middle and upper 1/3 of the posteromedial surfaces of each lateral lobe of the thyroid gland and the lower edge of the cricoid cartilage.

As for the lower pair, the glands belonging to it are larger in size compared to the upper ones and are located on the posterolateral surface of the lower 1/3 of each lateral lobe, 5–10 mm of the lower edge. In some cases, they are immersed in the tissue surrounding the thyroid gland from below.

Interesting! Both the upper and lower pairs of glandulae parathyroideae are located asymmetrically in most cases.

The connective tissue capsule covering each of them from the outside has processes directed inside the thickness of the glandular tissue, which divide the organ into lobules, and are rather weakly expressed.

The parathyroid gland is a parenchymal organ with a trabecular structure. The parenchyma is represented by epithelial cells that form cords, and the space between them is filled with connective tissue, generously supplied with a network of blood vessels, as well as accumulations of fat.

Structural elements of the gland

Individual trabeculae are built from two types of parathyroid cells - active cells of the parathyroid glands:

1. Basophilic or major.
2. Oxyphilic.

In turn, the main parathyroid cells are divided into two more types, differing in their functional state:

1. Dark (active).
2. Light (low-active).

The main active components of the parathyroid glands are dark basophilic parathyroid cells. They actively function, providing the functions of the parathyroid gland, due to the presence of more developed Golgi complexes and granular endoplasmic reticulum.

In the cytoplasm of dark basophilic cells there are many secretory granules, the diameter of which is no more than 400 nm; parathyrin, the hormone of this endocrine organ, is deposited in them. The parathyroid gland uses it to regulate the content of calcium ions in the blood.

In this case, the secretion of biologically active substances is carried out on the basis of the feedback principle - as soon as the calcium content in the peripheral blood drops, the production of parathyrin increases and, conversely, when the concentration of this microelement begins to exceed the norm, the iron reduces the secretion of the hormone.

Parathyroid hormone

Parathyroid hormone is the only biologically active substance that is synthesized by the secretory cells of the parathyroid glands. Its main function is to maintain a stable level of ionized calcium in the blood.

Calcium is the main microelement that represents the internal structure of bone tissue. It is responsible for strong and healthy bones, normal functioning of the heart and muscle tissue.

The parathyroid gland is an organ located on the thyroid gland and belongs to the endocrine system. The gland is often called the parathyroid gland. Despite its small size, the parathyroid gland has a huge impact on the functioning of the human body.

Brief anatomy and histology

The parathyroid gland is a round or oval, slightly flattened parenchymal organ. Her normal sizes are:

• length – from 0.2 to 0.8 cm;
• width – from 0.3 to 0.4 cm;
• thickness – from 0.15 to 0.3 cm.

There are from 2 to 8 such glands in the human body, but more often there are 4. Not only their number varies, but also their location. The parathyroid glands can be located in the thickness of the thyroid gland, on its posterior surface, next to the thymus, behind the esophagus, etc. It is very important for endocrinologist surgeons to know these features.

Adults have yellow parathyroid glands, which are therefore similar to the lymph nodes located nearby. In children, the glands are pinkish.

Histology has revealed that each parathyroid gland has its own capsule, from which connective tissue cords with blood vessels and nerves extend deeper. Around these layers of connective tissue are located secretory cells that secrete hormones that regulate the growth and development of the body, muscle contraction, etc.

How did you learn about the role of the parathyroid gland?

The study of the parathyroid glands began relatively recently. They were first discovered in rhinoceros in the mid-19th century, and a few years later in humans. It was the lack of knowledge about these organs that caused failures associated with resection of the thyroid gland. Previously, such operations ultimately led to death due to seizures associated with disturbances in the concentration of calcium ions.

And only after the structure of the parathyroid gland, its histology and functions were established, it became clear that it is an important organ that must regulate calcium metabolism.

A little about the role of calcium

Calcium is a macronutrient found mainly in bone tissue and teeth and influences various processes in the human body. He is involved in:

• building bones and teeth;
• contraction of skeletal and smooth muscles;
• glowing blood;
• conduction of a nerve impulse;
• heart function;
• regulation of cell membrane permeability.

Therefore, proper calcium metabolism, regulated including by the parathyroid gland, is important for the normal functioning of the body..

Functions of the parathyroid glands

The parathyroid glands belong to the endocrine system, that is, their function is to secrete hormones into the blood:

• parathyrin;
• calcitonin;
• biogenic amines (serotonin, histamine, etc.).

It is the first two that determine the main role of the parathyroid gland - the normalization of calcium metabolism.

Parathyroid hormone

Parathyroid hormone, or parathyrin, is the main biologically active substance secreted by the parathyroid gland. It belongs to the polypeptides. The effect of this hormone is shown in the table.

The peak concentration of the hormone occurs during night sleep. During the third hour of sleep, its blood levels are approximately 3 times higher than daytime levels. Parathyroid hormone begins to be released when the concentration of calcium ions decreases to 2 mmol/l.

The secretion of parathyrin is stimulated by hormones such as somatotropic hormone, glucagon, biogenic amines, prolactin, and magnesium ions.

Calcitonin, like parathyroid hormone, is a peptide hormone. It is an antagonist of parathyrin, because:

• reduces the reabsorption (reabsorption) of calcium in the kidneys;
• impairs the absorption of calcium in the intestines from food;
• blocks osteoclasts;
• slows down the secretion of growth hormone, insulin and glucagon.

The release of calcitonin occurs when the concentration of calcium in the blood increases above 2.25 mmol/l, as well as under the influence of cholecystokinin and gastrin. But the secretion of this active substance by the parathyroid gland is not so significant; it is also produced in other organs.

Variants of dysfunction of the parathyroid glands

The dependence of physiology on the parathyroid glands is clearly visible when their functioning is disrupted. The classification of dysfunctions of these organs includes two types.

• hyperparathyroidism;
• hypoparathyroidism.

The first condition is an increased secretion of parathyrin. The classification of hyperparathyroidism also includes 3 types.

1. Primary hyperfunction is caused by diseases of the parathyroid gland such as adenoma, cancer, etc.
2. Secondary hyperparathyroidism occurs due to kidney failure, vitamin D deficiency, poor absorption of nutrients in the intestines, and bone destruction.
3. Tertiary hyperparathyroidism is a condition in which the size of the parathyroid glands increases. It develops against the background of long-term secondary hyperparathyroidism.

Hyperfunction has the following clinical manifestations:

• frequent urination;
• constant thirst;
• nausea, lack of appetite, gas formation;
• high blood pressure and heart pain and arrhythmias;
• decreased muscle tone;
• osteoporosis;
• pain in the spine, arms, legs;
• loss of teeth;
• deformation of the skeletal system;
• increasing the concentration of total calcium in the blood to 3.5 mmol/l.

Hypoparathyroidism is insufficient production of parathyrin. This condition is most often associated with accidental removal of the parathyroid glands during operations on the thyroid gland, with swelling or hemorrhage as a result of trauma or surgery in the neck, with inflammation of the parathyroid glands.

The classification of this condition includes 2 forms: latent (hidden) and manifest. They differ in the severity of symptoms. Hypoparathyroidism has the following manifestations:

• seizures that can last for hours;
• dry skin, dermatitis;
• brittle nails and brittle teeth;
• cataract;
• frequent numbness in the limbs.

Lack of parathyrin has a negative effect on stool due to spasm in smooth muscles and on hair growth.

Thus, the parathyroid glands are organs that play an important role. They control calcium metabolism, which is involved in many life processes. Removing glands is dangerous, and an increase and decrease in the secretion of their hormone leads to unpleasant symptoms that significantly reduce a person’s quality of life.

The parathyroid gland (parathyroid, parathyroid) is one of the most important organs of the endocrine system of the human body, formed from 4 anatomical structures connected in pairs around the thyroid gland. The main function of the organ is the production of hormonal substances (parathyroid hormone).

The parathyroid gland is small. It is presented in the form of an oblong oval, no longer than 8 mm. The organ is located immediately behind the left or right lobe of the thyroid gland. The specific location itself is the reason why the organ is called the parathyroid organ.

The upper pair is located outside the capsule, and the lower pair of endocrine organs is located directly under the thyroid capsule. Each element weighs no more than 1.5 grams. Glandular formations do not always have an oval shape. Sometimes there are round formations, which is not a deviation from the norm.

The thyroid and parathyroid glands are covered with thin capsular tissue. The basis for its formation is connective cells, supplemented by secondary elements (nerve fibers, blood vessels).

How important is an organ for the human body?

The functions of the parathyroid glands are difficult to overestimate. The organ is involved in regulating the level of calcium concentration in the body of each person. This is important for the normal functioning of the musculoskeletal system, the integrity and strength of all bone structures.

As soon as the calcium level drops to a pathological minimum, the parathyroid formations receive a signal and begin to actively produce hormonal substances. Parathyroid hormone can actively influence the functional potential of osteoclasts. The main goal: to accelerate the process of calcium synthesis from bone tissue.

In addition, the hormonal substances of the parathyroid gland perform a number of other important functions:

1. Counteracts thyrocalcitonin, which is produced by C-cells of the thyroid gland;
2. Formation of favorable conditions for the normal functioning of the body, preventing the occurrence of pathologies.

Parathyroid glands are endocrine glands located on the posterior wall of the thyroid capsule. A more correct name is the term “parathyroid glands”.

Location and number of parathyroid glands

The size of the parathyroid glands is about 4x5x5 mm. Normally, a person can have from 2 to 8 glands (the typical number is 4, two on each side - one at the upper pole of the thyroid lobe, the second at the lower pole). A characteristic and very important feature of the parathyroid glands is the variability of their location and number. There are a significant number of possible locations of the glands - they can be located in the thymus gland, and next to the main neurovascular bundle of the neck, and behind the esophagus, on the anterior surface of the spine. The exceptional variability of location is an important feature that surgeons must take into account when performing operations.

Function of the parathyroid glands

The main function of the parathyroid glands is the production of parathyroid hormone, the main hormone that regulates the level of calcium in human blood. Parathyroid hormone is a polypeptide (i.e., consisting of amino acids, 84 amino acid residues) hormone. On the surface of the cells of the parathyroid gland there are receptors that are able to detect the concentration of calcium in the blood serum. When calcium concentrations decrease, the parathyroid glands begin to produce increased amounts of parathyroid hormone, which has three main effects in the body. The first effect is a decrease in calcium excretion in the urine. The second effect is an increase in the hydroxylation of vitamin D in the kidneys and, as a result, an increase in the concentration of the active form of vitamin D (calcitriol) in the blood, which increases the production of calmodulin in the intestinal wall, a transport protein that ensures the absorption of calcium into the blood. The third effect is the activation of bone-destroying cells, osteoclasts, with the destruction of bone tissue and the release of calcium contained in it into the blood. All three effects (reducing calcium excretion, increasing calcium absorption, transferring bone calcium into blood plasma) are aimed at increasing the concentration of calcium in the blood. Parathyroid hormone is the main substance that ensures normal calcium levels in the blood. Its antagonist, calcitonin, produced by C-cells of the thyroid gland and some intestinal cells, is quite weak, so it does not take a significant part in the regulation of phosphorus-calcium metabolism.

The importance of the parathyroid glands

Such a small organ as the parathyroid gland is extremely important for the human body. Removal of the parathyroid glands leads to a sharp decrease in the concentration of ionized calcium in the blood with the subsequent development of seizures leading to death. In the 19th century, the French Academy of Medicine even banned operations on the thyroid gland, since they all ended in the death of patients - the fact is that at that time the significance of the parathyroid glands had not yet been established, and surgeons always removed them during surgery, which ended fatally. Only after the discovery of these glands, the description of the features of their anatomical location and the clarification of their function, it became clear how important they are. Currently, thyroid surgery poses one of the most important tasks as mandatory preservation of the parathyroid glands and their blood supply - this task is one of the most difficult for an endocrinologist surgeon.

Both underfunction (hypoparathyroidism) and overfunction of the parathyroid glands (hyperparathyroidism) are harmful to the patient. With hyperparathyroidism, which most often develops as a result of the formation of a benign tumor of the parathyroid gland (adenoma), parathyroid hormone enters the blood uncontrollably, in large quantities. Due to an excess of parathyroid hormone, the work of osteoclasts in the bones increases, which leads to the destruction of bones with a decrease in their strength (osteoporosis). Due to the destruction of bone tissue and the entry of large amounts of calcium into the blood, a number of complications arise - fractures even with a slight load, the formation of kidney stones, calcification of blood vessels and heart valves, the formation of ulcers in the stomach and duodenum, etc. In severe cases, calcium levels reach such high levels that it leads to a deterioration in intelligence up to the development of coma.

History of the discovery of the parathyroid glands

The parathyroid gland was first discovered during an autopsy of an Indian rhinoceros, which died at the London Zoo in 1850. The young researcher Richard Owen was entrusted with dissecting the rhinoceros, who, after months of research, was able to discover a parathyroid gland weighing 8 g in the animal's carcass. This was the first case of identifying a parathyroid gland. glands. Since then, the symbol of parathyroid surgery has been the rhinoceros. In humans, this organ was discovered later, in 1880, by Ivar Sandstrom, a medical student at Uppsala University. However, it was not until 1925 in Vienna that the surgeon Felix Meindl was able to successfully remove a parathyroid adenoma from a patient with bone lesions and thereby cure the patient.

Diseases of the parathyroid glands

The most common diseases are:

Primary hyperparathyroidism (associated with the development of adenoma - a benign tumor that can be single or multiple);

Secondary hyperparathyroidism (develops with vitamin D deficiency - this form is treated by eliminating the deficiency by taking appropriate medications; another form of secondary hyperparathyroidism develops with chronic renal failure and is treated conservatively or surgically);

Tertiary hyperparathyroidism (develops with long-term chronic renal failure and can only be corrected surgically).

Operations on the parathyroid glands

Diseases of the parathyroid glands are treated by endocrinologists, and operations on this organ are performed by endocrinologist surgeons, and only those with sufficient experience in this field of surgery. Carrying out operations by surgeons who do not have sufficient experience in the field of surgery of the parathyroid glands, in a significant percentage of cases, leads to the persistence of the disease, as well as to a number of dangerous complications.

Currently, the Russian leader in the field of such operations is the North-Western Endocrinology Center, whose specialists annually perform more than 300 interventions of this type. In the vast majority of cases, operations are performed using a low-traumatic approach using video technology, which makes it possible to reduce the length of the skin suture to 1.5-2.5 cm, and the operation time to 10-20 minutes. Of course, such results are achieved only by using modern diagnostic principles and the same modern equipment.

Unfortunately, patients who do not require surgical treatment at all are often referred to an endocrinologist surgeon for surgery. The most common mistake is prescribing surgery for patients with vitamin D deficiency, which leads to increased levels of parathyroid hormone in the blood. In such cases, an experienced endocrinologist surgeon recommends that the patient, instead of surgery, start taking calcium or vitamin D supplements and thereby completely eliminate the existing problem.

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