THE PARATHYROID GLANDS 



hydatid disease. For the relief of ordinary goitre various methods have been employed. Tap- 

 ping, injection of astringents, simple incision, and the seton are obsolete. Ligation of the thy- 

 roid arteries is rarely performed as a curative measure. The superior and inferior thyroids of 

 one side have been tied in some cases; all four thyroids in other cases. Jaboulay has performed 

 exathyropexy. In this operation the gland is dislocated from its bed, brought out of the wound, 

 and left exposed, in hope that it will atrophy. 



Division of the isthmus is occasionally practised to relieve dyspnea. The operation some- 

 times succeeds, but often fails. 



Extirpation of one-half or two-thirds of the gland is a very successful operation. Removal of 

 the entire gland will be followed by operative myxedema. Removal or injury of the parathyroids 

 causes tetany. 



In extirpating a lobe of the thyroid by the method until recently in vogue, great care must be 

 taken to avoid tearing the capsules, as if this happens the gland tissue bleeds profusely. The 

 thyroid arteries should be ligated on the diseased side before an attempt is made to remove the 

 mass, and in ligating the inferior thyroid the position of the recurrent laryngeal nerve must be 

 borne in mind, so as not to include it in the ligature. In order to preserve the parathyroids from 

 injury, C. H. Mayo recommends that after the vessels entering and leaving the thyroid have been 

 double clamped and divided, the entire lobe should be elevated, the capsule split along the side 

 of the gland and pushed back with gauze, and the gland lifted and removed without disturbing 

 the posterior portion of the capsule. As pointed out before, the posterior portion of the capsule 

 is so thick and strong that it is easier to leave it in situ than to bring it out of the wound with the 

 gland. 



A cystic or solid tumor of the thyroid may be removed by intraglandular enucleation. If opera- 

 tion becomes necessary in exophthalmic goitre, partial extirpation is usually preferred. Bilateral 

 extirpation of the cervical ganglia of the sympathetic (sympathectomy or Jonnesco's operation) 

 has been practised by some surgeons for exophthalmic goitre. The value of the procedure is 

 uncertain. 



THE PARATHYROID GLANDS (Fig. 1196). 



The parathyroid glands are small, brownish-red bodies, situated near the thy- 

 roid gland, but differing from it in structure, being composed of masses of cells 

 arranged in a more or less reticular fashion with numerous intervening bloodvessels. 

 They measure on an average about a quarter of 

 an inch (6 mm.) in length, and from an eighth 

 to a sixth of an inch (3 to 4 mm.) in breadth, 

 and usually present the appearance of flat oval 

 disks. They are classified according to their 

 position into superior and inferior. The supe- 

 rior, usually two in number, are the more con- 

 stant in position, and are situated, one on either 

 side, at the level of the lower border of the 

 cricoid cartilage, behind the junction of the 

 pharynx anr) nRsnpha^u.s. and in front of the 

 prevertebral fascia. The inferior, also usually 

 tw<3 ' In ' rTUmber^~may be applied to the lower 

 edge of the lateral lobe, or may be placed at 

 some little distance below the thyroid body, or 

 may be found in relation with one of the inferior 

 thyroid veins. Although there are usually four 

 parathyroids, there may be but three, or there 

 may be six or even eight. Parathyroid tissue 

 may exist within the thyroid gland even when 

 the superior parathyroids are present. Acces- 

 sory parathyroids may be found over a wide 

 area. Rogers and Fergusson found one in the 

 middle of the posterior portion of the pharynx. 

 Ogle found a gland in the thorax which was partly 

 parathyroid. 



91 



FIG. 1196. The position of the para- 

 thyroid glands. Viewed from behind. 

 (Zuckerkandl.) 



