Type of Article:  Case Report

Volume 8; Issue 4.2 (December 2020)

Page No.: 7810-7813

DOI: https://dx.doi.org/10.16965/ijar.2020.227


Romini Niranjan *1, Surangi. G. Yasawardene 2.

*1 Department of Anatomy, Faculty of Medicine, University of Jaffna, Sri Lanka.

2 Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka,

Address for correspondence: Romini Niranjan, Department of Anatomy, Faculty of Medicine, University of Jaffna, Sri Lanka. E-Mail: rominiranjan@yahoo.com


Parathyroid glands are responsible for maintaining the calcium level in blood and usually, a pair of superior and inferior parathyroid glands are located in the thyroid gland. Parathyroid glands are smaller and have variations in their size, shape, number and location. Thus, it is difficult to identify the parathyroid gland and leads to its accidental removal during thyroidectomy. This case report is an incidental finding of two superior parathyroid glands in the left lobe of thyroid gland in 68-year female cadaver. Both superior parathyroid glands were located at the first tracheal ring, 2 mm in size, circular in shape, tan yellow in colour, covered by a thin capsule and separated from each other in a distance less than 1 mm. They appear similar to a twin pair and seems to kiss each other. Both were confirmed by the histological method as parathyroid tissues. Superior parathyroid gland developed from the dorsal wing of fourth pharyngeal pouch, get detached from its origin and assumed a relatively constant final location either at the cricothyroid junction or at first tracheal ring. In this present case, the dorsal wing of the fourth pharyngeal pouch have undergone earlier embryological division into two separate superior glands during its descent to the cervical region in the left side. Embryological development of thyroid gland is linked with the development of parathyroid, thymus and ultimobranchial body. Thyroid gland developed from two sources. The median one contributes to thyroid isthmus and parts of the lateral lobe of thyroid. Lateral thyroid lobes derived its contributions from the caudal pharyngeal endoderm of the 4th and 5th pharyngeal pouches.  The fusion of median and lateral thyroid forms the Zuckerkandl’s tubercle. Superior parathyroid gland might have travelled along the superior border of isthmus and any changes in the development of thyroid might have influence in the development of parathyroid glands. Up to now a very few cases of kissing parathyroid glands are reported in the literature and this will provide an additional anatomical information of kissing superior parathyroid glands.

Key words: Kissing superior parathyroid glands, Complications of thyroidectomy, Parathyroidectomy, Cricothyroid junction, Twin parathyroid.


[1]. Hojaji F, Vanderlei F, Plopper C, Rodrigues CJ, Jacomo A, Cernea C, Oliveria L, Marchi L, Brando L. Parathyroid gland anatomical distribution and relation to anthropometric and demographic parameters: a cadaveric study. Ana Sci Int, 2011;86(4): 204 -212.
[2]. Zhijie Liu, Shannon Yu, Nancy R. Manley. Gcm2 is required for the differentiation and survival of parathyroid precursor cells in the parathyroid/thymus primordial. Developmental Biology. 2007;305: 333-346.
PMid:17382312 PMCid:PMC1931567
[3]. Wang C. The anatomic basis of parathyroid surgery. Ann surg, 1976;183(3):271-275.
PMid:1259483 PMCid:PMC1344236
[4]. Mahbub, S., Ara, S, Alim, A, Nurunnabi, A.S.M, Omar, A.B.M, Faruque, Ahmed, R., Kishwara, S. Location and Number of Human Parathyroid Glands – A Postmortem Study. Bangladesh Journal of Anatomy, 2009;7(2): 73-79.
[5]. Nanka, O, Sedy, J, Vitkovia, I, Libansky, P, Adamek, S, Prague. Surgical Anatomy of Parathyroid Glands with Emphasis on Parathyroidectomy, Medical Report, 2006;107(2): 261-272.
[6]. Al-Bustami, F, and Khraisha, S. Variations in the Anatomical Position of the Normal and Diseased Parathyroid Glands. J Med J, 2009;43 (3):180-188.
[7]. Sadler T.W. Langman’s Medical Embryology. Eleventh edition, Second Indian reprint 2010.Lippincott Williams and Wilkins, Indian reprint ISBN, 13:978-81-8473-220-7.
[8]. Haynes, J.I. Parathyroids and Ultimobranchial Bodies in Monotremes. The Anatomical record, 1999;254:269-280.
[9]. Tanberg, A. The relationship between the thyroid and parathyroid glands. J Exp Med, 1916;24(5): 547-559.
PMid:19868059 PMCid:PMC2125478
[10]. Cheng, C.Y., Chang, Y.L., Hsiao, J.K., Wang, C.P. Metachronous thyroglossal duct cyst and inferior parathyroid cyst. A case report. Kaohsiung J Med Sci, 2008;24(9): 487-490.
[11]. Syrycki, M. The examinations of thyroid gland isthmus topography in foetal period development- Practical importance, Folia Morphol, 2003;62:57-60.
[12]. Swapna, A., Ambekar, Priya P., Wattamwar, Azhar, A., Siddiqui, Zuberi, H.R.. Hemiagenesis of thyroid gland: A case report. International Journal of Scientific and Research Publications, 2015;5(5): 1-4.
[13]. Kumar. G.P., Satyanarayana, N., Vishwakarma N.R., Guha, Dutta A.k., Sunitha P. Agenesis of isthmus of thyroid gland, its embryological basis and clinical significance – A case report. Nepal Med Coll J, 2010;12(4): 272-274.
[14]. Yun, J.S., Lee, Y.S., Jung, E.J., Nam, K.H., Chung, W.Y., Chang, H.S., Parkm C.S. The Zuckerkandl’s tubercle: A useful anatomical landmark for detecting both the recurrent laryngeal nerve and the superior parathyroid during thyroid surgery. Endocrine Journal, 2008;55 (5): 925-930.
[15]. Mohebati. A. and Shaha, A.R. Anatomy of thyroid and parathyroid glands and neurovascular relations. Head and neck service, Memorial Sloan Kettering Cancer Center, New York, New York Clinical Anatomy, 2012;25:19-31.
[16]. Niranjan.R., S Udhayakumar .S., Surangi, G.S Yasawardene. Location of superior and inferior parathyroid glands in relation to the midpoint of isthmus of thyroid and tracheal rings. Conference paper in the proceeding of the 2nd Jaffna University International research conference (JUICE) 2014; 213-217.

Cite this article: Romini Niranjan, Surangi. G. Yasawardene. KISSING SUPERIOR PARATHYROID GLANDS: A CASE REPORT. Int J Anat Res 2020;8(4.2):7810-7813. DOI: 10.16965/ijar.2020.227