𝗭𝘂𝗰𝗸𝗲𝗿𝗸𝗮𝗻𝗱𝗮𝗹 𝗧𝘂𝗯𝗲𝗿𝗰𝗹𝗲 (𝗭𝗧)

“ᴏᴠᴇʀᴠɪᴇᴡ, ɢʀᴀᴅɪɴɢ & ᴄʟɪɴɪᴄᴀʟ sɪɢɴɪғɪᴄᴀɴᴄᴇ”

  • The Tubercle of Zukerkandal (TZ) was first described in the medical literature in 1867 by Madelung as the “posterior horn of the thyroid,” and then in 1902 as the “processus posterior glandulae thyroideae” by Emil Zuckerkandl
  • The Tubercle of Zuckerkandl (TZ) is a distinct, well-described anatomical feature of the thyroid gland with a plausible embryological basis of genesis.
  • In the adult, the TZ is the most posterior extension of the lateral lobes of the thyroid gland at the area of the Ligament of Berry and is closely related to the superior parathyroid gland.
  • The literature describes a highly variable Tuberculum frequency, ranging from 14% to 55% of thyroidectomies and is usually less than 1 cm in diameter.
  • When present, it constitutes a useful anatomical landmark for the identification of the RLN and the superior parathyroid gland.
  • The TZ has been described as being shaped like an ‘𝗮𝗿𝗿𝗼𝘄 𝘁𝗵𝗮𝘁 𝗽𝗼𝗶𝗻𝘁 𝘁𝗼𝘄𝗮𝗿𝗱𝘀 𝘁𝗵𝗲 𝗥𝗟𝗡’.
  • This is because the RLN travels posteromedially to a well developed TZ in more than 80% of people, and in this location the nerve may often be mistaken as travelling intrathyroidally.
  • The RLN may, through gentle dissection and with medial retraction of the TZ, can be gradually exposed up to its entry into the larynx.
  • Like the TZ, the superior parathyroid glands are also derived from the fourth pharyngeal pouch; their common embryological origin explains the consistent posterior and superior location of the superior parathyroid gland in relation to the TZ.
  • Thus, the superior parathyroid gland should be routinely identified and its blood supply carefully preserved during thyroidectomy, especially when dissecting the TZ.
  • 𝗚𝗿𝗮𝗱𝗶𝗻𝗴 𝘀𝘆𝘀𝘁𝗲𝗺 𝗳𝗼𝗿 𝘁𝗵𝗲 TZ:
    • Pelizzo et al. have defined a grading system for the tubercle of Zuckerkandl:
      • Their classification is a numerical scale from 0 to 3, with:
        • 0 being unrecognizable
        • 1 being only a thickening of the lateral edge of the thyroid lobe
        • 2 measuring smaller than 1 cm
        • 3 measuring larger than 1 cm in size
  • In their series in which 104 thyroid lobes were assessed:
    • Grade 0 was present in 23 % of lobes
    • Grade 1 in 9 %
    • Grade 2 in 54 %
    • Grade 3 in 14%
  • 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻:
    • The tubercle of Zuckerkandl is a lateral and posterior projection of the thyroid gland. It is variably present, and it is more often found on the right side in humans.
    • The tubercle of Zuckerkandl is important to endocrine surgeons because of its close proximity to the recurrent laryngeal nerve and the superior parathyroid gland.
    • The tubercle is located inferior to the superior parathyroid gland, and superficial to the recurrent laryngeal nerve.
    • It is susceptible to hyperplastic and neoplastic diseases of the thyoid gland, and the anatomic relationships can be altered in these circumstances.
    • An understanding of the normal anatomy and its variants can benefi t surgeons who perform thyroid or parathyroid surgery so that the risks of injury to the recurrent laryngeal nerve or the superior parathyroid gland are minimized, and so that diseased tissue is not left behind when a total thyroidectomy is performed.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s