Nomenclature System for Localization of Parathyroid Adenomas

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Type A:
    • Adherent to the posterior thyroid parenchyma:
      • Posterior to the upper pole of the thyroid:
        • But not intrathyroidal
    • Type A glands are in the accepted, expected location of a normal parathyroid gland
  • Type B:
    • Behind the thyroid parenchyma
    • Type B glands are exophytic to the thyroid parenchyma and lie in the tracheoesophageal groove:
      • This category includes adenomas in:
        • Retroesophageal, retropharyngeal, high lateral pharyngeal, and carotid sheath locations
    • A ‘‘B+’’ subcategory can be used to document the location of adenomas above the level of the hyoid bone:
      • The ‘‘+’’ is meant to reflect cranial elevation
  • Type C:
    • Caudal to the thyroid parenchyma:
      • In the tracheoesophageal groove
    • A type C gland is more inferior than a type B gland on lateral images:
      • Located inferior to the inferior pole of the thyroid (closer to the clavicle)
  • Type D:
    • Directly over the recurrent laryngeal nerve:
      • At the level of the inferior thyroid vessels
    • The dissection may be difficult:
      • Because a type D gland is dangerously close to the recurrent laryngeal nerve
  • Type E:
    • Located in the external aspect of the inferior pole of the thyroid
    • A type E gland is in a location that is:
      • More superficial in an anterior–posterior plane than the recurrent laryngeal nerve:
        • It is the easiest to resect
  • Type F:
    • ‘‘Fallen’’ into the thyrothymic ligament:
      • Below the inferior pole of the thyroid in a pretracheal plane
    • A type F gland is frequently referred to as an ectopic gland:
      • Its resection usually involves:
        • Transcervical delivery of the thyrothymic ligament or superior portion of the thymus
  • Type G:
    • A gauge, true intrathyroidal gland location
Schematic representation of the nomenclature system for
localization of parathyroid adenomas. Anterior view (a); right lateral
view (b) of the superior thyroid pole is oriented to the left. The dotted
circle depicts the region where the recurrent laryngeal nerve is most at
risk
  • This nomenclature system has been designed that takes into account the pathologic position of the parathyroid glands (Figure):
    • Superior and inferior glands:
      • Are defined by the location of the gland’s pedicle and its relationship to the RLN:
        • Superior parathyroid glands:
          • Anatomically have a vascular pedicle superior and lateral to the RLN (type A through D glands)
        • Inferior parathyroid glands:
          • Anatomically have a vascular pedicle inferior and medial to the RLN (type D through F glands)
      • Type G glands:
        • Represent intrathyroidal parathyroid lesions
    • This information not only helps radiologists communicate potential parathyroid lesions of interest to surgeons:
      • But also helps surgeons direct their dissection in relation to the RLN

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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