The Undescended “Parathymus” An Occasional Cause of Failed Neck Exploration for Hyperparathyroidism

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Abstract
Arrested descent of the inferior parathyroid gland (parathymus) during embryologic development may leave the gland stranded high in the neck. Adenomas of such undescended glands are a rare cause of primary hyperparathyroidism but they may not be uncommon among patients who have already had a failed cervical exploration. Unless the surgeon is aware of this entity, he will probably over-look it. If one is to find these tumors, it is necessary to extend the dissection upward above the superior pole of the thyroid gland, sometimes as far as the angle of the jaw. Adenomas of undescended parathymus glands were encountered in 7 patients during a recent 20 mo. (May 1975-Dec. 1976) surgical experience encompassing 414 primary operations and 27 reoperations for hyperparathyroidism. These tumors were found at initial expoloration in 1 patient and at reoperation in 6 patients. The individual case histories are presented to illustrate the difficulties posed by this anatomic variant.