Anatomy of the thyroid

gland
By Idy Umoh
Introduction
• The thyroid gland is an endocrine structure located in the neck.
• It plays a key role in regulating the metabolic rate of the body.
Anatomical Location
The thyroid is a highly vascular, brownish-red gland
 located anteriorly in the lower neck,
extending from the level of the fifth cervical vertebra down to the
first thoracic
• The thyroid gland is located in the anterior neck and spans the C5-T1
vertebrae.
• It consists of two lobes (left and right), which are connected by a
central isthmus anteriorly – this produces a butterfly-shape
appearance.
• The lobes of the thyroid gland are wrapped around the cricoid
cartilage and superior rings of the trachea.
• The gland is located within the visceral compartment of the neck
(along with the trachea, oesophagus and pharynx).
• This compartment is bound by the pretracheal fascia.
• The thyroid gland is a butterfly-shaped organ composed of two lobes,
left and right, connected by a narrow tissue band, called an "isthmus".
• It weighs 25 grams in adults, with each lobe being about 5 cm long,
3 cm wide, and 2 cm thick and the isthmus about 1.25 cm in height
and width.
• The gland is usually larger in women than in men, and increases in
size during pregnancy
• The gland varies from an H to a U shape and is formed by 2 elongated
lateral lobes with superior and inferior poles connected by a median
isthmus, with an average height of 12-15 mm, overlying the second to
fourth tracheal rings.
• The isthmus is encountered during routine tracheotomy and must be
retracted (superiorly or inferiorly) or divided.
• Occasionally, the isthmus is absent, and the gland exists as 2 distinct
lobes
• The thyroid is near the front of the neck, lying against and around the front of the larynx and
trachea.
• The thyroid cartilage and cricoid cartilage lie just above the gland, below the Adam's apple.
• The isthmus extends from the second to third rings of the trachea, with the uppermost part of
the lobes extending to the thyroid cartilage and the lowermost around the fourth to sixth
tracheal rings.
• The infrahyoid muscles lie in front of the gland and the sternocleidomastoid muscle to the side.
• Behind the outer wings of the thyroid lie the two carotid arteries.
• The trachea, larynx, lower pharynx and esophagus all lie behind the thyroid.
• In this region, the recurrent laryngeal nerve and the inferior thyroid artery pass next to or in the
ligament.
• Typically, four parathyroid glands, two on each side, lie on each side between the two layers of
the thyroid capsule, at the back of the thyroid lobes.[
• The thyroid gland is covered by a thin fibrous capsule, which has an
inner and an outer layer.
• The inner layer extrudes into the gland and forms the septa that
divide the thyroid tissue into microscopic lobules.
• The outer layer is continuous with the pretracheal fascia, attaching
the gland to the cricoid and thyroid cartilages via a thickening of the
fascia to form the posterior suspensory ligament of thyroid gland, also
known as Berry's ligament.
• This causes the thyroid to move up and down with the movement of
these cartilages when swallowing occurs.
Anatomical Relations ( Summary)
• The thyroid gland is closely associated with numerous other
structures in the anterior neck:
• Anteriorly – infrahyoid muscles, namely the sternothyroid, superior
belly of the omohyoid and sternohyoid
• Laterally – carotid sheath, containing the common carotid artey,
internal jugular vein and vagus nerve
• Medially –
• Organs – larynx, pharynx, trachea and oesophagus
• Nerves – external laryngeal and recurrent laryngeal
Vasculature Arterial Supply
The thyroid gland secretes hormones directly into the circulation and is
highly vascularised.
Arterial Supply
• The arterial supply to the thyroid gland is via two main arteries:
1 Superior thyroid artery –
It arises as the first branch of the external carotid artery.
 It lies in close proximity to the external branch of the superior
laryngeal nerve (innervates the larynx).
2 Inferior thyroid artery –
It arises from the thyrocervical trunk (a branch of the subclavian artery).
It lies in close proximity to the recurrent laryngeal nerve (innervates the
larynx).
3 thyroid ima artery
In a small proportion of people (around 10%) there is an additional
artery present.
 It arises from the brachiocephalic trunk and
supplies the anterior surface and isthmus of the thyroid gland.
• The thyroid is supplied with arterial blood from
1. the superior thyroid artery, a branch of the external carotid artery,
2. the inferior thyroid artery, a branch of the thyrocervical trunk, and
3. the thyroid ima artery, an anatomical variant, which has a variable
origin.
• The superior thyroid artery splits into anterior and posterior branches
supplying the thyroid,
• the inferior thyroid artery splits into superior and inferior branches.
• The superior and inferior thyroid arteries join behind the outer part of
the thyroid lobes
Venous Drainage

• Venous drainage is carried by

The Principal innervation of the thyroid gland derives from the autonomic nervous system.
1. Parasympathetic fibers come from the vagus nerves,
2. sympathetic fibers are distributed from
 the superior,
 middle, and
 inferior ganglia of the sympathetic trunk.
• These small nerves enter the gland along with the blood vessels.
• Autonomic nervous regulation of the glandular secretion is not clearly understood, but most
of the effect is postulated to be on blood vessels, hence the perfusion rates of the glands.
• The thyroid gland is innervated by branches derived from the sympathetic trunk.
• These nerves do not control the secretory function of the gland – the release of thyroid
hormones is regulated by the pituitary gland
Lymphatic Drainage

• The lymphatic drainage of the thyroid is to the paratracheal and deep cervical
nodes.
• Lymphatic drainage of the thyroid gland involves
 the lower deep cervical,
 prelaryngeal,
 pretracheal, and
paratracheal nodes.
• The paratracheal and lower deep cervical nodes, specifically, receive lymphatic
drainage from the isthmus and the inferior lateral lobes.
• The superior portions of the thyroid gland drain into the superior pretracheal and
cervical nodes.
Clinical Significance
Many disease processes can involve the thyroid gland,
 Alterations in the production of hormones can result in hypothyroidism or hyperthyroidism.
 The thyroid gland is involved in inflammatory processes (e.g., thyroiditis),
 Autoimmune processes (e.g., Graves disease), and
 Cancers (e.g., papillary thyroid carcinoma, medullary thyroid carcinoma, and follicular carcinoma).
Recurrent Laryngeal Nerve
• The left and right recurrent laryngeal nerves lie in close proximity to the thyroid gland and care
must be taken not to damage them during thyroid surgery.
• They branch from their respective vagus nerve within the chest and hook around the right
subclavian artery (right RL nerve), or the arch of aorta (left RL nerve).
• The recurrent laryngeal nerve then travels back up the neck, running between the trachea and
oesophagus in the tracheoesophageal groove. It then passes underneath the thyroid gland to
innervate the larynx.
Thyroglossal Cyst
• In the embryo, the thyroid gland begins development near the base of the tongue – in an
area known as the foramen cecum. It descends during development and reaches its
destination in the anterior neck by week 7.
• The descent of the developing thyroid gland forms the thyroglossal duct – an epithelialised
tract that connects the gland to its origin at the foramen cecum. It usually regresses by the
10th week of gestation, but can persist in some individuals. If it fails to regress, the duct can
give rise to cysts or fistulae.
• A thyroglossal cyst results from a build-up of secretions within the duct. It typically presents
as a midline lump in the anterior neck which rises on tongue protrusion. If left untreated, this
cyst can become infected, and form a cutaneous fistula – discharging out onto the skin of the
anterior neck.
• Thyroglossal cysts and fistulae are usually treated with complete excision. Recurrence is
quoted at approximately 2.5%.