A detailed knowledge of gross anatomy is mandatory for the surgeon who is to
operate on the thyroid gland.
The thyroid gland consists of right and left lobes connected by a narrow isthmus.
It is a very vascular organ, normally accounting for 5% of the cardiac output.
measured in liters per minute (l/min). The amount of blood that is put out by the
left ventricle of the heart in one contraction is called thestr oke volume. The
stroke volume multiplied by the heart rate is the cardiac output. A normal adult's
heart can easily pump 4.7 liters of blood a minute.
It is surrounded by a sheath derived from the pretracheal layer of deep fascia.
The sheath attaches the gland to the larynx and the trachea and so moves with
these structures on swallowing.
Each lobe is pear-shaped and the isthmus extends across the midline in front of
the 2nd, 3rd and 4th tracheal rings.
The larynx, trachea, the pharynx and esophagus.
In the groove between the esophagus and the trachea is the recurrent laryngeal
nerve which must be preserved during thyroid surgery.
The rounded posterior border of each lobe is related posteriorly to the superior
and inferior parathyroid glands.
The superior thyroid artery, which is the first branch of the external carotid
artery, supplies the superior pole of the thyroid.
The inferior thyroid artery, which arises from the thyrocervical trunk as a branch
of the subclavian artery, supplies the lower pole of the gland.
A thyoidea ima artery occasionally arises from the aortic arch and connects to
the thyroid isthmus inferiorly.
The superior thyroid and middle thyroid veins drain into the internal jugular
The inferior thyroid veins drain into the internal jugular vein or into the
The recurrent laryngeal nerve runs in the tracheooesophageal groove in intimate
relationship to the posteromedial aspect of the thyroid gland.
On the right, the nerve recurs around the subclavian artery and runs an oblique
course from the lateral to medial, crossing the inferior thyroid artery before
entering the tracheooesophageal groove.
On the left, the nerve recurs around the aortic arch in the mediastinum and runs a
course parallel to the tracheooesophageal groove throughout its course in the
Injury to the recurrent laryngeal nerve most commonly occurs where the nerve
crosses the inferior thyroid artery or where it penetates the cricothyroid
membrane but injury can occur anywhere along its course.
Superior laryngeal nerve
The nerve is intimately intertwined with the branches of the superior thyroid
artery. The superior laryngeal nerve can be injured during mobilization of the
upper pole especially when the lobe is enlarged.
Injury results in voice weakness and can be avoided by ligation of the branches
of the superior thyroid artery at their junction with the gland rather than along
the course of the artery in the neck.
The thyroid gland develops from the thyroglossal duct. As development
continues the duct elongates and its distal end becomes bilobed. The duct
becomes a solid cord and migrates down the neck. By the seventh week it
reaches its final position in relation to the larynx and trachea. Meanwhile, the
solid cord connecting the thyroid gland to the tongue breaks up and disappears.
The site of origin of the thyroglossal duct on the tongue remains as a pit called
the foramen cecum.
The follicular cells produce the thyroid hormones T3 and T4.
Iodine and tyrosine combine to form T3 and T4. Both of these hormones bind
with thyroglobulin and are stored on the gland until released onto the
Release is under the control of TSH from the pituitary and TRH (thyrotropin
releasing hormone) from the hypothalamus.
A feed-back mechanism regulating T3, T4 release is related to the level of
circulating T3 and T4.
The thyroid hormones activate energy-producing respiratory processes, resulting
in an increase in the metabolic rate and an increase in oxygen consumption.
Increased glycogenolysis results in a rise in blood sugar.
The thyroid hormones also enhance metabolic, circulatory and somatic neuro-
muscular actions of catecholamines.
The result is:
-an increase in the pulse rate, cardiac output and blood flow
-nervousness, irritability, muscular tremor and muscle wasting can also occur
-these effects can be blocked by the use of beta-blockers.
The parafollicular or C cells produce thyrocalcitonin. The principal physiologic effect of thyrocalcitonin is to lower serum calcium and phosphate concentrations through the inhibition of osteoclastic activity with a resulting reduction in both bone resorption and the release of calcium and phosphate into the extracellular fluid. In the kidney, thyrocalcitonin accelerates calcium, phosphate and sodium excretion.
1. Agenesis of the thyroid gland may occur and is the commonest cause of
cretinism. Cretinism is arrested physical and mental development due to
congenital lack of thyroid secretion.
2. Incomplete descent of the thyroid gland may occur and the thyroid may be
found at any point between the base of the tongue and the trachea.
Lingual thyroid is the commonest form of incomplete descent.
It may be the only functioning thyroid tissue in the individual.
3. A thyroglossal duct may appear in childhood or young adults. It is due to a
persistence of a segment of the thyroglossal duct. The cyst occurs in the midline
of the neck at any point along the thyroglossal tract.
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