Thyroid Gland

Consists of right and left lobe connected by a narrow isthmus

Vascular organ surrounded by a sheath derived from the pretracheal layer of
deep fascia. This sheath attaches the thyroid gland to the larynx and trachea
and this explains why the thyroid gland follows the movement of larynx while
swallowing
Each lobe is pear shaped
Apex: directed upward as far as the oblique line on the lamina of the thyroid
cartilage
Base: lies below the level of the 4th or 5th tracheal ring
Blood Supply
o Superior thyroid artery, branch of the external carotid artery,
descends to the upper pole of each lobe, accompanied by the external
laryngeal nerve
o Inferior thyroid artery, branch of the thyrocervical trunk of the
subclavian artery, ascends behind the gland to the level of the cricoid
cartilage. It is closely related to the recurrent laryngeal nerve
o Thyroidea ima, if present may arise from the brachiocephalic artery
or arch of the aorta. Ascends in front of the trachea to the isthmus
o A venous hum may be audible over the thyroid area
consequent to a marked increase in blood supply to the
hypertrophic gland
Sustained TSH stimulation leads to the long-term effects of
hypertrophy and hyperplasia of follicular cells. Capillaries
proliferate, and thyroid blood flow increases. These actions,
which underlie the growth-promoting effects of TSH on the
gland, are supported by the local production of growth factors
Palpation

Auscultation

Ultrasound

Normal
Not visible, usually
not palpated

No abnormal sounds
are heard

Vary
from
individual
to
individual but
each
lobe
approximately
measures
4
cm
Homogenous
appearance

Graves Disease
Diffusely
enlarged
thyroid gland can be
palpated, palpable thrill
(feels like a vibration) is
noted
Thyroid bruit is audible
which is usually present
in the upper and lower
poles
Enlarged
thyroid
gland
Heterogeneous
appearance
With
color
Doppler, shows a
pulsatile
pattern
known as thyroid
inferno.
This

pattern consists of
multiple
small
areas
of
intrathyroidal flow
seen
diffusely
throughout
the
gland.
This hyper
vascularity is due
to
capillary
proliferation
in
the thyroid gland.