Thyroid Anatomy

Stephanie Johnson PGY 2 ENT

Background
What: brownish-red, highly vascular gland brownish Location: ant neck at C5-T1, overlays 2nd C54th tracheal rings  Avg width: 12-15 mm (each lobe) 12 Avg height: 50-60 mm long 50 Avg weight: 25-30 g in adults (slightly 25more in women) **enlarges during menstruation and pregnancy** 

Background Pyramidal lobe:  often ascends from the isthmus or the adjacent part of either lobe (usu L) up to the hyoid bone  may be attached by a fibrous/fibromuscular band levator levator of the thyroid gland .

Transverse view: relationship to other NB structures in neck .

iodothyroglobulin (precursor of thyroid hormones).Structure    Under middle layer of deep cervical fascia (pretracheal) thyroid inner true capsule thin and closely adherent to the gland capsule extensions within the gland form septae. dividing it into lobes and lobules lobules are composed of follicles = structural units of the gland layer epithelium enclosing a colloid-filled cavity colloid-  colloid (pink on H&E stain) contains an iodinated glycoprotein. .

.Structure   Follicles = variable size surrounded by dense plexuses of fenestrated capillaries. lymphatic vessels. and sympathetic nerves.

light).Structure Epithelial cells = 2 types:  principal (ie: follicular) formation of colloid (iodothyroglobulin)  parafollicular (ie: C cells -clear. lie adjacent to follicles w/in basal lamina produce calcitonin .

SCM (lower portion) ** careful .  .sternohyoid  Inferior .omohyoid muscle .Relation w/ Strap muscles Lateral .sternothyroid  Anterior .motor nerve supply from the ansa cervicalis enters these muscles inferiorly.

only when R aortic arch and ligamentum arteriosum concurrent w/ L retroesophageal subclavian artery. .branches fr X at ~ cricoid cartilage directly enters the larynx without looping around SC L sided .Recurrent laryngeal nerve    Recall: innervates all larynx except cricothyroid Closely assoc with ITA (see next slides for details) NB: non recurrent LN ~5/1000 pt s on R side When retroesophageal R SCA from dorsal aortic arch NRLN .

Vascular Anatomy .ARTERIAL: ARTERIAL:  superior and inferior thyroid arteries (occ thyroidea ima)  ++ collateral anastomoses (ipsi and anastomoses contralaterally)  thyroid ima (when pres) originates from aortic arch or innominate artery. enters the thyroid at inferior border of isthmus.

Vascular Anatomy .

Vascular Anatomy SUPERIOR THYROID ARTERY    first anterior branch ECA descends laterally to the larynx under the omohyoid and sternohyoid muscles runs superficially on the anterior border of the lateral lobe. sending a branch deep into the gland before curving toward the isthmus where it anastomoses with the contralateral artery .

ext branch of SLN runs w/ STA before turning medially supply cricothyroid muscle **careful when ligating artery** .Vascular anatomy SUPERIOR THYROID ARTERY: Relationship with SLN:  Cephalad to the superior pole.

Vascular anatomy INFERIOR THYROID ARTERY SCA   thyrocervical trunk ITA ITA ascends vertically and then curves medially to enter the tracheoesophageal groove (posterior to carotid sheath) Branches penetrate the posterior aspect of the lateral lobe .

Relationship with RLN:  RLN ascends in the TE groove and enters the larynx b/w the inferior cornu of the thyroid cartilage and the arch of the cricoid  RLN can be found after it emerges from the superior thoracic outlet: Sup: thyroid lobe Lat: common carotid artery Medial: trachea Vascular anatomy .

relationship between RLN and ITA highly variable (Redd.Vascular anatomy **Careful . 1943 described 28 variations) Examples:  Deep to ITA (40%)  superficial (20%)  b/w branches of the artery (35%) **also only 17% of the time is the nerve/artery relationship the same on both sides **at level ITA extralaryngeal branches RLN present 5% of the time .

Vascular anatomy VENOUS: 3 pairs of veins: 1) STV asc along STA and becomes a tributary of the IJV 2) MTV directly lateral IJV 3) ITV (variable): R passes ant to innominate a R BCV or ant trachea L BCV L drainage L BCV **occ both inf veins form a common trunk thyroid ima vein empties into L BCV .

multidirectional flow periglandular prelaryngeal (Delphian) pretracheal paratracheal (along RLN) brachiocephalic (sup mediastinum) deep cervical thoracic duct NB: regional mets of thyroid carcinoma are superior and lateral.  .Lymphatics   Extensive. of the pretracheal and paratracheal LNs and obstruction of normal lymph flow. along IJV ie: invasion lateral.

Lymphatics .

and inferior ganglia of the sympathetic trunk Enter the gland along with the blood vessels. . middle.Innervation Principally from ANS  Parasympathetic fibers from vagus  Sympathetic fibers from superior.

com Gray s anatomy http://www.gov/books/ bv.330 Netter s anatomy .fcgi?rid=endocrin.com www.nih.box.emedicine.nlm.ncbi.utdol.References: 1) 2) 3) 4) 5) 6) Schwartz www.

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