Thyroid gland Anatomy, Histology and Embryology

DR. DARWISH H. BADRAN

Anatomy of the thyroid gland

DR. DARWISH H. BADRAN

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Lies in front and sides of the neck.

Consists of two lobe connected anterior to the trachea by an isthmus, weighs 10-20 gm.

A small pyramidal lobe projects upwards from the left lobe in 40% of cases.

The pyramidal lobe is connected to the hyoid bone by fibrous band, that may contain few smooth muscle fibres; levator glandulae thyroidae.

Each lobe is conical in shape having:

Apex: rests on thyroid cartilage, and reaches its oblique line. Base: reaches 5-6 tracheal ring. Isthmus: lies on tracheal rings 2-4.
DR. DARWISH H. BADRAN

Surfaces and relations.. 1 Anterolateral (superficial) surface

Rounded and covered by:

Skin, superficial fascia including the platysma muscle. Pretracheal fascia Infrahyoid muscles except thyrohyoid. Anterior border of sternocleidomastoid.
Omohyoid

Thyrohoid

Sternothyroid

Sternohyoid

DR. DARWISH H. BADRAN

Surfaces and relations.. 2 Medial surface

Slightly concave and related to:

Thyroid and cricoid cartilages. Cricothyroid and inferior pharyngeal constrictor muscles. Trachea and esophagus. External laryngeal and recurrent laryngeal nerves.
DR. DARWISH H. BADRAN

Surfaces and relations.. 3 posterior surface

Related to:
Common carotid artery in front of the longus coli muscle. Parathyroid glands. Inferior thyroid artery.
DR. DARWISH H. BADRAN

Arterial supply of the thyroid gland..1

Superior thyroid artery:
The 1st branch from the anterior aspect of the external carotid artery. Supplies the upper 1/3 of the thyroid lobe and upper of the isthmus. Runs with the external laryngeal nerve for part of its course and then diverges away close to the gland.
DR. DARWISH H. BADRAN

Arterial supply of the thyroid gland..2

Inferior thyroid artery:
Branch from the thyrocervical trunk from the 1st part of the subclavian artery. Supplies the lower 2/3 of the thyroid lobe and lower of the isthmus. Forms a loop before it reaches the gland, its branches are related to the recurrent laryngeal nerve.
DR. DARWISH H. BADRAN

Arterial supply of the thyroid gland..3

Thyroidea ima artery:
An occasional branch that is rarely seen. If present it supplies the isthmus. It originates directly from the aortic arch or the brachiocephalic artery. If accidently cut during surgery it retracts to the thorax.
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Venous drainage of the thyroid gland

Superior thyroid vein:
Drains the apex of each lobe jugular or common facial vein.

Middle thyroid vein:

Drains the lateral aspect of the lobes internal jugular vein.

Inferior thyroid vein (or veins):

Drains the basal part of the gland brachiocephalic vein.
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Lymphatic drainage of the thyroid gland

Prelaryngeal nodes: in front of the cricothyroid muscle. Pretracheal nodes: in front of the trachea. Paratracheal nodes: alongside the trachea. Upper and lower deep cervical nodes: alongside the internal jugular vein. Brachiocephalic nodes: in the superior mediastinum.
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Histology of the thyroid gland

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Thyroid follicle:
The structural and functional unit of the thyroid gland. Consists of a group of cells resting on the same basal lamina surrounding a lumen filled with colloid. The follicles are roughly spherical and variable in size. Hormones are stored in the follicles. Each follicle is surrounded by variable amount of connective tissue, which is highly vascular.
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Follicular epithelium contains two types of cells:

Follicular cells (principal cells)

DR. DARWISH H. BADRAN

Parafollicular cells (C cells)

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Follicular cells (principal cells):

Squamous-columnar cells according to activity. Basophilic cytoplasm. Nucleus: round-ovoid with 2 nucleoli. Supra-nuclear Golgi, many rER. Supranuclear Golgi complex. Apical microvilli. Numerous vesicles, mitochondria and lysosomes are seen in in the apical cytoplasm.
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Parafollicular cells (Clear cells, C cells):

Pale staining, larger than follicular cells. Occur singly or in and included in the same basal lamina of the follicle. Overlapped by follicular cells. E.M: Moderate rER. Well-developed Golgi. small, dense, basal secretory granules. Secrete calcitonin: Inhibits bone resorption by osteoclasts. Stimulated when Ca2 is high.
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Thyroid gland function is essential to normal growth and development.

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T3 and T4 are synthesized and secreted by follicular cells. Both hormones:

Regulate cell and tissue basal metabolism Regulate heat production Influence body growth and development
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Parafollicular cells synthesize and secrete calcitonin, which

Physiologic antagonist to parathormone Has an important role in regulating serum calcium It lowers calcium level by suppressing the resorptive action of osteoclasts and promotes calcium deposition in bones.

High calcium blood level stimulate calcitonin secretion

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Calcitonin is secreted by several endocrine tumors; that is why it is considered as a tumor marker to monitor the progress of certain tumors. Calcitonin is used to treat certain bone diseases (osteoporosis, Pagets disease) No disease has been associated with its deficiency or even its absence after thyroidectomy.

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Synthesis of T3 and T4
Regulated by:
Iodide level in the follicular cells. Binding of TSH to its receptors on follicular cells.

Thyroglobulin is synthesized on rER. Glycosylation of thyroglobulin occurs on rER and Golgi. Vesicles are transported to apical plasmalemma. Vesicular content is released into the colloid and stored in the lumen.

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Steps of T3 and T4 formation and release

Synthesis of thyroglobulin.
Resorption, diffusion, and oxidation of iodide. Iodination of thyroglobulin. Formation of T3 and T4. Resorption of colloid. Release of T3 and T4.
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Iodine is reduced to iodide in the alimentary canal.

Iodide is transported to the thyroid gland.

Iodide is actively absorbed at the basal part of the cell. In the cytoplasm iodide is oxidized in the presence of H2O2. Activated iodide enters colloid iodination of tyrosine residues of thyroglobulin.
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Release of T3 and T4

Binding of TSH on the basal plasmalemma of follicular cells formation of apical filopodia endocytosis of colloid cleavage of thyroglobulin by proteases transfer to cytoplasm as T1, T2, T3, T4.
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Thyroid disorders

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Embryology of the thyroid gland

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The thyroid gland is the first of the body's endocrine glands to develop, on approximately the 24th day of gestation.

It originates as a proliferation of endodermal epithelial cells on the median surface of the developing pharyngeal floor which lies between 2 key structures, the tuberculum impar and the copula, and is known as the foramen cecum.

It initially develops inferior to the tuberculum impar, which is also known as the median tongue bud. This embryonic swelling arises from the first pharyngeal arch and occurs in the midline on the floor of the developing pharynx, eventually helping form the tongue as the 2 lateral lingual swellings overgrow it.
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The foramen cecum begins rostral to the copula, also known as the hypobranchial eminence. This median embryologic swelling consists of mesoderm that arises from the second pharyngeal pouch (although the third and fourth pouches are also involved). The thyroid gland, therefore, originates from between the first and second pouches.

The initial thyroid precursor, the thyroid primordium, starts as a simple midline thickening and develops to form the thyroid diverticulum. This structure is initially hollow, although it later solidifies and becomes bilobed.

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The initial descent of the thyroid gland occurs anterior to the pharynx while the thyroid is still connected to the tongue via the thyroglossal duct. The tubular duct later solidifies and subsequently obliterates entirely (during gestational weeks 7-10). The foramen cecum represents the opening of the thyroglossal duct into the tongue. A pyramidal lobe of the thyroid may be observed in ~ 60% of cases. This lobe represents a persistence of the inferior end of the thyroglossal duct that has failed to obliterate. Further descent of the thyroid gland carries it anterior (or ventral) to the hyoid bone and, subsequently, anterior (or ventral) to the laryngeal cartilages.

As the thyroid gland descends, it forms its mature shape, with a median isthmus connecting 2 lateral lobes.
The thyroid completes its descent in the seventh gestational week, coming to rest in its final location immediately anterior to the trachea.

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Parafollicular (C cells) are a special subset of cells within the thyroid gland that secrete calcitonin.

The parafollicular cells arise from the ultimobranchial body. This body represents the last structure derived from the branchial pouches, hence its name.

The ultimobranchial body arises from the fifth pharyngeal pouch, which is alternately described as the ventral portion of the fourth pharyngeal pouch. (Whether fifth pharyngeal pouches actually exist is debatable.) Migrating cells from the neural crest region infiltrate the ultimobranchial body. This structure is then incorporated into the thyroid gland, as the ultimobranchial body fuses with the thyroid gland and disseminates its cells into it. The C cells of the thyroid, therefore, are of neural crest origin
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The superior parathyroid glands are also known as parathyroid IVs because they arise from the dorsal wing of the fourth pharyngeal pouch, differentiating at gestational weeks 5-6.
At gestational week 7, the glands lose connections with the pharynx and attach themselves to the thyroid gland, which is migrating caudally, albeit far less a migration than the thymus (with parathyroid IIIs as described above). Because of the lesser length of migration, the superior parathyroid glands (IV) are in a more constant location than the inferior parathyroids (III). The superior parathyroids are generally located more posterior and medial than the inferior parathyroids, and their final resting point is usually on the dorsal surface of the thyroid gland, outside the fibrous capsule of the thyroid gland.

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The inferior parathyroid glands are also known as parathyroid IIIs because they arise from the dorsal wing of the third pharyngeal pouch. The third brachial pouch differentiates at gestational weeks 5-6, with the ventral wing becoming the thymus. The thymus and parathyroids both lose their connections to the pharynx at gestational week 7. The thymus then migrates caudally and medially, pulling the parathyroids with it; therefore, parathyroid IIIs are further inferior than are parathyroid IVs. The parathyroid in turn loses its connection with the thymus. The inferior parathyroid glands usually stop at the dorsal surface of the thyroid gland, outside of the fibrous capsule of the gland itself

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