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THYROID GLAND

By: Kathleen Kaye A. Luceara


THYROID GLAND
GOITER

Latin Guttur (Throat)

An enlargement of the
thyroid gland

Embryology
Primitive foregut: 3 WEEKS AOG
Origin: Foramen Cecum
Endoderm cells (floor of pharyngeal anlage):
Medial Thyroid Anlage to form (1) Hyoid and
(2) Larynx
Connection: Thyroglossal Duct
Epithelial cells of anlage becomes the Thyroid
Follicular Cells
Embryology
Paired lateral anlage are neurectodermal in
origin fuse with median anlage becomes
Parafollicular or C cells
Apparent by 8 WEEKS
Produce colloid by 11 WEEKS

Embryology
Developmental Abnormalities
(1) Thyroglossal Duct Cyst and Sinuses

Most commonly encountered
5 WEEKS gestation begins to become
OBLITERATED
8 WEEKS completely OBLITERATED
Occurs anywhere in the path of the thyroid
80% in juxtaposition to the HYOID BONE
Asymptomatic but frequently become infected
Developmental Abnormalities
Thyroglossal Duct Cyst and Sinuses

HISTOLOGY:
pseudostratified ciliated columnar epithelium and
squamous epithelium with heterotopic thyroid tissue
(20% of the time)
DIAGNOSIS:
1 to 2 cm, smooth, well-defined MIDLINE neck mass
that moves upward with protrusion of the tongue
Thyroid imaging not done routinely, thyroid
scintigraphy and ultrasound done to detect thyroid
tissue
Developmental Abnormalities
Thyroglossal Duct Cyst and Sinuses

TREATMENT:
Sistrunk operation: en bloc cystectomy and excision of
the central hyoid bone to prevent recurrence.
MALIGNANT TENDENCY:
1% found to have cancer most common type
PAPILLARY (85%)
Medullary CA NOT FOUND in Thyroglossal Duct Cysts

Developmental Abnormalities
(2) Lingual Thyroid

Failure of the median thyroid anlage to descend
INTERVENTION needed with signs of obstruction:
Choking
Dysphagia
Airway obstruction
MEDICAL TREATMENT:
Administer exogenous thyroid hormone to suppress TSH
Radioactive iodine (RAI) ablation followed by hormone
replacement
SURGICAL MANAGEMENT:
Rarely needed but if needed check for thyroid tissue in the neck
Developmental Abnormalities
(3) Ectopic Thyroid

Normal thyroid tissue found anywhere in the neck
compartment
Aortic arch
Aortopulmonary window
Pericardium
Interventricular septum
Lateral Aberrant Thyroid: Lateral to carotid sheath
and jugular vein METASTATIC THYROID CANCER
in lymph nodes (Papillary Thyroid Cancer)
Developmental Abnormalities
(4) Pyramidal Lobe

Thyroglossal duct
atrophies
50%- distal end
persists connected to
isthmus

THYROID ANATOMY
GROSSLY:

COLOR :Brown
CONSISTENCY :Firm
LOCATION :Behind strap muscles
WEIGHT :20 grams
LOBES :adjacent to thyroid cartilage
connect in midline to the
isthmus, cc inferior to the
cricoid cartilage
CAPSULE: :thin, adherent fibrous layer
condensed into a posterior
suspensory (Berrys) ligament

THYROID ANATOMY
DRAINAGE:
1. Superior and middle thyroid
vein drain to the internal
jugular vein
2. inferior thyroid vein drains
into the brachiocephalic veins
THYROID ANATOMY
BLOOD SUPPLY:
1. Superior thyroid arteries from
the external carotid arteries
divide to Anterior and
Posterior Branches
2. Inferior thyroid arteries from
thyrocervical trunk travel
upward POSTERIOR to carotid
sheath enter at the midpoint
3. Thyroidea Ima aorta or
innominate artery (1 4%)0
THYROID ANATOMY
NERVES:
1. LEFT RLN from vagus nerve
at its intersection with the
aortic arch, ascends at the
tracheoesophageal groove
2. RIGHT RLN from vagus
nerve at its intersection with
the right subclavian artery,
more oblique the left.

***Terminate at the larynx post
to cricothyroid muscle
NERVES:
Innervate all INTRINSIC
muscles except Cricothyroid
Muscles
INJURY
One RLN normal but weak
voice
Both RLN airway obstruction
Superior laryngeal Nerve
(external branch) cannot reach
high-pitched sounds
THYROID ANATOMY
LYMPHATIC DRAINAGE:
Levels
Regions
THYROID HISTOLOGY
FOLLICLES
Number : 20 40 per lobule
Size : 30m in diameter
Lining : Simple cuboidal epithelial cells
Content : Colloid under the inf. of TSH

C CELLS
Hormone : Calcitonin



THYROID PHYSIOLOGY
IODINE METABOLISM
average daily iodine requirement 0.1mg from:
1. Fish
2. Milk
3. Eggs
4. Additives in bread or salt
Absorbed in STOMACH and JEJUNUM
Converted to Iodide
Active transport into the THYROID FOLLICLES
THYROID: 90% of iodine in the body; 1/3 of plasma
iodine loss
CLERANCE: Renal

THYROID PHYSIOLOGY
THYROID HORMONE SYNTHESIS, SECRETION and
TRANSPORT

THYROID PHYSIOLOGY
THYROID HORMONE SYNTHESIS, SECRETION and
TRANSPORT
1. Iodide trapping NIS, TSH
2. Oxidation of iodide to iodine and iodination of tyrosine
residues
3. Coupling of two DIT (form T4) or a DIT and a MIT (form T3)
(Thyroid Peroxidase)
4. Thyroglobulins are hydrolyze to form Free T3 andT4
5. Deiodination of T4 recycle iodide and reused in the
thyrocyte
6. Deiodination at periphery via 5-mono-deiodinase
THYROID PHYSIOLOGY
THYROID HORMONE SYNTHESIS, SECRETION and
TRANSPORT

THYROID PHYSIOLOGY
HYPOTHALAMIC, PITUITARY, THYROID AXIS

NOTE:

- Pituitary has the ability to
convert T4 to T3
- T3 is more important in the
feedback control
- T3 can also inhibit TRH
release
THYROID PHYSIOLOGY
HYPOTHALAMIC, PITUITARY, THYROID AXIS

Thyroid Autoregulation:

- With LOW IODINE INTAKE produces more T3 than T4
- Iodine Excess thyroid hormone secretion is inhibited
- Excessively large doses of IODIDE increased
organification, suppression Wolffe-Chaikoff Effect
- Epinephrine and HCG - stimulate Thyroid Hormone
Production
- Glucocorticoids - inhibit thyroid hormone production
THYROID PHYSIOLOGY
THYROID HORMONE FUNCTION
Nuclear receptors
Thyroid hormone receptors are tissue specific
Alpha Central NS
Beta Liver
T3 Function:
Increase oxygen consumption
Increase basal metabolic rate
Heat production
Positive inotropic and chronotropic effect (inc. Ca Atpase)
Increased beta-adrenergic receptors
THYROID PHYSIOLOGY
THYROID HORMONE FUNCTION

Other functions:
Maintain normal hypoxic and hypercapnic drive in the
respiratory center
Increase GI motility
Increase bone and protein turnover
Increased speed of muscle contraction and relaxation
Increased glycogenolysis, gluconeogenesis, intestinal
glucose absorption, cholesterol synthesis and degradation