Thyroid

Anatomy
Stephanie Johnson
PGY 2
ENT
 Background

 What: brownish-red, highly vascular gland

 Location: ant neck at C5-T1, overlays 2 nd –
4th tracheal rings
 Avg width: 12-15 mm (each lobe)
 Avg height: 50-60 mm long
 Avg weight: 25-30 g in adults (slightly
more 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” of the thyroid gland
Transverse view:
relationship to other NB
structures in neck
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 (pink on H&E stain) contains an iodinated glycoprotein,

iodothyroglobulin (precursor of thyroid hormones).
Structure

 Follicles = variable size

 surrounded by dense plexuses of
fenestrated capillaries, lymphatic
vessels, and sympathetic nerves.
Structure

Epithelial cells = 2 types:

 principal (ie: follicular) – formation of
colloid (iodothyroglobulin)
 parafollicular (ie: C cells -clear,
light), lie adjacent to follicles w/in
basal lamina  produce calcitonin
Relation w/ Strap
muscles
 Lateral - sternothyroid
 Anterior
- omohyoid muscle
- sternohyoid
 Inferior - SCM (lower portion)

** careful - motor nerve supply from the

ansa cervicalis enters these muscles
inferiorly.
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 - branches fr X at ~ cricoid cartilage
– directly enters the larynx without looping
around SC
– L sided - only when R aortic arch and
ligamentum arteriosum concurrent w/ L
retroesophageal subclavian artery.
 Vascular Anatomy
ARTERIAL:
 superior and inferior thyroid arteries (occ
thyroidea ima)
 ++ collateral anastomoses (ipsi and
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
Vascular anatomy

SUPERIOR THYROID ARTERY:

Relationship with SLN:
 Cephalad to the superior pole, ext
branch of SLN runs w/ STA before
turning medially  supply cricothyroid
muscle

**careful when ligating artery**

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
 Vascular anatomy
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
**Careful - relationship between RLN and ITA highly variable
(Redd, 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
Lymphatics
 Extensive, 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, along IJV ie: invasion
of the pretracheal and paratracheal LNs and
obstruction of normal lymph flow.
Lymphatics
Innervation

Principally from ANS

 Parasympathetic fibers – from vagus

 Sympathetic fibers – from superior,

middle, and inferior ganglia of the
sympathetic trunk
Enter the gland along with the blood
vessels.
References:

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