DEVELOPMENT & STRUCTURE OF THYROID GLAND DR TATHEER ZAHRA ASSISTANT PROFESSOR ANATOMY

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2 DEVELOPMENT & STRUCTURE OF THYROID GLAND DR TATHEER ZAHRA ASSISTANT PROFESSOR ANATOMY

3 DEVELOPMENT OF THYROID Concept of pharyngeal arch

4 3 rd week 4 th week Adults 7 th week

5 HISTOGENESIS OF THYROID GLAND DEVELOPMENT OF FOLLICULAR CELLS 7 TH WEEK: Solid cord of cells breaks into network of epithelial cells as invaded by vascular mesenchyme 10 TH WEEK: Cellular groups formation, Lumen formation 11 TH WEEK: Colloid formation 20 TH WEEK: level of TSH, Adult levels by 35 th week

6 DEVELOPMENT OF PARAFOLLICULAR CELLS 4 th or 5 th pharyngeal pouch Ultimobranchial body Neural crest cells origin

7 Ultimopharyngeal body / Ultimobranchial body

8

9 AGENESIS OF THE THYROID GLAND Defective development of thyroid gland ~ Congenital hypothyroidism i.e. Cretinism No central cause related to Hypothalamic-Pituitary axis Absence of gland or one of its lobes ~ Rare anomaly Thyroid Hemiagenesis ~ Left lobe most commonly Mutations in the receptors for TSH is involved in some cases

10 PYRAMIDAL LOBE 40% population Usually to the left of midline Levator glandulae thyroideae Innervated by branch of external laryngeal nerve

11

12 THYROGLOSSAL DUCT CYSTS Asymptomatic ~ unless the lesion become infected Painless, progressively enlarging swelling Appear in childhood, adolescence or young adults Treatment: Surgery with removal of hyoid bone

13 POSSIBLE LOCATIONS OF THYROGLOSSAL CYSTS

14 THYROGLOSSAL SINUS & FISTULA

15 ABERRANT/ ECTOPIC THYROID GLAND

16 ACCESSORY THYROID TISSUE

17 GROSS STRUCTURE OF THYROID Only endocrine gland to store its secretions Location & extent Shape Length: 5 cm Width: 2.5 cm Weight: g True Capsule Pretracheal fascia covering

18 RELATIONS OF THE LOBES ANTEROLATERALLY POSTEROLATERALLY MEDIALLY

19

20 RELATIONS OF THE ISTHMUS ANTERIORLY POSTERIORLY

21 WHY SWELLINGS OF THYROID GLAND MOVE WITH SWALLOWING?

22 THYROID GLAND & AIRWAY

23 ARTERIAL SUPPLY Superior thyroid artery (Anterior & posterior branches) Inferior thyroid artery Stroma richly vascularized Vessels lie between true & false capsule

24

25

26 RELATIONSHIP OF NERVES WITH THYROID ARTERIES & THEIR DAMAGE Superior Thyroid Artery Ligation: Close to gland Inferior Thyroid Artery Ligation: Lateral to gland

27 INJURY TO THE RECURRENT & NON RECURRENT LARYNGEAL NERVES Blood accumulation and serous exudate after the operation ~ Pressure effects & nerve compression Non-recurrent laryngeal nerve (due to lack of normal subclavian artery) 1% incidence ~ Possible hazard in thyroidectomy

28 A:Weakness of voice B: Speech not greatly affected; Hoarseness of voice; temporary aphonia or disturbance of phonation (voice production) and laryngeal spasm C: Impaired breathing, speech lost D: Greater degree of paralysis of abductors E: Dyspnea & stridor; Needs cricothyroidotomy or tracheostomy

29 VENOUS DRAINAGE

30

31 LYMPHATIC DRAINAGE PRETRACHEAL PRELARYNGEAL PARATRACHEAL DEEP CERVICAL NODES THORACIC DUCT

32 NERVE SUPPLY SUPERIOR CERVICAL SYMPATHETIC GANGLIA MIDDLE CERVICAL SYMPATHETIC GANGLIA INFERIOR CERVICAL SYMPATHETIC GANGLIA Periarteriolar nervous plexus:vasomotor not secretomotor Hypothalamic control of secretion

33 FUNCTIONS & REGULATION OF SYNTHESIS OF THYROID HORMONES

34

35 ENLARGEMENT OF THYROID GLAND PHYSIOLOGICAL (e.g., during menstruation & pregnancy) PATHOLOGICAL e.g., GOITER (HYPOTHYROIDISM/ HYPERTHYROIDISM)

36 HYPOTHYROIDISM CONGENITAL HYPOTHYROIDISM/ CRETINISM IODINE DEFICIENCY GOITER/ ENDEMIC THYROID AUTOIMMUNE/ HASHIMOTO S THYROIDITIS ADULT HYPOTHYROIDISM/ MYXEDEMA

37 HYPERTHYROIDISM/ TOXIC GOITER/ GRAVES DISEASE Exophthalamic goiter Autoantibodies Treatment options: Surgery Radiotherapy Radioactive iodine ingestion

38 EXTENT & MECHANICAL EFFECTS OF GOITER Attachment of sternothyroid muscle Limits upward extension No limit to downward expension behind sternum Enlarges anteriorly, posteriorly, inferiorly, or laterally Retrosternal or substernal more common Compression of trachea ~ Dyspnea Severe venous compression

39 SURGICAL APPROACH OF THYROID GLAND TRANSVERSE INCISION IN A LOW SKIN CREASE ON THE FRONT OF NECK VERTICAL DIVISION OF INVESTING FASCIA RETRACTION / DIVISION OF STERNOHYOID & STERNOTHYROID MUSCLES DIVISION OF PRETRACHEAL FASCIA TO EXPOSE GLAND PROPER

40 LOBECTOMY & ISTHUMUSECTOMY

41 TOTAL THYROIDECTOMY

42 NEAR TOTAL & SUBTOTAL THYROIDECTOMY

43 SURFACE ANATOMY OF THYROID GLAND Extent of gland: C5-T1 Vertebrae Isthmus: 2 nd, 3 rd & 4 th tracheal rings

44 MICROSTRUCTURE OF THE THYROID GLAND PARENCHYMA STROMA FOLLICULAR/ PRINCIPAL CELLS PARAFOLLICULAR/ C CELLS 3D VIEW OF THYROID FOLLICLES

45 PARENCHYMA & STROMA

46 FOLLICULAR CELLS PRINCIPAL/ CHIEF CELLS

47 PARAFOLLICULAR CELLS C CELLS/ CALCITONIN CELLS

48 HYPOACTIVE & HYPERACTIVE VS. EUTHYROID STAGE Hypoactive stage: Simple squamous epithelium lined follicle filled with colloid Hyperactive stage: Simple columnar epithelium lined follicle with in colloid Euthyroid stage: Simple cuboidal epithelium + colloid The height of the follicular cells is directly proportional to the glandular activity.

49 REFERENCES The Developing Human, Clinically Oriented Embryology, By KEITH L. MOORE - Latest Edition LANGMAN S Embryology, By T.W.SADLER - Latest Edition LAST S Anatomy Regional & Applied, By CHUMMY S. SINNATAMBY - Latest Edition Clinically Oriented Anatomy, By KEITH L. MOORE - Latest Edition Clinical Anatomy By Regions, By RICHARD S. SNELL - Latest Edition Basic Histology Text & Atlas, By LUIZ CARLOS JUNQUEIRA & JOSÃ CARNEIRO - Latest Edition

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