Anatomy of the Thyroid Gland
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1 Anatomy of the Thyroid Gland
2 Introduction Nomenclature G, thyreos= shield, eidos= like Location Root of the neck ventrally (C5-T1) Function endocrine gland that secretes: Thyroxine (T4) T3 Calcitonin LWW, Grant s Atlas of Anatomy, 11 th edition
3 Structure of Thyroid Gland Butterfly-shaped organ - 2 lobes (wings) lobus dexter (Rt.) lobus sinister (Lf.) cone-shaped str. Apex oblique line of thyroid cartilage Base 5 th or 6 th tracheal ring - Isthmus (G, a narrow passage) connects the 2 lobes
4 Isthmus of Thyroid Gland - Passes anterior to 2-4 th tracheal rings - Encompasses a cranially extending thyroid tissue, usually left to midline Pyramidal Lobe* ( 50%) - A fibromuscular band connects the pyramidal lobe to hyoid bone is frequently present. - Muscular part Levator Glandulae Thyroideae* Gray s Anatomy, Fig *embryological remnants of the thyroglossal duct
5 Fascial Covering of Thyroid Gland 2 coverings External: pretracheal layer of deep cervical fascia (Visceral part) Internal: Thin fibrous capsule Capsula fibrosa glandulae thyroideae Attaches the gland posteriorly to: cricoid cartilage & upper tracheal rings
6 Relations of the Thyroid Gland Anterolateral Relations Posterior Relations Medial Relations
7 Anterolateral: Relations of the Thyroid Gland sup. Belly of omohyoid (upper) ant. border of SCM (lower) sternohyoid & sternothyroid muscles (middle)
8 Relations of the Thyroid Gland Medial: thyroid & cricoid cartilages (upper) upper 6 tracheal rings (lower) Essential Clinical Anatomy, 3 rd edition, Fig.8.8.A
9 Posterolateral: Carotid sheath Relations of the Thyroid Gland Posterior: inf. thyroid a. parathyroid glands Posteromedial: recurrent laryngeal n. LWW, Grant s Atlas of Anatomy, 11 th edition
10 Vasculature of Thyroid Gland
11 1. Superior Thyroid Artery: Arterial Blood Supply Arises from ECA Reaches sup. aspect of gland divides ant. & post. Branches 2. Inferior Thyroid Artery: Arises from Subclavian a. Essential Clinical Anatomy, 3 rd edition, Fig.8.9.B Reaches the post. aspect of gland
12 LWW, Grant s Atlas of Anatomy, 11 th edition LWW, Grant s Atlas of Anatomy, 11 th edition
13 3. Thyroid Ima Artery: (ima= L, lowest) 10% Origin varies (commonly from?) Ascends in front of trachea isthmus *clinical relevance to tracheostomy Essential Clinical Anatomy, 3 rd edition, Fig.8.9.B * Thyroid a. anastomose profusely over the surface of the gland between external and internal fascial coverings
14 Venous Drainage of Thyroid Gland Thyroid venous plexus 3 pairs of veins 1. Superior Thyroid Vein: Upper part IJV 2. Middle Thyroid Vein: Middle part IJV 3. Inferior Thyroid Vein: Lower part brachiocephalic veins (behind manubrium) *sometimes anastomose with each other plexus thyroideus impar Essential Clinical Anatomy, 3 rd edition, Fig.8.9.C
15 Clinical Anatomy by Regions, 8 th edition, Fig
16 Lymphatic Drainage of Thyroid Gland Lymphatic plexus on the surface of the gland drains through lymphatic vessels into: Superiorly prelaryngeal L.N. Inferiorly pretracheal L.N. Medially paratracheal L.N. Laterally inf. Deep cervical L.N. *Ends up deep cervical L.N.
17 Innervation of Thyroid Gland Autonomic nervous control Sympathetic: - Superior, middle & inferior cervical sympathetic ganglia - Reaches through sup. + inf. Thyroid periarterial plexuses Parasympathetic: - Vagus nerve (X) - Reaches via sup. & recurrent laryngeal n. *Autonomic innervation is mainly vasomotor endocrine secretion is hormonally regulated by pituitary gland
18 Clinical Notes: Thyroidectomy & Risks of Surgery to the Gland
19 Thyroidectomy Indications: The surgical removal of thyroid gland Thyroid cancer Goiter: enlargement of the thyroid gland 90% iodine deficiency extending retrosternal &/or compression on nearby structures Benign nodules or cysts Graves disease: autoimmune disease that affects the thyroid gland causing it to enlarge & become overactive autoantibodies bind and activate TSH receptors
20 Risks of Surgery on Thyroid Gland 1. Recurrent laryngeal nerve dysphonia (unilateral) impaired breathing (bilateral) 2. Postoperative Bleeding: 2 a. + 3 v. * hemorrhage can be confined within the space surrounded by pretracheal fascia compress the difficulty in breathing suffocation trachea 3. Parathyroid glands: inadvertent removal serum Ca2+ Tetany
21 Tetany involuntary muscle spasm due to hypocalcaemia Opisthotonus, painting by Sir Charles Bell, 1809
22 Short Clinical Case (Homework) As an ER resident, a patient who was exposed to a car accident was admitted to your department with a broken mandible and obstructed upper airway. Your first aim is to maintain the patient breathing by applying a tracheostomy procedure. Based on the this fact, please answer the following questions: 1. What are the soft tissues that you need to cut through in order to reach the trachea? 2. What is the preferred tracheal site for tracheostomy? 3. What procedures will you adopt to protect the thyroid isthmus and thyroid ima artery if present?
1. Thyroxine (inactive form) also called T4 (90% of the secretion). 2. Triiodothyronine (active form) also called T3 (10% of the secretion).
A Introduction The nomenclature of the thyroid gland comes from its close relation to the thyroid cartilage (the thyroid cartilage was named like this because thyroid means shield and it is shielding the
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