ANA 301: GROSS ANATOMY OF
HEAD AND NECK, AND NEUROANATOMY
THYROID AND PARATHYROID GLADS
PROF EDWIN OJIMS EWUNONU
The Thyroid Gland
a vascular, reddish-
brown endocrine
organ.
responsible for
regulating metabolism
and calcium
homeostasis.
produces thyroxine
(T4) and
triiodothyronine (T3)
hormones.
Location and Position
in the midline of the lower part
of the anterior aspect of the
neck.
extends from the oblique line of
thyroid cartilage (at the level of
the C3-C4 vertebrae) to the 5th-
6th tracheal cartilage rings.
lies opposite to the C5, C6, C7
and T1 vertebral levels, anterior
to the trachea and larynx.
Structure of the Thyroid Gland
Shape:
Butterfly- or H-shaped - comprising two lateral lobes (right and left) connected by a central
isthmus.
A small pyramidal lobe may be present, extending upwards from the upper border of the
isthmus, slightly to the left of the midline.
The pyramidal lobe may be connected to the hyoid bone by a fibromuscular band
called levator glandulae thyroideae - a remnant of the embryonic thyroglossal duct.
Each lobe is conical, with an apex reaching up to the oblique line of the thyroid cartilage and
a base lying at the level of the 4th or 5th tracheal cartilage rings.
The isthmus crossing in front of the 2nd to 4th tracheal cartilage rings.
Dimensions of Thyroid gland
Weight: approximately 25 gms.
Length: Each lobe is 5 - 6 cm long.
Width: 3 cm (1.5-2 cm) wide.
Thickness: 3cm (2 -3 cm) thick.
The isthmus is 1.5-2 cm wide.
Coverings of the thyroid gland
enclosed in two capsules, an inner true capsule and an outer false capsule.
The Inner True Capsule:
A fibrous layer that intimately encloses the gland. It is formed by condensation of fibrous
stroma of the gland.
The Outer False Capsule:
formed by the pretracheal fascia,
provides additional support for the gland by connecting the gland to the trachea and larynx.
thickens on the medial surface of the lobes to form the Suspensory Ligament of Berry, which
attaches the lobes to the cricoid cartilage.
Ligament of Berry therefore stabilizes the gland in its position during swallowing and
breathing
Surfaces and borders
Each lobe of thyroid gland is pyramidal in shape and is characterized by:
An Apex (Upper pole): directed upwards and laterally and extends to the
oblique line of thyroid cartilage. It lies opposite to C5 vertebra.
A Base (Lower pole): extends up to the 5th or 6th tracheal cartilage ring, and
lies opposite to T1 vertebra.
Three Surfaces: lateral (superficial), medial and posterolateral
Two Borders: anterior and posterior
The Isthmus of thyroid gland has:
Two surfaces: anterior and posterior
Two borders: superior and inferior
Relations of Thyroid Gland
Apex (Upper lobe):
lies between the sternothyroid and inferior constrictor muscle of pharynx.
Superior thyroid artery and external laryngeal nerve diverge from each other
close to upper pole.
The artery is superficial and nerve lies deep to the upper pole.
Base (Lower pole):
related to inferior thyroid artery and recurrent laryngeal nerve.
Lateral (superficial) surface:
Sternohyoid, sternothyroid, superior belly of omohyoid and anterior border of
sternocleidomastoid.
Relations of Thyroid Gland cont.
Medial surface is related to:
Two tubes: trachea and oesophagus
Two muscles: inferior constrictor and cricothyroid
Two cartilages: cricoid and thyroid
Two nerves: external laryngeal and recurrent laryngeal
Posterolateral surface is related to:
Carotid sheath and its contents (common carotid artery, internal jugular vein
and vagus nerve).
Ansa cervicalis is embedded in the anterior aspect of carotid sheath.
Anterior border is thin and is related to:
anterior branch of superior thyroid artery.
Relations of Thyroid Gland cont.
Posterior border is thick and rounded and is related to:
parathyroid glands and anastomosis between superior and inferior thyroid
arteries.
Isthmus of thyroid gland has following relations:
Anterior surface is related to sternothyroid and sternohyoid muscles and
anterior jugular veins.
Posterior surface is related to 2nd -4th tracheal rings.
Superior border is related to anastomosis between anterior branches of
superior thyroid arteries.
Inferior border is related to inferior thyroid veins that leave isthmus along
this border.
BLOOD SUPPLY
BLOOD SUPPLY
Superior thyroid artery:
It supplies upper 2/3rd of the lobe and upper ½ of the isthmus
a branch of external carotid artery.
Descends down to the upper pole of lateral lobe of thyroid gland
accompanied by external laryngeal nerve (the nerve diverges from the
artery near the upper pole).
At the apex of lateral lobe, it divides into anterior and posterior branches
Anterior branch descends along anterior border and anastomoses with
the its fellow of opposite side along the superior border of isthmus
Posterior branch descends along posterior border and anastomoses with
the ascending branch of inferior thyroid artery.
Blood Supply
Inferior thyroid artery:
A branch of thyrocervical trunk
passes behind the carotid sheath and descends to reach the base
of thyroid gland
Near the base (lower pole) the artery is very close to recurrent
laryngeal nerve
supplies the lower 1/3rd of the lobe and lower half of the
isthmus.
Thyroideaima artery:
Not always present
It is a branch of brachiocephalic trunk or arch of aorta
Ascends in front of trachea to supply the isthmus
Venous Drainage
Venous Drainage
3 pairs of veins.
arise from the venous plexus deep to the true capsule of thyroid gland.
do not accompany arteries.
Superior thyroid veins :
emerge at the upper pole of thyroid gland
drains into the internal jugular vein.
Middle thyroid veins:
short veins that emerge at the middle of the lobe of thyroid gland
drain in internal jugular vein.
Venous Drainage cont.
Inferior thyroid veins:
emerge at the lower border of isthmus
descend in front of trachea
Anastomose with each other to form plexus in front of trachea
drain into left brachiocephalic vein.
Vein of Kocher:
Sometimes a fourth vein (Vein of Kocher) emerges between the middle and
inferior thyroid veins
drains into internal jugular vein.
Lymphatic Drainage
Pre-laryngeal (Located near
the cricothyroid membrane)
and upper deep cervical
lymph nodes: drain
the upper part of thyroid
Pretracheal, paratracheal
and lower deep cervical
lymph nodes: drain
the lower part of thyroid
gland
Nerve Supply
Sympathetic Innervation
Derived from the cervical sympathetic ganglia.
Controls the vasomotor tone of the blood vessels.
Parasympathetic Innervation
From branches of the vagus nerve, including the recurrent laryngeal nerve.
Note: Recurrent laryngeal nerve lies close to the inferior thyroid artery and is
at risk during thyroid surgery.
Histology
Follicles:
spherical structures lined by
follicular cells.
contain colloid, which stores
thyroglobulin, the precursor of T3
and T4.
Parafollicular Cells (C-Cells):
secrete calcitonin, a hormone
involved in calcium homeostasis.
Applied Anatomy
Goiter: Enlargement of the thyroid gland due to iodine deficiency or autoimmune
diseases such as Graves' disease. Patients with large goitre present with classical symptoms of
Dysphonia (hoarseness of voice), Dysnoea (difficulty in breathing), Dysphagia (difficulty in swallowing).
Thyroidectomy: Surgical removal of the thyroid gland. Care must be taken to preserve the
recurrent laryngeal nerve and parathyroid glands.
Thyroid Nodules: Benign or malignant growths within the thyroid tissue. Ultrasound and
fine-needle aspiration cytology are used for evaluation.
Thyroiditis: Inflammation of the thyroid gland, often caused by autoimmune conditions
such as Hashimoto's thyroiditis.
Thyroglossal Cyst: A midline neck swelling resulting from persistent remnants of the
thyroglossal duct
Clinical Correlations
The venous plexus is located deep to the true capsule. Therefore, the thyroid gland is
removed together with the true capsule during thyroidectomy.
Superior thyroid artery is close to the external laryngeal nerve in the upper pole, and they
diverge near the apex of lateral. Therefore, during thyroidectomy the superior thyroid
artery should be ligated close to the apex to avoid injury to the external laryngeal.
Inferior thyroid artery is very close to the recurrent laryngeal nerve near the base/lower
pole of the thyroid gland. Therefore, during thyroidectomy it should be ligated away from
the inferior pole of thyroid gland to avoid injury to the recurrent laryngeal nerve.
Partial Thyroidectomy: posterior part of thyroid lobes are left behind to avoid removal of
parathyroid glands which otherwise may result in tetany.
Cretinism and Myxedema: Hypofunction of thyroid in infants and children is
called cretinism and in adults, is called myxedema.
