THE THYROID GLAND

1. The thyroid gland is the lobulated,

butterfly
-shaped
and
highly
vascular
endocrine gland
located in the cervical region
where it clasps the upper part of
the trachea.
2. It spans vertebral C5 to T1
1. Reddish-brown in appearance and
weighing
about 25gm, it is made up of two

Each lobe measures about 5cm

rostrocaudally
and
has
three
surfaces (anterolateral, posterior
and medial) an upper pole (Its
apex) and a lower pole (The base).
Furthermore, each lobe extent
rostrocaudally from the oblique
line of the thyroid cartilage to the
sixth tracheal ring (Cartilage).
The entire gland is enclosed in a
fascial sheath
(The pretracheal fascia), which
attaches the gland superiorly to

 This
attachment
is
responsible
for
the
movement of the gland in the
process of swallowing and
phonation.
This is of clinical significance
in distinguishing a thyroid
mass from other cervical
masses. The latter will not
move during swallowing and
phonation.

Relations of the Thyroid Gland

The concave medial surface of each
lobe is related to:
1. Upper part of the trachea
2. Upper part of the esophagus
3. The recurrent laryngeal nerve lies
between the trachea and
esophagus
4. Cricoids cartilage
5. Thyroid cartilage
6. Cricothyroid muscle
7. Inferior constrictor muscle
8. External branch of the superior
laryngeal nerve

The posterior surface of each lobe is

related to:
1.The
parathyroid
glands
are
embedded in this surface
2.Prevertebral fascia
3.Longus colli muscle
4.The carotid sheath which encloses
the common carotid artery, the
vagus nerve and the internal jugular
vein.

The convex anterolateral surface of

each lobe is related to:
1.Sternothyroid muscle
2.Sternohyoid muscle
3.Omohyoid muscle Superior belly)
4.Medial
part
of
the
sternocleidomastoid muscle

 The narrow isthmus lies anterior

to the second to the fourth
tracheal cartilage. It is cover
anteriorly by the cervical fascia
and skin. A pyramidal lobe of the
gland may be attached to the left
aspect of the upper border of the
isthmus. This lobe is usually
attached to the hyoid bone by a
muscular or fibrous band referred
to as the Levator Thyroideae
Glandulae.

Development of the Thyroid Gland

The thyroid is the caudal expansion
of the Thyroglossal duct, an
epithelial down growth from the
junction of the first and second
pharyngeal
arches
(Foramen
caecum).
The duct runs anterior to the hyoid
bone, the thyroid and cricoids
cartilages.
It is firmly attached to the hyoid
bone and the segment between the
hyoid bone and the isthmus

Blood Supply and Venous Drainage of

the Thyroid gland
The thyroid gland is irrigated by (Fig:
2):
The inferior thyroid artery, the
largest branch of
the thyrocervical trunk of the
subclavian artery.
Branches of this artery approach the
gland from
its lower pole and supplies several
branches to
the posteroinferior aspects of the
gland
The superior thyroid artery, which is

The Thyroidae ima artery is the third

artery
which supplies the gland but only in
10% of the
population. It is a slender branch
that could
have as its parent trunk, the
brachiocephalic
trunk, the arch of the aorta, the right
common
carotid, right subclavian or the right
internal
thoracic arteries.
This artery runs upward anterior to
the trachea

Venous Drainage:
The thyroid gland is drained by three
pairs of
veins. These are:
The
superior
thyroid
vein
a
companion vein of
the superior thyroid artery drains
the superior
part of the gland into the internal
jugular vein
The middle thyroid vein which runs
parallel to
the inferior thyroid artery drains the
middle part

Lymphatic Drainage of the Thyroid

Gland
Lymph vessels are widely distributed
in the interlobular connective tissue
from
which
lymph
is
drained
superficially to a capsular network of
lymph vessels.
From the network, lymph is drained
into three groups of lymph nodes.
These are
Prelaryngeal nodes from which lymph
drains into superior deep cervical
nodes
Pretracheal nodes from which lymph
drains into inferior deep cervical
lymph nodes
Paratracheal lymph nodes from which

Innervation of the Thyroid Gland

The thyroid gland derives its
vasomotor fibres
from the superior, middle and
inferior cervical
sympathetic ganglia.
These
fibres
accompany
the
arteries of the
gland.
The
gland
is
devoid
of
secretomotor fibres since
the secretion of its hormone is

Microscopic Anatomy of the Thyroid

Gland
(Figs: 3 & 4)
The thyroid gland is invested in two
coats of connective tissue; an outer
pretracheal fascial sheath and an
inner thin fibrous capsule.
The inner capsule sends into the
substance of the gland connective
fibres which form the interlobular
septa of the thyroid gland.
Embedded in the septa are the
blood/lymphatic vessels and nerves

The lobules between the septa consist

of spheroidal-shaped follicles filled
with a homogeneous colloid material
of variable sizes.
The follicles are enclosed by a simple
cuboidal epithelial cell layer which is
supported by a basal lamina.
Furthermore, the follicles are filled
with Thyroglobulin which is the
storage form of Thyroxine (T4) and Triiodothyronine (T3).
About 90% of thyroid hormone is in
the form of T4 but the active form of
the hormone is T3

Synthesis, Storage and Release of

Thyroid hormones

An
active,
hormonesynthesizing/secreting
gland
is
characterized by the conversion of
cuboidal epithelial cell to tall columnar
epithelial cells.
A second types of cells (Thyroid C cells
or Parafollicular cell C) are also
encountered in the thyroid gland.
These
are
often
found
singly
intervening amongst the epithelial cells
or in clusters in the septa between the
follicles.
They are usually larger than the
epithelial cell but pale staining with
abundant granular cytoplasm.

CLINICAL CORRELATES
THYROTOXICOSIS: There are two
forms of the disease:
1
Nodular Hyperplasia:
A small number of follicular cells may
undergo
hyperplasia
leading
to
continuous synthesis and secretion
of thyroid home without a resting,
inactive phase.
This is referred to as Nodular
Hyperplasia of the thyroid gland.
This might present as an isolated

2. Graves disease (Diffuse

Hyperplasia):
1. This
is
characterized
by
the
production of auto antibodies to TSH
receptors, which act as Long-Acting
Thyroid Stimulator (LATS) which
continuously stimulates the entire
follicles
leading
to
excessive
secretion
of
thyroid
hormone
(Hyperthyroidism) and enlargement
of the gland (Goiter)
2. Graves disease is also accompanied
by inflammation and growth of

HYPOTHYROIDISM:
There
are
various
forms
of
Hypothyroidism which includes:
Iodine Deficiency Goiter in which there
is
inadequate consumption of iodine
leading to
Impaired secretion of thyroid hormone
leading to

Excessive secretion of thyroid

stimulating
hormone (TSH) leading to

Enlargement of the thyroid gland

(Goiter).
If this occurs from birth, it might lead to
cretinism (Hypothyroid
dwarfism or
Infantile Hypothyroidism)

Developmental Anomalies of the

Thyroid Gland:
An Ectopic thyroid gland may be
found within the
substance of the tongue (Lingual
Thyroid) or
At any point along the path of
descent of the
Thyroglossal duct or
In the thymus gland,
On the thyrohyoid muscle or
In the thorax (Accessory thyroid