THYROID GLAND y y The thyroid gland is situated lower down at the front of the neck It has 2 symmetrical lobes

that are united by an isthmus that lies in front of the 2nd, 3rd and 4th rings of the trachea. The lobes lie on either side of the larynx and trachea and extend from the oblique line of the thyroid cartilage to the 6th ring of the trachea. y y The gland is covered by a capsule and also enclosed by an envelope of pre-tracheal fascia. Lateral lobes: Each lobe is pear-shaped; has a narrow upper pole and a broader lower pole Appears triangular in cross-section with medial, lateral and posterior surfaces. Lateral/ superficial surface: under the sternothyroid and sternohyoid Medial surface: lies against the lat side of the larynx and the upper trachea; the lower pharynx and upper esophagus are immediately behind it. This surface is also related to the cricothyroid muscle and the inferior constrictor muscle of the pharynx and the external & lateral recurrent laryngeal nerves. Posterior surface: overlaps the medial part of the carotid sheath (the part containing the carotid artery) The parathyroid glands usually lie in contact w/ this surface, betw this surface and the fascial sheath. The posteromedial aspects of the lobes are attached to the side of the cricoids cartilage by a lateral thyroid lig (the suspensory ligament of Berry) y Isthmus: Joins the ant surfaces of the lobes towards their lower poles The posterior surface of the isthmus is firmly adhered to the 2nd, 3rd, 4th rings of the trachea with the pretracheal fascia fixed between them. The fixing of the pretracheal fascia and the investment of the entire gland by the fascia is responsible for the gland moving up and down with the larynx during the process of swallowing. An anastomosis betw the 2 sup thyroid arteries runs across the upper border of the isthmus; tributaries of the inf thyroid veins emerge from the lower border A small portion of the gland projects upwards from the isthmus generally to the left of the midline and forms the pyramidal lobe it represents a development of glandular tissue from the caudal end of the thyroglossal duct. It may be attached to the inf border of the hyoid bone by fibrous tissue. Muscle fibres are sometimes present in it: levator glandulae thyroideae (from the body of the hyoid to the isthmus or pyramidal lobe). These are innervated by the external laryngeal n.

Relations

Ant: Ant branch of the sup thyroid artery

Pos: -

Ext laryngeal n. Recurrent laryngeal n.

Anterolat: Sternothyroid Sternohyoid Ant. Border of SCM Sup belly of Omohyoid

Esophagus Pharynx

Pos surface of gland: Inf thyroid art anastomosis w/ pos branch of the sup thyroid art Parathyroid glands

Medially: Larynx Trachea Inf constrictor mus of pharynx Pos part of cricothyroid Pos part of the thyroid lamina & side of cricoid cart

Posterolat: Carotid sheath

Relationship of the Recurrent Laryngeal N. to the gland This relationship is very imp in thyroid surgery As the nerves approach the med surface of the gland from below, they lie in or in front of the groove betw the trachea and the esophagus. Left n: recurves around the arch of aorta in sup mediastinum Right n: recurves around the right subclavian ar. at the root of the neck and may be more lat to the trachea Each nerve is behind the pretracheal fascia, and runs medial/lateral/through a thickening of the fascia attached to the cricoid cartilage and upper tracheal rings i.e. the suspensory lig of Berry. Nerve runs behind the cricothyroid joint and passes upwards under the inf constrictor At the level of the upper border of the isthmus, nerve often divides into 2: Ant (larger branch) motor branch to laryngeal musc Pos branch sensory only Blood supply Sup Thyroid Artery - st branch from the ant aspect of the external carotid -> pierces the pretracheal fascia as a single vessel to the reach the summit of the upper pole. - Artery divides on the gland to give off: Anterior branch -> runs down the isthmus & supplies ant surface of gland Posterior branch -> supplies the posterior surface of the gland & anastomoses w/ the ascending branch of the inf thyroid artery from the lower pole. - The external laryngeal n is immediately behind the artery as it approaches the upper pole. Inf Thyroid Artery - From the thyro-cervical trunk - Arches upward and medially behind the carotid sheath -> loops downwards to the lower pole - Divides outside the pre-tracheal fascia into: Supplies the pos & inf surfaces of Inferior/ Descending branches the gland - Ascending branch supplies the parathyroid glands - Closely related to the Recurrent Laryngeal N. Thyroid ima artery - Enters the lower part of the isthmus in 3% of ppl - Arises from the brachiocephalic trunk, arch of aorta or R. common carotid art Venous Drainage Superior/Ascending branches

Sup Thyroid Vein - Arises from the venous plexus on the surface of the gland - Follows the sup thyroid artery -> enters the IJV or facial V.

Middle Thyroid Vein - Crosses ant to the common carotid artery (CCA) -> drains into IJV Inferior Thyroid Vein - Arise from glandular venous plexus - Connects w/ the sup and middle thyroid v. - Drain downwards into L. brachiocephalic v. Lymph drainage - Lymphatics drains mainly into the Deep cervical nodes - Few pass into the pre-laryngeal, pre & paratracheal nodes - Few drain directly into the thoracic duct Innervation - Sympathetic (vasoconstrictor) nerves from the sup, middle and inf cervical ganglia - Postganglionic fibres along the arteries to the gland

PARATHYROID GLANDS y y y Normally lies behind the lobes of the thyroid gland There are usually 4 glands, 2 on each side. Each weighing approx 50mg Structure - Gland is a mass of small closely packed chief or principal cells that secretes parathyroid hormone (PTH). - Mass of cells resembles lymphoid tissue superficially but a clear distinction is shown by the presence of a number of blood capillaries in the gland Superior gland - more constant in position - usually w/in the pre-tracheal fascial capsule of the thyroid at the middle of the back of the thyroid lobe; level with the 1st ring of the trachea and above the inf thyroid artery Inferior gland

- Less constant in position - Usually w/in the pre-tracheal fascial sheath behind the lower pole but position may vary: below the inf thyroid arteries, near the inferior lobar poles, or outside the sheath, immediately above the inf thyroid artery or in the gland near the inf pole. Glands are yellowish-brown in color can be easily distinguished from the deep red color of the thyroid gland. y y Glands are also easily subjected to subcapsular hematoma formation upon handling Blood Supply - Both the upper and lower parathyroids are supplied by the inf thyroid artery or by an anastomosis betw the superior and inferior thyroid arteries. Venous Drainage - The minute veins join the thyroid veins and drain into the plexus of veins on the ant surface of the thyroid. Lymph Drainage - Numerous lymph vessels present associated w/ the lymph vessels of the thyroid gland and the thymus Innervation Nerve supply is by sympathetic vasoconstrictor fibres that enter w/ the arteries Sympathetic supply is either direct from the superior or middle cervical ganglia or via a plexus in the fascia on the pos lobar aspects The activity of the parathyroid gland is controlled by variations in the level of calcium in the blood : Activity is inhibited by a rise of Ca2+ & stimulated by a fall in Ca2+

y -