THYROID – ANATOMY &

PHYSIOLOGY
D SREEKAR
• Endocrine gland in the lower part of the front and
sides of the neck.
• Parts – Right and left lobes, isthmus , pyramidal
lobe.
Extent

• Lobes = middle of thyroid cartilage to 4th/5th

tracheal ring.
• Isthmus = 2nd to 4th rings.
• Vertebral level – C5 – T1.
• Weight = 25gms
• Capsule – TRUE – peripheral connective tissue.
Contains dense capillary plexus.
FALSE – Pre tracheal layer of deep cervical fascia –
Suspensory ligament of Berry which connects to
cricoid cartilage
Relations
DEVELOPMENT
• Starts from late 4th week of
gestation as an ENDODERMAL
proliferation at the apex of
FORAMEN CECUM as MEDIAN
THYROID DIVERTICULUM.
• Descends at the end of
THYROGLOSSAL DUCT.
• Reaches inferior to Cricoid by
7th week.
• PARAFOLLICULAR CELLS
develop from neural crest cell
and reach thyroid by
ULTIMOBRANCHIAL bodies
derived from 4th pharyngeal
pouch.
• Gland begins to function by
12th week.
HISTOLOGY
BLOOD SUPPLY

In 3% of individuals –
Thyroidea ima artery
which arises from
brachio cephalic trunk
or arch of aorta.

Accessory thyroid
arteries arise from
tracheal and
oesophageal arteries.
Venous
drainage

Superior and middle

thyroid veins drain
into IJV.

Inferior thyroid vein

drains into Brachio
cephalic vein.

Fourth thyroid vein of

Kocher between
middle and inferior
veins drains into IJV.
Recurrent
laryngeal nerves
Branches of Vagus
nerve

Right – Right Subclavian

Left – Arch of Aorta

The left nerve has more

distance to reach the
tracheo oesophageal
groove and therefore
runs in a medial plane.
On the right it runs
obliquely as there is less
distance.
Runs posterior to
thyroid and enters
larynx at
cricothyroid joint
at Berry’s ligament.

Highest risk of
injury at this point.

2% on the right are

non recurrent.
BEAHR’S
TRIANGLE
• In the tracheo
oesophageal groove

• Medial – Nerve
• Lateral – Common
carotid artery
• Supeior – Inferior
thyroid artery

Lies under the Tubercle

of Zuckerkandl.
SUPERIOR
LARYNGEAL
NERVE

• Arises from the vagus nerve.

• Lies in close proximity to Superior

thyroid artery.

• Divides into internal and external

branches.

• Supplies Cricothyroid and Mucosa

of Larynx above the vocal cords.
CERNEA
CLASSIFICATION

TYPE 1 – >1 cm above

the superior pole.

TYPE 2a - <1cm above

the superior pole.

TYPE 2b – crosses
below the superior
pole.
EMBRYOLOGIC
AL REMNANTS

• Thyroglossal tract
(thyroglossal cyst
and pyramidal lobe)

• Tubercle of
Zuckerkandl

• Thyrothymic rests
 Thyroglossal tract remnants
• Lingual thyroid – most common ectopic thyroid –
arrest of descent

• Inferior end of the duct fails to obliterate –

Pyramindal lobe

• Thyroglossal cyst can form along the line of descent.

• Sub hyoid – most common location.

 The forgotten tubercle
• Derived from 4th branchial pouch, the ultimobranchial
body.
• Most posterior side of each lobe in close relation to RLN
and Superior parathyroids.
• RLN lies in deeper fibrous layer, teritiary branches of
superior thyroid artery (tubercle and parathyroid) lie in
superficial vascular fascial layer antero lateral to the
nerve.
• Enlargement of the tubercle can attribute to the
pressure symptoms.
 Thyrothymic rests
• Continued descent of thyroid beyond the lower
pole into mediastinum.
• Mistaken for lymphnodes or parathyroids.
• 80% - attached to thyroid gland
• 20% - completely separate

• Majority are <1cm and at risk of being left behind.

• Can enlarge and form retro sternal goitres.

Physiology
Hypothalamus – TRH
Thyrotrophs of Ant.
Pituitary – TSH
TSH receptor on
Thyroid – T4 and T3

T4 and T3 have
negative feedback on
Pituitary and
Hypothalamus

Somatostatin also
inhibits secretion of
TSH from Pituitary
 HORMONE
SYNTHESIS
Iodine transported -
Sodium iodide symporter

Oxidation of Iodine

Organification of Iodine –
TPO

Coupling – TPO

Releases T3 and T4 by
proteolysis of Tg.
• Transported in bound form to Thyroxin binding
globulin, Transthretin and Albumin.
Peripheral conversion of T4 to more potent T3
occurs by Deiodinase at 5’ position.
• Deiodination at 5 position yields RT3 which is
biologically inactive.

• RT3 is increased during gestation, malnutrition,

chronic disease and surgical stress.

• T3 binds to Nuclear receptors (TR alpha and beta) –

alters the production of mRNA – physiological
effects.
 Functions
• Increases the Basal Metabolic Rate.
• Increases Heart rate, cardiac output and repiratory
rate.
• Potentiates the action of catecholamines.
• Catabolism of proteins and carbohydrates.
• Maintains the bone matrix.
• Brain development.
• Endometrial thickening in females
Calcitonin
References

• Bailey and Love’s Short Practice of Surgery, 27th e

• Guyton and Hall textbook of Medical Physiology
• Embryological remnants of thyroid gland and their significance in
Thyroidectomy
THANK YOU