Thyroid gland

Dr.

Sara Al-Ghanem intern from KFU

Objectives

SIZE of Thyroid gland

The thyroid gland weighs 10 to 20 grams in

normal adults.
Thyroid volume measured by ultrasonography
(US) is slightly greater in men than women
it increases with age and body weight.
it decreases with increasing iodine intake.
The thyroid is one of the most vascular organs in
the body. Thus, US measurements of thyroid
volume and even nodule size can differ markedly
from the size after devascularization and
resection.

Its location & relations

The normal thyroid gland is immediately caudal
to the larynx and encircles the anterolateral
portion of the trachea.
The thyroid is bordered by the trachea and
esophagus medially and the carotid sheath
laterally.
The sternocleidomastoid muscle and the three
strap muscles (sternohyoid, sternothyroid, and
the superior belly of the omohyoid) border the
thyroid gland anteriorly and laterally

Shape
It consists of two lobes connected by
a narrow isthmus.
Each lobe is pyramidal in shape, with
its apex directed upward and its base
directed downward.
The isthmus is the narrow part of
the gland connecting the two lobes.
A small pyramidal lobe projecting
upward from the isthmus is often
present to the left of the midline.

BLOOD SUPPLY
The arterial blood supply to the thyroid
gland is primarily from the right and left
superior and inferior thyroid arteries,
derived from the external carotid arteries
and thyrocervical trunk, respectively.
The venous drainage consists of the
superior, middle, and inferior thyroid
veins that drain into the internal jugular
vein and innominate vein

 Superior thyroid artery is the first branch off

the external carotid artery. It extends inferiorly to
the superior pole of the thyroid lobe.
In addition to supplying the thyroid, the superior
thyroid artery is the primary blood supply to
approximately 15 percent of superior parathyroid
glands.
The superior thyroid artery is a landmark for
identification of the superior laryngeal nerve,
which courses with the artery until approximately
1 cm from the superior thyroid pole

 Inferior thyroid artery

is a branch of the
thyrocervical trunk which arises from the subclavian
artery.
The inferior thyroid artery courses posterior to the carotid
artery to enter the lateral thyroid. The point of entry can
extend from superior to inferior thyroid poles.
The inferior thyroid artery also supplies the inferior
parathyroid glands and approximately 85 percent of
superior parathyroid glands.
The RLN may course anterior or posterior to the inferior
thyroid artery. In some cases, the RLN may branch into
both an anterior and posterior position.

 Thyroidea ima artery is found in

approximately 3 percent of individuals and
arises from the aortic arch or innominate
artery and courses to the inferior portion of
the isthmus or inferior thyroid poles.
Surgical control of the thyroidea ima artery
is essential during thyroidectomy.
The thyroidea ima artery can be quite
enlarged in patients with thyroid disease
such as goiter or hyperthyroidism

Venous drainage
Superior thyroid vein:

It arises from the upper part of the lobe.

It ends into the internal jugular vein.

Middle thyroid vein:

It arises from the middle of the lobe.

It ends into the internal jugular vein.

Inferior thyroid veins:

Arise from the isthmus and lower parts of the

lobes.
Descend in front of the trachea.
End into the left brachiocephalic vein.

Lymphatic drainage
The lymphatic vessels of the thyroid gland drain into:

1) Pretracheal lymph nodes.

2) Paratracheal lymph nodes.
- The efferent of these nodes drain
into
the deep cervical lymph nodes.

Thyroid Physiology
Synthesis of the thyroid
hormone
Trapping of inorganic iodide from
the blood
.Oxidation of iodide to iodine
Binding of iodine with tyrosine to
.form iodotyrosines
Coupling of mono-iodotyrosines
and di-iodotyrosine to form T3,
T4

Synthesis of the thyroid hormone

The metabolic effects of the thyroid

hormones are due to unbound T4
.and T3
T3 is the more important and is also
produced in the periphery by
.conversion from T4
T3 is quick acting (within a few hours)

REGULATION
OF THYROID
HORMONE
PRODUCTION

Thyrotropin-releasing hormone (TRH)

increases the secretion of thyrotropin (TSH),
which stimulates the synthesis and secretion
of trioiodothyronine (T3) and thyroxine (T4) by
the thyroid gland.
T3 and T4 inhibit the secretion of TSH, both
directly and indirectly by suppressing the
release of TRH.
T4 is converted to T3 in the liver and many
other tissues by the action of T4
monodeiodinases.
Some T4 and T3 is conjugated with
glucuronide and sulfate in the liver, excreted
in the bile, and partially hydrolyzed in the
intestine.

Effects of Thyroid
Hormone

Fetal brain and skeletal maturation

Increase in basal metabolic rate
Increases sensitivity to catecholamines
Stimulates gut motility
Increase bone turnover
Increase in serum glucose, decrease in
serum cholesterol

Parathyroid gland

SIZE AND LOCATION

Normal parathyroid glands are approximately

the size of a grain of rice or a lentil.
Normal glands are usually about 5 by 4 by 2
millimeters in size and weigh 35 to 50 milligrams.
Enlarged parathyroid glands can be 50
milligrams to 20 grams in weight, most typically
weighing about 1 gram and 1 centimeter in size

Superior parathyroid glands

Normal superior parathyroid glands are
usually located on the posterior-lateral surface
of the middle to superior thyroid lobe.
They lie under the thyroid superficial fascia,
posterior to the recurrent laryngeal nerve and
can be visualized by carefully dissecting the
thyroid capsule in this region.

Inferior parathyroid glands

The two inferior parathyroid glands reside in the

anterior mediastinal compartment, anterior to the
recurrent laryngeal nerve.
They are most often found in the thyrothymic
tract, or just inside the thyroid capsule on the
inferior portion of the thyroid lobes

The superior parathyroid glands receive most of

their blood supply from the inferior thyroid artery
and also are supplied by branches of the superior
thyroid artery in 15 to 20 percent of patients.

The inferior parathyroid glands receive their endarterial blood supply from the inferior thyroid
artery.

References

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