II.

THYROID

A. ANATOMY

Thyroid and Parathyroid

Head and Neck
YL5: 05.11

Jose Jonathan Franco, MD

November 5, 2015 | 10:00AM - 12:00PM

GROUP 4: Apal, Benitez, Ibañez, Idian, Juat, Pilapil, Quion, Sarmiento, Taliño

OUTLINE
OUTLINE ............................................................................................................... 1  
I. OBJECTIVES ..................................................................................................... 1  
II. THYROID........................................................................................................... 1  
A. ANATOMY .................................................................................................... 1  
B. BLOOD SUPPLY .......................................................................................... 2  
C. NERVE SUPPLY .......................................................................................... 3   Figure 1. Anterior View of Thyroid (Netter, 2014)
D. LYMPHATICS .............................................................................................. 4  
E. EMBRYOLOGY ............................................................................................ 4  
D. PHYSIOLOGY .............................................................................................. 5   • 2 Pear/teardrop-shaped lobes connected by a thin isthmus
PARATHYROID ..................................................................................................... 7   • 4-6cm long
A. ANATOMY .................................................................................................... 7   rd
B. BLOOD SUPPLY .......................................................................................... 7   • Thin superior pole up to the middle 3 of thyroid cartilage
C. LYMPHATICS .............................................................................................. 8   and the oblique line
D. NERVES....................................................................................................... 8   • Oblique line – upper limit of the thyroid lobe
E. EMBRYOLOGY ............................................................................................ 8   o insertion of sternothyroid muscle
F. PHYSIOLOGY .............................................................................................. 8   th th
G. CLINICAL CORRELATIONS ........................................................................ 8   • Bigger inferior pole – 5 or 6 tracheal ring
REVIEW CENTER ................................................................................................. 9   • Shape – Anteriorly convex, posteriorly concave
FREEDOM SPACE ................................................................................................ 9   • Pyramidal Lobe
REFERENCES .................................................................................................... 10   o Found in around 30-50% of thyroid glands
o Thyroid tissue that is a remnant caudal portion of the
QUICK REVIEW thyroglossal duct (failure of degeneration)
Abbreviations o Attached to the isthmus or medial part of lobe
DIT Diiodotyrosine o Found during Thyroidectomy, and Thyroid scan
MIT Monoiodotyrosine
PIII Parathyroid III Clinical Point: Goiter
PIV Parathyroid IV
PTG Parathyroid Gland
PTH Parathyroid Hormone
RLN Recurrent Laryngeal Nerve
SCM Sternocleidomastoid
STA Superior thyroid artery
T3 Triiodothyronine
T4 Tetraiodothyronine
TBG Thyroxine Binding Globulin
TPO Thyroperoxidase
TRH Thyrotropin releasing hormone

I. OBJECTIVES Figure 2. Normal Thyroid vs Goiter (Darling, 2015)

• Discuss the anatomy, embryology, physiology of the thyroid
gland, and parathyroid gland • Any enlargement of the part or the whole thyroid gland
• Discuss the relevant clinical points • Important to know anatomy and physiology because some
goiters need to be removed and some will be treated with
medicine
o Surgery: Anatomy
o Medical: Physiology
§ Thyroid hormones

Relations
• Anterior – inner sternothyroid and outer sternohyoid
• Anterolateral – sternocleidomastoid (SCM)

05:11: Thyroid and Parathyroid 1 / 10

• Inferomedial – trachea, esophagus B. BLOOD SUPPLY
o Tracheoesophageal groove – where the recurrent
laryngeal nerve passes Arterial Supply
• Posterolateral/inferolateral – carotid sheath containing the
common carotid artery, internal jugular vein, vagus nerve,
and ansa cervicalis

Clinical Point: Thyroidectomy

Figure 4. Arterial Supply of Thyroid (StudyBlue, Inc., 2015)

• Thyroid is very vascular

Figure 3. Before and After Thyroidectomy (About.com, 2015)
• Thyroidectomy - a procedure to remove all or part of the
thyroid gland (About, 2015)
• Operation is done when medicine does not work anymore
• Incision through skin à subcutaneous fat à platysma à
loose connective tissue (very good place to dissect, not very
bloody) à thyroid gland
o Adam’s apple – laryngeal prominence of the thyroid
cartilage
o Superficial layer of the deep cervical fascia –
envelops SCM and strap muscle
o To differentiate SCM from platysma, look at the direction
of striations
o Dense anastomosis of vessels around and within the
vessel (Franco, 2015)
• Superior thyroid artery (STA)
o Main blood supply
st
o 1 branch of external carotid artery
§ Will course down beside the larynx and will branch to 3
branches as it reaches the superior pole
o Note that the external carotid artery is actually internal
and the internal carotid artery is actually external
o Thyroidectomy – ligate before the 3 STA branches

Attachment to Laryngotracheal Skeleton (Suspensory

Ligament)
• Anterior Suspensory Ligament – condensation of visceral
fascia
• Posterior Suspensory Ligament – attaches posteromedial
st nd
part of thyroid gland to cricoid and 1 and 2 tracheal rings
o A.k.a Berry’s ligament
o More important
• Never run your suture around your recurrent laryngeal nerve
(Franco, 2015)

Figure 5. Relative Positions of Internal and External Carotid

Arteries (Academic AMC, 2015)

• Inferior thyroid artery

o Largest thyrocervical trunk branch of subclavian artery
o Passes under common carotid then to the inferior pole
o Inserts inferior/medial part of the gland (variable)
• Thyroid ima artery
o Rogue artery

05:11: Thyroid and Parathyroid 2 / 10

 o In 10% of the people, it arises from the brachiocephalic
trunk
o May arise from subclavian/common carotid/aorta
o Goes upward in front of the trachea into thyroid gland via
isthmus
Clinical Point: Tracheostomy
Figure 6. Tracheostomy Procedure (Academic AMC, 2015)
• A surgical procedure done to create an opening through the
neck into the trachea
• When the patient cannot breathe (blocked airway)
o Assisted ventilation (spinal nerve injury)
• Tube is inserted directly into trachea, below the isthmus
• The presence of tyroidea ima artery can cause bleeding in
this type of procedure especially when a transverse cut is
made, rather than a longitudinal cut
o Tyroidea ima artery arises from the brachiocephalic trunk
and ascends in front of the trachea to the lower part of the
thyroid gland
Venous Drainage
Figure 7. Venous Drainage of Thyroid (Netter, 2014)
05:11: Thyroid and Parathyroid
• Does not follow the arterial supply except for the superior
thyroid vein
• 3 pairs of veins provide venous drainage to the thyroid gland
o Superior thyroid vein
§ Drains superior part of the lobe and drains to the
internal jugular vein
§ Runs with superior thyroid artery
o Middle thyroid vein
§ From the middle lobe runs laterally/directly into the
internal jugular vein
§ There is no middle thyroid artery
§ If avulsed from the root, it will cause troublesome
bleeding from the internal jugular vein
o Inferior thyroid vein
§ From brachiocephalic vein (or sometimes from the
internal jugular vein) then drains to the lower part of
the lobe and isthmus
C. NERVE SUPPLY
Figure 8. Nerve Supply of Thyroid (UpToDate, 2011)
• Autonomic Nervous System
• Superior cervical ganglion – sympathetic supply
o Has nothing to do with the gland’s activity
o But it dilates/constricts the blood vessels supplying the
thyroid gland
• Parasympathetic fibers come from the vagus nerves
• Sympathetic fibers are distributed from the superior, middle,
and inferior ganglia of the sympathetic trunk
• Vasomotor fibers
• Two Nerves
o Hs nothing to do with the gland but very closely related
o Recurrent laryngeal nerve (RLN) – from the vagus (CN
X)
§ Inferior to superior laryngeal nerve
§ Goes to the thorax à tracheoesophageal groove à
thyroid gland à inferior pharyngeal constrictor à
cricothyroid membrane at the back à larynx to supply
the intrinsic muscles of the larynx
§ Location – under the Berry’s ligament (sometimes on
top, within, or divided)
§ Usually injured
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 § Thyroid gland can be removed without damaging the Clinical Point: Thyroid Cancer
RLN
§ Sensory – to inferior part of vocal cord and below
§ Clinical point
− Recurrent Laryngeal Nerve Paralysis
§ No voice/hoarse voice
§ Right true vocal cord paralyzed (if right RLN is
damaged)
o Superior laryngeal nerve – from vagus (CN X)
§ From the hyoid bone, divides into external and internal
branch
§ Internal branch – pierces thyrohyoid membrane and
provides sensory innervation to the larynx above the
vocal cords
§ External branch – continues downward and runs with
the superior thyroid vessels and provides motor
innervation to the cricothyroid
§ Supplies the cricothyroid muscle
− Stretches the vocal cord and is responsible for the
pitch of voice; enables it to tighten
§ Clinical point
− Superior Pole Vessel Ligation (Superior
Laryngeal Nerve Injury)
§ Bowing of vocal cord
§ One-sided paralyze cricothyroid muscle – Figure 9. Different Stages of Thyroid Cancer (THANC Foundation,
onconation of the larynx will go to the side of 2015)
paralyze muscle
§ Issues with pitch variation • Thyroid malignancy
§ Stretches vocal cord à affects pitch • Irregular shape
§ Lower voice, cannot reach high pitches • Posterolateral – carotid artery
§ Anita Galli-Curci • No contrast in circular area between internal jugular vein
= Famous opera singer who underwent and carotid artery à lymph node
thyroidectomy in 1935 o Indicative of a malignant process
= Injured SLN ruined her voice o Within the carotid sheath

D. LYMPHATICS E. EMBRYOLOGY
nd rd
• Lymphatic drainage of the thyroid gland is extensive and • Floor of primitive pharynx (2 or 3 week of gestation)
st th
flows multidirectionally • 1 -4 arch
• Middle to upper pole of lobe, superior portion of isthmus • Thyroid diverticulum – where the thyroid begins
o Drains to superior deep cervical nodes o Behind the primitive tongue bud
o Can also drain to prelaryngeal node aka. Delphian node o Initially hollow then later solidifies and becomes bilobed.
• Levels of lymph nodes in the neck to standardize • Foramen caecum – where the thyroid diverticulum starts
o Level 6 – contains prelaryngeal, pretracheal, and • Thyroid comes from
paratreacheal nodes o Primitive pharynx
• Lower lobe and isthmus – drains into pretracheal, § Central part of thyroid comes from mesodermal part of
paratreacheal, and inferior deep cervical nodes primitive gut
• Thyroid problem usually has enlarged lymph nodes in levels o Lateral thyroid from Ultimobrachial pouch
th th
2, 3, and 4 where the deep cervical chain is found (Franco, § Ultimobrachial pouch – 4 and 5
2015) branchial/pharyngeal pouch
nd th
• May go to Level 5, but hardly ever goes to Level 1 • 2 -7 week – descend inferiorly in front of the hyoid until it
will rest in front of the cricoid and trachea (adult placement)
o Maintains a connection to the foramen caecum until the
th
7 week by thyroglossal duct which connects thyroid
gland to foramen caecum
th th
• 7 to 10 week – Thyroglossal Duct
o solidifies then obliterates
th
o by the 10 week, it will disappear
th
• 10-11 week – the thyroid begins to bind iodine

05:11: Thyroid and Parathyroid 4 / 10

Clinical point: Thyroglossal Duct Cyst
• Thyroglossal duct sometimes does not disintegrate
• Found in suprahyoid (above)
• Can occur at any part of the thyroglossal duct course (neck,
close or just inferior to the body of the hyoid bone)
• Presents in childhood as a cystic mass in the midline
• Forms a swelling in the anterior part of the neck that moves
with tongue protrusion, which differentiates the thyroglossal
duct from sebaceous cysts (that does not move at all)
• Surgical excision may be necessary via the Sistrunk
procedure
o Surgical resection of the duct to the base of the tongue
and removal of the central portion of the hyoid bone
Figure 10. Thyroglossal Duct Cyst (Yale School of Medicine, 2015)
• Thyroglossal Duct Cyst vs Sebaceous Cyst
o Thyroglossal duct cyst is connected to the tongue
o Ask the patient to protrude the tongue and the cyst will
move upward and backward
o Sebaceous cyst will not move at all
Clinical Point: Lingual Thyroid
• Thyroid behind the tongue
• Failure of the thyroid diverticulum to descend causing the
thyroid to develop in the foramen caecum
• Managed medically unless the mass blocks the airway 
or
causes dysphagia (the difficulty to swallow)
• Removal may mean lifelong dependency on
thyroid 
hormone analogs
Figure 11. Lingual Thyroid (Ghorayeb, 2015)
05:11: Thyroid and Parathyroid
D. PHYSIOLOGY
• Largest endocrine gland
• Produces 2 kinds of hormones
o Thyroid hormones – has wide range of effects on body
controlling metabolism, growth and development
o Calcitonin –Hormone related to calcium balance,
produced by the parafollicular cells (a.k.a. C cells)
• Main production unit – follicles
o Thyroid follicle – thyrocytes arranged in a sphere with
colloid inside
o Thyroglobulin – colloid
• Basal is in contact with blood
• Apex is in contact with colloid
o Where production of thyroid is done
• 2 essential components in building thyroid hormones
o Iodine
§ Thyroid follicle is good in collecting iodine anion from
the blood
o Tyrosine
§ Thyroglobulin – main source of tyrosine
− Produced by thyrocyte
− carries tyrosine in colloid
Figure 12. Overview of Thyroid Physiology (Arulkumaran, 2015)
Sodium-Iodide Symporter
• Used by the body to separate iodine from the blood
• Electrochemical transporter
• Sodium is rid off inside the cell by the Na-K-Pump (to
maintain gradients) while potassium enters the cell
• Iodide is transported inside the cell then to the apical part à
apical membrane
o Iodide is incorporated to thyroglobulin and attached to
tyrosine by thyroperoxidase (TPO)
§ Attaches to aromatic ring of tyrosine
o Two chemicals are produced
§ Monoiodotyrosine (MIT) and Diiodotyrosine (DIT)
− DIT + DIT = Tetraiodothyronine (T4)
− MIT + DIT = Triiodothyronine (T3) – more active
• Endocytosis – cell membrane eats thyroglobulin with T3 and
T4 à becomes an endosome
o Lysosome will fuse with it, digest it and release the T3
and T4 hormones
o T3 and T4 will go to the bloodstream which will be taken
up by carriers
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• In the bloodstream Clinical Correlations: Hyperthyroidism
o Thyroxine Binding Globulin (TBG) – largest carrier
§ Main protein carrier
§ Carries T3 and T4 hormone
o Albumin can also carry the hormones

Control System by the Hypothalamic-Pituitary-Thyroid Axis

• Thyroid hormones are tightly controlled
o Feedback system
o For metabolism maintenance
§ Thyroid stimulating hormone (TSH) – released by
the anterior pituitary gland
− Main stimulant of thyroid hormone production (T3
and T4), thus enhancing all processes
− When it attaches to the basal membrane of
thyrocyte, it increases number of symporter, rate of
endocytosis, amount of TPO, and amount of
thyroglobulin production
o Thyroid
§ Thyrotropin releasing hormone (TRH)
− Produced by hypothalamus Figure 14. Manifestations of Hyperthyroidism (Netter, 2014)
− Stimulates the anterior pituitary gland to release
TSH • Overproduction of thyroid hormones causing increased
§ Sleep/ Cold/ Stress metabolism, irregular heartbeat,
 sweating, nervousness and
− TRH – anterior pituitary à TSH à thyroid gland à irritability
T3 and T4 (Feedback) à target organs à high o Grave’s disease - an autoimmune disorder in which
metabolic rate antibodies produced by your immune system stimulate
§ Negative feedback your thyroid to produce too much T4
− Extracellular T3 and T4 work with the anterior § Most common cause of hyperthyroidism.
pituitary gland to reduce TSH and with o Hyperfunctioning thyroid nodules (Plummer’s disease) –
hypothalamus to reduce TRH benign lumps that overproduce T4
o Thyroiditis – swelling of the thyroid gland may cause a
leak of stored hormones.
• Signs and Symptoms
o Nervousness
o Heat intolerance
o Sweating
o Trachycardia
o Palpitations

Clinical Correlations: Hypothyroidism

Figure 13. Control System of Hypothalamic-Pituitary-Thyroid Axis

(Tulane University School of Medicine, 2015)

o Mechanism of action
§ Genomic
− Modulate gene expression of proteins
§ Goes inside target cell to nucleus à receptor à
informs thyroid hormone receptor complex which binds
to reactive element in DNA à inhibition or promotion of
protein production
o Function
§ Metabolism homeostasis Figure 15. Manifestations of Hypothyroidism (Netter, 2014)
§ Growth and development

05:11: Thyroid and Parathyroid 6 / 10

• Thyroid gland does not produce enough thyroid hormones • Inferior parathyroid glands
which may cause obesity, joint pain, infertility, and heart o Found in the general area of the inferior pole of the
disease.
 thyroid gland
o More likely in women especially those over 60 o Location is more variable than superior parathyroid
o Hashimoto’s thyroiditis – autoimmune disease where glands
antibodies attack the thyroid gland o Ideally found 1 cm inferior to the arterial entry point
o Radiation – exposure may affect the thyroid gland
o Floppy Baby – neonatal hypothyroidism. Signs include a B. BLOOD SUPPLY
dull look, puffy face, and a thick tongue that sticks out.
§ More advanced symptoms include choking episodes, Arterial Supply
jaundice, lack of muscle tone, stunted growth,
• Mostly from the inferior thyroid artery
sluggishness.
• Around 40% from the superior thyroid artery
• Signs and Symptoms
• May also receive blood from the thyroid ima artery or
o Weakness and fatigue
laryngeal, tracheal, and esophageal arteries (Moore, 2004)
o Cold intolerance
o Weight gain
o Hair loss
o Edema
o Swelling in the front of the neck (goiter)

PARATHYROID
• Typically numbered in 4
o 2 superior parathyroid glands
o 2 inferior parathyroid glands
• Found at the posterior side of the thyroid gland
• Small (20-40 grams), tan in color, encapsulated, and very
well vascularized
• 10% of the population will have less than 4 parathyroid
glands
• Intimately related to the thyroid gland
• Produces parathyroid hormone (PTH)
o Controls extracellular calcium and phosphate
concentrations
• Even enlarged parathyroid glands are not palpable, so color
is very important (2019 Trans) Figure 17. Arterial Supply of Parathyroid (Moore, 2006)

Venous Drainage
• Parathyroid veins drain into thyroid plexus of veins then to
the internal jugular vein and brachiocephalic vein
o Thyroid plexus of veins – plexus formed by the thyroid
veins on thyroid surface

Figure 16. Posterior View of Thyroid Gland (Netter, 2014)

A. ANATOMY

Anatomic Relations
• Superior parathyroid glands
o More consistent in location
o Found usually 1 cm above the crossing point of the
inferior thyroid artery and the recurrent laryngeal nerve
o Usually at the level of the inferior border of the cricoid Figure 18. Venous Drainage of Parathyroid (UpToDate, 2011)
cartilage

05:11: Thyroid and Parathyroid 7 / 10

C. LYMPHATICS
• Parathyroid lymphatic vessels drain with lymphatic vessels
from the thyroid gland into deep cervical lymph nodes and
paratracheal lymph nodes (Moore, 2004)
• Same as thyroid gland

D. NERVES
• Abundant nerve supply of the parathyroid glands
• Derived from thyroid branches of the cervical (sympathetic)
ganglia
• Vasomotor because the parathyroid is hormonally regulated
(Moore, 2004)
• Does not really need innervation

E. EMBRYOLOGY
rd th
• From the endoderm of the 3 (PIII) and 4 (PIV) brachial
pouches

Figure 20. Physiology of Parathyroid (2019 Trans)

PTH Detects Low Calcium

Figure 19. Embryology of Parathyroid (2019 Trans)
o Parathyroid III (PIII) – migrates inferiorly with the thymus
§ Thymus parathyroid
§ Thymus travels further to the mediastinum and drags
PIII along with it
o Parathyroid IV (PIV) – migrates inferiorly with the
ultimobranchial body
§ Lateral parathyroid
§ Travels less than PIII
§ Ends up superior to PIII
o Superior Parathyroid Gland (PTG) is from the dorsal
part of PIV, while the inferior PTG is from PIII
o Superior PTG is sometimes called the thyroid
parathyroid, while the inferior PTG is sometimes called
the thymus parathyroid (Franco, 2015)
F. PHYSIOLOGY
• Parathyroid glands produce parathyroid hormones (PTH)
o For calcium regulation and metabolism
• Acts on 3 areas
o Kidney, bone, and gut (indirectly)
• Parathyroid glands have a membrane protein called a
calcium-sensing receptor that detects low calcium
• Once it detects low calcium
o Kidney increases reabsorption of calcium
§ Activate 1-hydroxylase, which converts vitamin D3
into its most active form 1,25-(OH)2-D3 or 1,25-
dihydroxycholecalciferol
§ Active vitamin D is required for calcium absorption in
the intestines
§ Kidney also decreases phosphate through excretion
o Bone releases more calcium (increased resorption by
osteoclasts)
o Gut/intestines increase calcium absorption
• Net effect of PTH – increase in serum calcium ions
• Increase in calcium concentration is caused by
o Effect of PTH to increase calcium and phosphate release
from the bone
o Rapid effect of PTH to decrease the excretion of calcium
by the kidneys (Guyton and Hall, 2011)
Feedback Regulation of PTH
• Negative feedback due to increased serum calcium levels in
parathyroid glands
o PTG decreases PTH production
• Weak negative feedback by 1,25-(OH)2-D3 or 1,25-
dihydroxycholecalciferol
G. CLINICAL CORRELATIONS
Hypocalcemia
• Occurs after surgery when parathyroid glands are
accidentally removed or when the inferior thyroid artery is
cut
• A complete thyroidectomy will inevitably cause an
unintentional excision of the PTG, which leads to
hypocalcemia (2019 Trans)
• Decreased calcium levels in the body
• Clinical Presentation:

05:11: Thyroid and Parathyroid 8 / 10

 o Early stages – perioral numbness, numb fingertips, REVIEW CENTER
paresthesia, muscle cramps, mid-mental status change
o Late stages – mental status changes, seizures, 1. The upper limit of the thyroid lobe is the _____.
hypocalcemic tetany a) Oblique line c) Upper border
• Treatment for parathyroid gland excision – hydrous calcium b) Superior line d) Pyramidal lobe
and Vitamin D supplements for life
• Only hours without calcium, you can die (Franco, 2015) 2. This nerve branches out from the vagus nerve (CN X)
a) Superior laryngeal nerve c) Recurrent laryngeal nerve
b) Inferior laryngeal nerve d) None of the above

3. This is the area behind the primitive tongue bud and

is where the thyroid begins
a) Cricoid c) Delphian node
b) Foramen caecum d) Thyroid diverticulum

4. The parathyroid gland is supplied solely by the

inferior thyroid artery. It is composed of 2 superior
glands and 4 inferior glands
a) Only the first sentence is true
b) Only the second sentence is true
c) Both sentences are true
d) Both sentences are false

5. The superior part of the PTG is from

a) PI c) PIV
b) PIII d) PXI

Figure 21. Manifestations of Hypocalcemia (Netter, 2014) Answers: a, c, d, d, c

Hypoparathyroidism After Thyroidectomy FREEDOM SPACE

• Inferior thyroid artery is ligated in thyroidectomy
o Inferior thyroid artery supplies PTG
• Permanent condition will require lifetime high calcium
supplement
• To avoid hypoparathyroidism, ligate very near the thyroid
gland
• Girls do better in classrooms, mas masipag, mas attentive
(Franco, 2015)
• Did you know?
o L-thyroxine is an oral T4, a thyroid hormone medicine. It
is used for dieting. It was stopped because it affects brain
development.
• Clinton, you can run but you can’t hide (Franco, 2015)

Figure 22. Hypoparathyroidism (Netter, 2014)

05:11: Thyroid and Parathyroid 9 / 10

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http://surgery.about.com/od/proceduresaz/ss/ThyroidSurgery.htm,
Accessed 6 November 2015

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https://academic.amc.edu/martino/grossanatomy/site/Medical/Lab%20
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Arulkumaran, Sabaratnam (2015). Physiology and Tests of Thyroid

Function. Retrieved from
http://www.glowm.com/section_view/heading/Physiology%2520and%2
520Tests%2520of%2520Thyroid%2520Function/item/306, Accessed 6
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Darling, David (2015). Goiter. Retrieved from

http://www.daviddarling.info/encyclopedia/G/goiter.html, Accessed 6
November 2015

Ghorayeb, Bechara (2014). Lingual Thyroid. Retrieved from

http://www.ghorayeb.com/LingualThyroid.html, Accessed 6 November
2015
th
Guyton, AC, & Hall, JE. (2006). Textbook of Medical Physiology. (11
ed). Philadelphia, PA: Elsevier Saunders.

Moore, KL (2006). Clinically Oriented Anatomy, 6th ed. US: Lippincott

Williams & Wilkins.

Netter, F. H. (2014). Atlas of Human Anatomy (6th ed). Philadelphia,

PA: Elsevier Saunders.

StudyBlue, Inc. (2015). Thorax. Retrieved from

https://www.studyblue.com/notes/note/n/thorax/deck/5197362,
Accessed 6 November 2015

THANC Foundation (2015). Advanced Thyroid Cancer. Retrieved from

http://www.headandneckcancerguide.org/teens/cancer-basics/explore-
cancer-types/neck-cancers/advanced-thyroid-cancer/, Accessed 6
November 2015

Tulane University School of Medicine (2015). Thyroid Gland. Retrieved

from http://tmedweb.tulane.edu/pharmwiki/doku.php/thyroid_gland,
Accessed 6 November 2015

UpToDate (2011). Nerves of Thyroid. Retrieved from

http://cursoenarm.net/uptodate/contents/mobipreview.htm?12/4/12355,
Accessed 6 November 2015

Yale School of Medicine (2015). Surgical Exploration of the Neck.

Retrieved from http://www.anatomy.yalemedicine.org/Lab_17/,
Accessed 6 November 2015

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