Presented by

Dr/ Mennat Allah Abd El-fattah Saqr

Lecturer, Anatomy and Embryology Department, Faculty
of Medicine, Alexandria University.
 Shape and position
Capsule
Relations
Blood supply
lymphatic drainage

Innervation
Nerves related
Development & congenital anomalies
• The largest gland in the body, It usually
weighs 25 g.

• The gland is slightly heavier in females,

and enlarges during menstruation and
pregnancy.

• The thyroid gland is placed anteriorly in

the lower neck, level with the 5th cervical
(C5) to the 1st thoracic vertebrae (T1).

• It consists of right and left lobes

connected by a narrow, median isthmus.

• It is ensheathed by the pretracheal layer

of deep cervical fascia.(false capsule)
The lobes of the thyroid gland are
approximately conical.

• Their ascending apices diverge

laterally to the level of the
oblique lines of the thyroid
cartilage, and their bases are
level with the 4th or 5th tracheal
cartilages.

• Each lobe is usually 5 cm long,

its greatest transverse and
anteroposterior extents being 3
cm and 2 cm respectively.
The isthmus
• connects the lower parts of the
two lobes, although occasionally
it may be absent.
• It measures 1.25 cm transversely
and vertically, and is usually
anterior to the 2nd , 3rd & 4th (middle 3)
tracheal cartilages.
 • A conical pyramidal lobe often
ascends towards the hyoid bone from
the isthmus or the adjacent part of
either lobe (more often the left).

• A fibrous or fibromuscular band, the

levator of the thyroid gland, musculus
levator glandulae thyroideae,
sometimes descends from the body
of the hyoid to the isthmus or
pyramidal lobe.
The levator glandulae thyroideae muscle (a.k.a. musculus levator glandulae thyroideae or levator glandulae
thyroideae of Soemmerring) is an anatomic variant, consisting of a band of fibrous/fibromuscular tissue, connecting
the pyramidal lobe of the thyroid to the hyoid bone. When muscle fibers are present it is an accessory muscle
1. True capsule:
• It is a connective tissue capsule.
2. False capsule:
• also called the perithyroid sheath
or surgical capsule.
• lies external to the true capsule
• It is a well developed layer of fascia
derived from the pretracheal fascia.
• There is a thickening of this fascia
that fixes the posteromedial aspect
of each lobe to the cricoid cartilage.
the ligaments of Berry.
1.Relations of the lateral lobes
2.Relations of the isthmus
Anterolateral:
1. Skin, superficial fascia and
deep fascia.
2. Its upper part is crossed by
sup. Belly of omohyoid.
3. Its middle part is covered
by sternohyoid and
sternothyroid m.
4. Its lower part is overlapped
by the ant. Border of
sternomastoid.
Medial surface:
UPPER PART
• Pharynx (inferior constrictor muscle)
• Larynx (Thyroid, Cricoid cartilage &
Cricothyroid muscle)
• External laryngeal nerve
LOWER PART
• Trachea
• Oesophagus
• Recurrent laryngeal nerve.
Posterior surface:
1. Parathyroid glands
2. Inferior thyroid arteries which comes from the subclavian arery
3. the carotid sheath, and overlaps the
common carotid artery.
4. Lonus colli muscle
Anterior:
1. Skin and superficial
fascia.
2. Ant. Jugular veins.
3. Deep fascia.
4. Sternohyoid and
sternothyroid muscles.
Posterior:
• Trachea (2nd ,3rd and 4th
ring).
Upper border
1. The superior anastomotic a.rtery
(between right and left superior
thyroid aa).
2. The pyramidal lobe may project
upwards.
Lower border
1.inferior thyroid veins.
2.The thyroid ima a.
3.An inf. anasmomtic a. runs along
the lower border.
 Arteries:
1. Superior
2. inferior thyroid artery
3. thyroida ima artery (sometimes) .
The superior thyroid artery
• From the external carotid artery
• Descends to the superior poles of the
gland
• Pierce the pretracheal fascia
• Divide into anterior and posterior
branches supplying mainly the
anterosuperior aspect of the gland.
• This artery is accompanied by the external
laryngeal nerve.
The inferior thyroid artery
• The largest branch of the
thyrocervical trunks arising from
the subclavian arteries
• Runs superomedially posterior to
the carotid sheaths to reach the
posterior aspect of the thyroid
gland.
• It divides into several branches that
pierce the pretracheal fascia and
supply the posteroinferior aspect.
• This artery is related to the
recurrent laryngeal nerve.
 The right and left superior and inferior
thyroid arteries anastomose extensively on
and within the gland, ensuring its supply
while providing potential collateral
circulation between the subclavian and
external carotid arteries.
Thyroid ima artery
• In approximately 10% of people
• Small, unpaired
• From the brachiocephalic trunk;
however, it may arise from the arch
of the aorta or from the right
common carotid, subclavian, or
internal thoracic arteries.
• Ascends on the anterior surface of
the trachea, supplying small
branches to it.
• The artery then continues to the
isthmus of the thyroid gland,
where it divides and supplies it.
 Veins: The venous drainage of the
thyroid gland is usually via superior,
middle, and inferior thyroid veins.

1. The superior thyroid vein emerges

from the upper part of the gland and
runs with the superior thyroid
artery; it drains into the internal
jugular vein.
2. The middle thyroid vein collects
blood from the lower part of the
gland: it emerges from the lateral
surface of the gland and drains into
the internal jugular vein.
 Veins:
3. The inferior thyroid veins;
• These veins form a pretracheal
plexus, from which the left inferior
vein descends to join the left
brachiocephalic vein and the right
descends to join the right
brachiocephalic vein.
• The inferior thyroid veins often open
via a common trunk into the
superior vena cava or left
brachiocephalic vein.
• Thyroid lymphatic vessels pass to:
1. Prelaryngeal nodes
2. Pretracheal
3. Paratracheal nodes
4. Brachiocephalic nodes (sometimes) in
the superior mediastinum.

• Laterally the gland is drained by vessels

lying along the superior thyroid veins
to the deep cervical nodes.

• Thyroid lymphatics may drain directly,

with no intervening node, to the
thoracic duct.
The external laryngeal nerve:
 Injury to the external laryngeal nerve results in a voice that is
monotonous in character because the paralyzed cricothyroid
muscle supplied by it is unable to vary the length and tension of
the vocal fold.
• To avoid injury to the external laryngeal nerve the superior
thyroid vessels should be clamped and divided within (not
above) the substance of the upper pole of the thyroid gland.
 The recurrent laryngeal nerves:
• The right recurrent laryngeal nerve loops inferior to the right
subclavian artery.
• The left recurrent laryngeal nerve loops inferior to the arch of
the aorta.
• After looping, the recurrent laryngeal nerves ascend
superiorly to the posteromedial aspect of the thyroid gland,
where they ascend in the tracheo-esophageal groove,
supplying both trachea and esophagus and all the intrinsic
muscles of the larynx except the cricothyroid.
• Near the inferior pole of the thyroid gland, the recurrent laryngeal
nerve is intimately related to the inferior thyroid artery and its
branches.
• This nerve may cross anterior or posterior to branches of the artery, or
it may pass between them.
• Because of this close relationship, the inferior thyroid artery is ligated
some distance lateral to the thyroid gland, where it is not close to the
nerve.
 All the intrinsic muscles of the larynx are innervated by
the recurrent laryngeal nerves, with the exception of the
cricothyroid muscle, which is supplied by the external
laryngeal nerve.

Regarding sensory supply of the mucosa of the larynx,

the upper part is supplied by the internal laryngeal
nerve , while the lower part is supplied by the recurrent
laryngeal nerve.
 Injury of RLN:

Unilateral Bilateral

Partial Complete Partial Complete

Dyspnoea on Hoarseness of
Suffocation Aphonia
effort voice inability to speak
through disease of
or damage to the
larynx or mouth
General features
Location

Blood supply

lymphatic drainage

Innervation

Development
• Small, yellowish-brown, oval shaped,
usually lying between the posterior
lobar borders of the thyroid gland and
its capsule.

• They are commonly 6 mm long, 3–4

mm across, and 1–2 mm from back to
front, each weighing about 50 mg.

• Typically there are two on each side,

superior and inferior.
• The anastomotic connection between the superior and
inferior thyroid arteries that occurs along the posterior
border of the thyroid gland usually passes very close to
the parathyroids, and is a useful aid to their identification
The superior parathyroid glands:
• Are more constant in location than the inferior
• Usually at the middle of the posterior surface of
the thyroid lobe.
The inferior parathyroid glands:
 Are more variably situated.
 Usually at the lower part of posterior surface of
thyroid lobe
 They may also:
1. Descend with the thymus into the thorax
2. Remain above their normal level near the
carotid bifurcation
3. They may be within the fascial thyroid
sheath, or outside the sheath
• These variations are surgically important.
• Both superior and inferior parathyroid
glands are usually supplied by the inferior
thyroid arteries

• the superior parathyroid may be supplied

by the superior thyroid artery or from
anastomoses between the superior and
inferior thyroid arteries in 10–15% cases.

• The glands drain into the plexus of veins

on the anterior surface of the thyroid.

• Lymph vessels are numerous and

associated with those of the thyroid and
thymus glands.
• The nerve supply is sympathetic, either direct
from the superior or middle cervical ganglia.

• Parathyroid activity is controlled by variations in

blood calcium level; it is inhibited by a rise and
stimulated by a fall of calcium level.

• The nerves are believed to be vasomotor but not

secretomotor.