Thyroid glandThyroid glandStructure : it is the largest endocrine gland in the body. It has butterfly shape. It consists of 2 lateral ( right & left ) lobes connected by a narrow isthmus.

Capsule : it is surrounded by : 1-a sheath derived from pretracheal layer of deep cervical fascia. this sheath attaches the gland to larynx and trachea, so it is responsible for movement of gland with lartnx up & down during deglutition. 2-Fibrous capsule : is firmly attached to the gland.

Each lobe : is pear shaped, its apex is directed upward as far as the oblique line/ on lamina / of thyroid cartilage, while its base lies at the level of 5 or 6th tracheal ring.

Thyroid glandThyroid glandIsthmus :

It lies in the midline in front of 2,3, and 4th tracheal rings.

A pyramidal lobe is often projects upwards from isthmus, usually to left of midline. It is connected to the hyoid bone by a fibromuscular band called levator glandulae thyroidae (remnant of thyroglossal duct in embryo). This band may be absent.

Relations of LobesRelations of Lobes of of Thyroid Gland :Thyroid Gland : Anterolaterally :

sternothyroid, sternohyoid, superior belly of omohyoid, anterior border of sternocleidomastoid.

Postrolaterally : carotid sheath (common carotid artery + internal jugular vein + vagus nerve).

Medially : larynx + trachea, pharynx + esophagus, recurrent laryngeal nerve, cricothyroid muscle + its nerve supply, the external laryngeal nerve.

Posteriorly : the posterior border of each lobe is related to superior & inferior parathyroid glands + anastomosis between superior & inferior thyroid arteries.

Cross section of the neck at level of 6th cervical vertebra.

Relations of IsthmusRelations of Isthmus of of Thyroid Gland :Thyroid Gland :

Anteriorly : skin, fascia, anterior jugular veins, sternohyoids & sternothyroids.

Posteriorly : 2,3,and 4th tracheal rings.

N.B : superior thyroid arteries anastomose along its upper border.

Arteries of thyroid glandArteries of thyroid glandSuperior thyroid artery : a branch of external carotid artery, descends to upper pole of each lobe. -it is accompanied by superior thyroid vein + external laryngeal N. -it divides into anterior & posterior branches. The anterior anastomoses with its fellow of opposite side on the upper border of the isthmus, and the posterior one descends on posterior surface to anastomose with inferior thyroid artery.

Inferior thyroid artery : a branch of thyrocervical trunk from 1st part of subclavian A. -It turns medially and downward then, upward to posterior border of gland. -it is accompanied by recurrent laryngeal nerve.

Thyroidea ima artery : if present, may arise from brachiocephalic artery or arch of aorta. It ascends in front of trachea to the isthmus.

Anterior surface

Posterior surface

Veins and lymph drainage of Veins and lymph drainage of thyroid gland :thyroid gland :

Superior thyroid vein : drains into internal jugular vein.

Middle thyroid vein : drains into internal jugular vein.

Inferior thyroid vein : receives its tributaries from isthmus & lower poles of gland and descend in front of trachea to drain into left brachio-cephalic vein in the thorax.

The lymph from thyroid gland drains mainly into upper & lower deep cervical L.Ns. (along I.J.V)- Few into paratracheal L.Ns.(along side of trachea).

Parathyroid glandsParathyroid glandsThey are 2 pairs (2 superior + 2 inferior) of small endocrine glands embedded in the posterior aspect of the lobes of thyroid gland.

Superior parathyroid : lies at the middle of posterior surface of thyroid, they are more constant in position.

Inferior parathyroid : lies near base of thyroid gland.

They lie within the fascial sheath, / embedded in the posterior wall of fibrous capsule.

Arterial supply : inferior thyroid vessels.

Lymph drainage : as thyroid gland.

Cervical part of TracheaCervical part of Trachea

It is a mobile cartilaginous & membranous tube starting at the level of cricoid cartilage of larynx opposite 6th cervical vertebra.

It ends at the level of disc between 4th & 5th thoracic vertebrae opposite the sternal angle.

Relations :Relations :Anteriorly : -isthmus of thyroid (in front of 2nd ,3rd ,and 4th rings) + inferior thyroid vein + thyroidea ima artery + jugular arch. -sterno thyroid + sternohyoid muscles + skin & fascia.

Posteriorly : recurrent laryngeal nerves + esophagus + vertebral column.

Laterally : lobes of thyroid gland (down as far as 5th or 6th ring ) + carotid sheath.

Blood supply : inferior thyroid vessels.

Lymph drainage : pretracheal + paratracheal L.Ns.

Nerve supply : vagus & recurrent laryngeal N. + sympathetic trunks.

Cervical part of esophagus & Cervical part of esophagus & its relations :its relations : It is a muscular tube about 25 cm long

extending from pharynx to stomach. It begins at the level of cricoid cartilage opposite 6th cervical vertebra, and ends to join the stomach in the abdomen.

Anteriorly : trachea, R.L.N. in groove between trachea & esophagus.

Posteriorly : prevertebral layer of deep cervical fascia, longus coli, and vertebral column.

Laterally : lobe of thyroid gland + carotid sheath.Blood supply : inferior thyroid vessels.

Lymph drainage : deep cervical L.Ns.

Nerve supply : recurrent L.N. + sympathetic trunks.