It lies behind the sternohyoid and sternothyroid muscles, wrapping around the cricoid cartilage and superior tracheal rings. Page 167 videoassisted neck surgery for endoscopic resection of thyroid tumours was proposed by shimizia, et al. The thyroid gland sits on top of and to the sides of the windpipe trachea. The thyroid surgeon must have full knowledge of the anatomy of the thyroid gland, including all of its embryological, congenital, or acquired variations. The distal portion of this duct gives rise to the pyramidal lobe and levator superioris thyroideae in adults. The external and anterior jugular veins lie in the superficial fascia deep to the platysma. The cornerstone of safe and effective thyroid surgery is thorough training in and understanding of thyroid anatomy and pathology. Surgical anatomy of the thyroid gland sciencedirect. Surgical anatomy of the thyroid gland springerlink. Three related narrated slide shows and a subtotal thyroidectomy video. Surgical anatomy of thyroid and parathyroid glands and basic principles of operative technique abstract. A free powerpoint ppt presentation displayed as a flash slide show on id.
Its hormones regulate basal metabolism, oxygen use, nutrient metabolism, the production of atp, and calcium homeostasis. Part 1 surgical anatomy and surgical technique 3 incisions. Its branches communicate with the superior thyroid artery sta and with the blood supply of the contralateral thyroid lobe via the thyroid isthmus. During the latter half of the nineteenth century a revolution in surgery and surgical technique occurred. Surgical anatomy of the thyroid gland basicmedical key. It is an endocrine gland, divided into two lobes which are connected by.
This atlas is a complete guide to thyroid disorders and thyroid surgery. Thyroid anatomy 1 surgery for medical students learning surgery episodes prof. The thyroid gland is composed of right and left lobes that are positioned anterolateral to the larynx and trachea. Particular attention needs to be paid to identifying and preserving the recurrent laryngeal nerve rln, the external branch of the superior laryngeal nerve sln figure and the parathyroid glands. Pdf surgical anatomy of thyroid and parathyroid glands. Pbilippi, west virginia in 1916 dequervain16 wrote, goiter opera tions are based on one of two principles.
Surgical anatomy sternothyroid muscles oblique line of thyroid cartilage,prevent the lobes from moving upwards presence of isthmus makes palpating the tracheal cartilages difficult and difficult tracheostomy presence of thyroidae ima a chance of profuse bleeding procedures in. It sits below the adams apple and above the collar bone. Conventional open thyroidectomy is still a standard procedure that includes a collar incision of a few centimeters depending on the indication. Surgical anatomy in patients undergoing total thyroidectomy emingurleyik, 1 gunaygurleyik, 2 samidogan, 1 utkucobek, 1 fuatcetin, 1 andufukonsal 1 department of surgery, duzce university medical faculty, duzce, turkey department of surgery, haydarpasa numune education hospital, istanbul, turkey. Closure these steps are now considered in relation to the relevant surgical anatomy.
The thyroid gland is composed of 2 lobes connected by an isthmus. An understanding of the developmental relationship of the parathyroid glands to the thyroid and the thymus is fundamental in the delineation of the embryologic origin of the parathyroid glands. Elucidating how the thyroid gland the only source of thyroid hormones in the bodydevelops is thus key for understanding and treating thyroid dysgenesis, and for generating thyroid cells in vitro. Thyroid volume measured by ultrasonography us is slightly greater in men than women it increases with age and body weight. Even so, understanding the surgical anatomy of the thyroid gland and its possible variations is paramount to safe and effective surgery. A doctor will perform this surgery in a hospital while the patient is under general anesthesia. The cornerstone of safe and effective thyroid surgery is thorough training in and understanding of thyroid anatomy. Important surgical anatomy the thyroid which means shield gland is composed of two lobes connected by an isthmus that lies on the trachea approximately at the level of the second tracheal ring figs. Scribbles of a doctor to share the knowledge of medicine. Postoperative hypoparathyroidism in thyroid surgery. Surgical anatomy in patients undergoing total thyroidectomy emingurleyik, 1 gunaygurleyik, 2 samidogan, 1 utkucobek, 1 fuatcetin, 1 andufukonsal 1 department of surgery, duzce university medical faculty, duzce, turkey.
The thyroid nodule clinic provides a 1stop thyroid nodule evaluation that includes a focused clinical assessment, ultrasound evaluation, and. Divided into eight sections, the book begins with an introduction to examination of the thyroid and recognition of symptoms that may lead to the diagnosis of various disorders. The parathyroid gland, located within the surgical capsule of the thyroid subcapsular, when diseased, remains in place locally. Graves disease is caused by antibodies in the blood that turn on the thyroid and cause it to grow and secrete too much thyroid hormone. The thyroid gland consists of two lobes joined by an isthmus. The most common cause in more than 70% of people is overproduction of thyroid hormone by the entire thyroid gland. Microscopically, the functional unit of the thyroid gland is the. The left and right inferior parathyroid ipg were mainly supplied by the ita 72. This is the recommended procedure for patinets with known or suspected thyroid cancer. See surgical management of hyperthyroidism and differentiated thyroid cancer. The thyroid gland is the largest endocrine organ with the highest frequency of disorders of all the endocrine organs.
The thyroid gland has two lobes connected by isthmus. It has a shape a bit like a butterfly, with the thyroid lobes forming the wings and the isthmus the body of the butterfly fig. Surgical treatment options thyroid surgery can be performed with conventional or minimally invasive techniques. Thyroid testing fna sensitivity of 6898% specificity of 56100% tsh single best test frozen section useless 18 evil villain paralyzed thyroid glands and made victims swollen and ugly. These septa also serve as conduits for blood vessels. Anatomy clasps anterior and lateral surface of pharynx, larynx, oesophagus and trachea like a shield lies deep to sternothyroid and sternohyoid muscles parathyroid glands usually lie between posterior border of thyroid gland and its sheath usually 2 on each side of the thyroid, often. Pdf surgical anatomy of thyroid and parathyroid glands and. The superior thyroid artery is the first branch of the external carotid artery and courses inferiorly to the upper pole of the thyroid gland. The pl is defined as a thyroid tissue remnant of embryological origin located in the pretracheal region between the isthmus and the hyoid bone during intrauterine descent of the foetal lingual. The thyroid gland is located in front of the neck below the thyroid cartilage. Each chapter is a separate essay from an embryologic, anatomic and surgical viewpoint and follows the format below. Patients will require lifelong thyroid hormone replacement. Anatomy of the thyroid gland university of medical. Surgical anatomy of double pyramidal lobe on total.
The thyroid gland may become overactive hyperthyroidism or underactive hypothyroidism. A successful treatment of both benign and malignant diseases of the thyroid is. Thyroid nodule program massachusetts general hospital. Minimally invasive thyroidectomy uti lizing endoscopic techniques may also affect the practice of thyroid surgery. Mayo clinic endocrinologists opened the thyroid nodule clinic in 2009 to streamline this evaluation and provide a coordinated approach that meets the needs of patients with thyroid nodules. Double pyramidal lobe dpl of the thyroid gland is an extremely rare anatomical variation that has been reported only twice in the literature 1, 2. Surgical anatomy of thyroid gland otolaryngology online. Thyroid surgery involves removing all or a portion of the thyroid gland. Five things you should know about the surgical anatomy of the thyroid gland the thyroid gland is located in front of the neck below the thyroid cartilage. Functional disorders t a k e n f r o m b a t m a n c o m i c s 1 9 4 2. Surgical anatomy the thyroid gland consists of two lobes joined by an isthmus.
Surgical anatomy in patients undergoing total thyroidectomy emingurleyik,1 gunaygurleyik,2 samidogan,1 utkucobek,1 fuatcetin,1 andufukonsal1. The whole gland is covered anteriorly by infrahyoid group of muscles. With appropriate techniques, total thyroid lobectomy and total thyroidectomy which should be considered simply as a bilateral total thyroid lobectomy performed during the same operation can be undertaken with minimal risk of damage to the recurrent. The presence of the pyramidal lobe pl is a typical example of anatomical variations affecting the completeness of thyroidectomy. Each lobe has a conical shape and measures approximately 5. Surgical anatomy of the mandibular region for reconstructive purposes. Original research article study on recurrent laryngeal.
Dimension 5x3x2 cm lateral lobe extends from oblique line of thyroid cartilage. Anatomy, physiology and pathology of the thyroid gland. Surgical anatomy a detailed knowledge of thyroid anatomy is a prerequisite for thyroid surgery. The indications for thyroidectomy and surgical techniques are discussed elsewhere. The thyroid gland, originates from between the first and. Sulaiman, md, fcap medical director of laboratories. These lobes are connected in the midline by a sleeve of thyroid tissue known as the isthmus. Dissection of the upper pole and superior laryngeal nerve 3. Surgical anatomy of thyroid gland410 thyroid gland weighs about 2025 gms and larger in females than in males. Pdf the thyroid gland is the largest endocrine organ with the highest frequency of disorders of all the endocrine organs. They also contribute to protein synthesis and the normal growth and development of body tissues, including maturation of the nervous. These keywords were added by machine and not by the authors. Ashraf khater professor of surgery and onco surgery, mansoura university. The thyroid gland is located in the anterior neck, spanning between the c5 and t1 vertebrae.
Before that time, thyroid surgery was limited to treating only lifethreatening conditions. For thyroid tumors smaller than 3 cm, a minimally invasive technique could be an option. Thyroid gland historical aspects, embryology, anatomy. It consists of two lobes connected by an isthmus in the middle. In this article, we shall look at the anatomical position, vasculature, innervation and any clinical correlations. Afhns clinical practice guidelines for thyroid nodules and cancers in develop. It lies deep to the platysma, sternothyroid and sternohyoid muscles. Thyroid position in the neck in front of the trachea windpipe the thyroid is a gland that sits across the windpipe like a bow tie, just below the adams apple. Emil theodor kocher and theodor billroth pioneered the surgical management of thyroid disease in the late 1800s. It is surrounded by a dense irregular collagenous connective tissue capsule, in which posteriorly the parathyroid glands are embedded. Since thyroid surgery is one of the most frequently done routine surgery and is one of the most common procedures with serious complication, neurovascular relationships around the thyroid gland have been extensively studied in cadavers as well as in surgical cases by various authors especially in the nineteenth and twentieth centuries. Bhavin vadodariya dnb surgical oncology 1st year resident, apollo cbcc cancer care, ahmedabad date05082017 2. They were cured by injecting thyroid extract thyroid diseases.
Rather than attempt to duplicate this material it will be the authors purpose to point out the structures encountered in areas of the neck entered most frequently by the general surgeon. There is an abundance of detailed information on the applied anatomy of the neck. The thyroid gland weighs 10 to 20 grams in normal adults. The thyroid gland has two lobes the right and the left. It is an endocrine gland, divided into two lobes which are connected by an isthmus.
A gland outside of the capsule extracapsular is often displaced. The thyroid is located at the front of the neck, below the adams apple. Anatomy of the thyroid gland lecturio online medical library. Thyroid and parathyroid surgery details and risks thyroidectomy all of the thyroid gland is removed during a total thyroidectomy. Anatomy of the thyroid gland by cfcf own work, license. Surgical anatomy and embryology of thyroid gland by dr. With appropriate techniques, total thyroid lobectomy and total thyroidectomy which should be considered simply as a bilateral total thyroid lobectomy performed during the same operation can be undertaken with minimal risk of damage to the recurrent laryngeal. Thyroid surgery download ebook pdf, epub, tuebl, mobi. Gland occupies the important position in the central compartment of the neck, lying astride the trachea just above the thoracic inlet. Ais channel the ultimate surgical training experience. Also patients with bilateral thyroid nodules may bene. Surgical anatomy of the parathyroid glands uptodate.
The carotid sheath, a condensation of the cervical fascia, is entered 2 to 3 cm above the clavicle and the jugular vein is isolated, carefully ligated, and divided after absolute. The thyroid gland location blood supply teachmeanatomy. The thyroid is situated in the lower aspect of the neck, the isthmus crossing the trachea at the level of the second and third tracheal rings. Of the neck muscles, the thyroid is covered anteriorly by the strap or infrahyoid muscles and. The thyroid gland is an endocrine structure, located in the neck. The thyroid gland is shaped like a butterfly, with the wings corresponding to the lobes of the thyroid and the connecting piece between the lobes, known as the isthmus. This process is experimental and the keywords may be updated as the learning algorithm improves. Embrology and anatomy of parathyroid glands overview. Ppt surgical anatomy thyroid and parathyroid glands. The challenges and art of thyroid surgery are immortalized in the annals of surgery by this famous quotation of halstead the extirpation of the thyroid gland for goiter typifies, perhaps, better than any operation the supreme triumph of the surgeons art. The gland is enveloped by the deep cervical fascia and is attached firmly to the trachea by the ligament of berry. The average weight of the thyroid gland, in healthy adults, is 1530 g. Clinical anatomy of the thyroid gland ohio university skandalakis surgical anatomy 2004 thyroid cartilage cricoid cartilage suspensory ligament of berry visceral layer of pretracheal fascia false capsule. Clinical study pyramidal lobe of the thyroid gland.
Surgical anatomy of thyroid and incidence of malignancy in. Swelling or fluid buildup called seroma may occur at the surgical site after surgery. Thyroid gland historical aspects, embryology, anatomy and physiology. Emil theodor kocher and theodor billroth pioneered the surgical management of thyroid disease. In the case of benign pathologies that do not affect the entire thyroid gland, a lobectomy with or without isthmusectomy is sufficient. Background thyroid peroxidase tpo is essential for physiological function of the thyroid gland. Aug 31, 20 the thyroid gland is located in front of the neck below the thyroid cartilage. A thorough understanding of thyroid anatomy is central to the performance of safe thyroid surgery 1.
The high prevalence of thyroid peroxidase antibodies tpoabs in patients with breast cancer and. It provides blood supply to the parathyroids, thyroid, upper oesophagus and trachea. Pdf surgical anatomy of thyroid and parathyroid glands and basic. World surgery surgeons approach to the thyroid gland. Thyroid gland is a butterfly shaped endocrine gland situated in the anterior neck. Thyroid gland anatomy the thyroid gland is an extremely vascular organ that is brown to red in color, firm in consistency, located posterior to the strap muscles, and anteriorly in the lower aspect of the neck, extending from the level of the fifth cervical vertebra down to the first thoracic vertebra 18 19. The thyroid, or thyroid gland, is an endocrine gland in the neck consisting of two connected lobes. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a lifethreatening operation to one with acceptable morbidity. Surgical anatomy thyroid and parathyroid glands 1 surgical anatomy thyroid and parathyroid glands. Feb 11, 2019 surgeons approach to the thyroid gland. Clinical anatomy of thyroid gland linkedin slideshare.
Surgical anatomy of the thyroid gland and the technique of. Surgical anatomy definition of surgical anatomy by medical. The thyroid gland is subdivided by capsular septa into lobules containing follicles. The presence of this variation may encumber the completeness of total and subtotal thyroidectomy, which is usually the treatment of choice for benign and malignant diseases of the thyroid gland. The technique of thyroid surgery and its surgical anatomy were established by great works of kocher, billroth, lahey. A thorough understanding of thyroid anatomy is central to the performance of safe thyroid surgery. Dissection of the lateral aspect of the thyroid lobe, preserving the recurrent laryngeal nerve and parathyroid glands 4. Assistant clinical professor of surgery assistant clinical professor of surgery references 1. The thyroid gland is a butterflyshaped organ located in the neck anterior to the trachea. Surgical anatomy of the thyroid and parathyroid glands.