The thyroid develops from midline diverticulum

which grows down in front of the neck from the

floor of the pharynx.
The lower end of diverticulum enlarges to form
the gland.The rest of the diverticulum remains
narrow and is known as thyroglossal duct.Most
of the duct soon disappears.
The position of the upper end is marked by
foramen caecum of tongue,and the lower end
persists as the pyramidal lobe.
The gland becomes functional during third
month of development.
SUPERIOR THYROID ARTERY:is a branch of
external carotid artery, enters the
upperpole of the gland, divides into

ANTERIOR BRANCH
POSTERIOR BRANCH
and anastomoses with ascending branch of
inferior thyroid artery.
 INFERIOR THYROID ARTERY: is a branch
of thyrocervical trunk and enters the
posterior aspect of the gland.
THYRIODEA IMA ARTERY: is a branch of
either brachiocephalic trunk or direct
branch of arch of aorta and enters the lower
part of isthmus in about 2-3% of cases.
 SUPERIOR THYROID VEIN: drains the
upper pole and enters the internal jugular
vein.
MIDDLE THYROID VEIN: is single, short
and wide and drains into internal jugular
vein.
INFERIOR THROID VEIN: form a plexus
which drain into innominate vein.
KOCHERs VEIN: is rarely found (vein in
b/w middle and inferior thyroid vein).
 EXTERNAL LARYNGEAL NERVE: Vagus gives
rise to superior laryngeal nerve which divides
into two branches at skull base
LARGE INTERNAL LARYNGEAL
NERVE(sensory to the larynx).
SMALL EXTERNALLARYNGEAL
NERVE(sensory to upper half of the larynx and
supplies to cricothyroid muscle).
This nerve is away from the vessels near the
upper pole.Hence thyroidectomy, upper pedicle
should be ligated as close to thyroid as possible.
 RECURRENT LARYNGEAL NERVE(RLN):
it is a branch of vagus nerve, hooks around
Ligamentum arteriosum on left
SubClavian artery on the right,
Runs in tracheoesophageal groove near the
posteriomedial surface.
Nerve lies close to the gland in b/w the
branches of inferior thyroid artery.Hence
ITA should be ligated away from the gland,
to avoid damage to RLN.
 SUB CAPSULAR LYMPHATIC PLEXUS:
drains intopretracheal nodes and
prelaryngeal nodes which ultimatelydrain
into lower deep cervical nodes.
The chief lymph nodes are middle and lower
deep cervical lymph nodes.
SUPRACLAVICULAR NODES AND NODES
IN THE POSTERIOR TRIANGLE can also be
involved in malignancies of thyroid gland,
especially papillary carcinoma thyroid.
T3 and T4 are the hormones secreted by
thyroid gland.
Dietary requirementof iodine per day is 100-
200 micrograms.
SOURCES OF IODINE: milk, dairy products
and sea food including fish.
1) IODIDE TRAPPING: from the blood into the thyroid, is
the first step in the formation of T3 and T4.
THIOCYANATES and PERCHLORATES block this step.

2) OXIDATION OF IODIDE INTO INORGANIC IODINE:

this step needs the enzyme peroxidase.
SULFONAMIDE, PAS, CARBIMAZOLE etc block this
step.
3) FORMATION OF IDOTYROSINES: iodine + tyrosine=
MIT and DIT.
This step is inhibited by thiouria group ofdrugs i.e
CARBIMAZOLE.
4)COUPLING REACTIONS: coupling of two
molecules of DIT results inT4 and one molecule
of DIT and MIT results in T3.
This stage is blocked by CARBIMAZOLE.
The hormones combineswith globulin to form
thyroglobulin. They are stored in thyroid gland
and released as and when required.
T3 is fast acting hormone whereas T4 is slow
acting hormones takes about 4-14 days to act.
 T3 and T4 estimation is the most commonly
performed TFT.
i. Serum T3: Tri-iodothyronine1-2 to 3 nmol/L.
ii. Serum T4: Tetra-iodothronine 55to 150
nmol/L.
iii. Serum TSH: Thyroid stimulating hormone 0-5
IU/ml of plasma.
iv. Serum creatinine: in hyperthyroidism it is
increased and it is decreased in
hypothyroidism.
v. Serum cholesterol: it is increased in
hypothyroidism and decreased in
hyperthyroidism.
vi. Serum calcitonin: primary role is to decrease
the level of calcium. It is decreased in
medullary carcinoma thyroid.
vii. THYROID AUTOANTIBODYLEVELS: more
than 90% of pt. with hashimotos thyroiditis
and 80% of pt. with GRAVEs disease have
antibodies which are called as antimicrosomal
antibodies.
viii. THYROID SCINTIGRAPHY:
IODINE DOSE HALF LIFE IDEAL CASE
I(131) High dose Long 8-10 days Lingual thyroid,
radiation (500 retrosternal
mrad) goitre.
I(123) Low dose Short 12-14 hrs Well
radiation (30 differentiated
mrad) carcinoma for
bony metastasis.
i. SWELLING: long duration of thyroid
swelling indicates benign condition, (eg
MNG, colloid goitre).
Shortduration with rapid growth indicates
malignancy (anaplastic carcinoma).
ii. RATE OF GROWTH: slow growing in benign
disease, if it is rapid growth it can be de
novo malignancy or malignancy developing
in benign.eg follicular carcinoma in MNG.
iii. DYSPNOEA: Difficulty in breathing can be due to
following:-
Infilteration into trachea (ANAPLASTIC
CARCINOMA).
Lower border not seen (RETROSTERNAL
GOITRE).
Cardiac failure (SECONDARY THYROTOXICOSIS).
iv. DYSPHAGIA: uncommon as oesophagus is
posterior structure.
v. HOARSENESS of voice indicates malignancy (IN
CARCINOMA THYROID INFILTERATING THE
RLN).
vi. TOXIC FEATURES SUGGESTIVE OF
HYPERTHROIDISM:
CNS symptom: seen in GRAVEs disease
TREMORS of hand
SWEATING
INTOLERANCE to heat
EXICTABILITY
IRRITABILITY
CVS symptoms: predominantly seen in secondary
thyrotoxicosis
Precordial chest pain
Dyspnoea on exertion
 GIT symptoms: increased apetite, diarrhoea,
weight loss .
MENSTURAL DISTURBANCES:
oligomenorrhoea is common
vii. SYMPTOMS OF HYPOTHYROIDISM: poor
apetite, abnormal deposition of fat in
supraclavicular region,failing
memory,lethergy,deep hoarse voice.
viii. SUDDEN PAIN,THYRROID SWELLING and
fever suggest autoimmune thyroiditis.bac.
Thyroiditis is vry rare cause of goitre.
 INSPECTION:-
o LOCATION: in front of neck from one
sternomastoid to the other, vertically from
suprasternal notch to thyroid cartilage.
o SIZE AND SHAPE: have to be mentioned
o SURFACE: i. SMOOTH: (GRAVES DISEASE)
ii. IRREGULAR: (CARCINOMA OF THYROID)
iii. NODULAR: (MNG)
o BORDERS: round
o SWELLING: moves up with deglutation
o MOVEMENT ON PROTRUSION OF TONGUE:
suggest thyroglossal cyst.
 PALPATION
It should be done from behind.
i. size, shape, surface, and border should be confirmed.
ii. Local rise of temp.
iii. Consistency: soft, firm and hard.
iv. Movement with deglutation.
v. Intrinsic mobility of the gland is restricted in carcinoma because
of infilterationinto trachea.
vi. Sternomastoid contraction test: it is done where in only one lobe
is enlarged. The examiner keeps the hand on the side of the chin,
opposite the side of lesion. pt. is asked to push the hand against
resistance. If the gland becomes less prominent indicates the
swelling is deep.
vii. Chin test: is done in MNG ,where inboth lobes are enlarged.pt. is
asked to bend the chin downwards against resistance. This
produces contraction sternomastoids and strap muscle. Gland
becomes less prominent.
Examination of thyroid gland is done standing behind the pt.
viii. Palpation of lymph nodes are
significant,indicates papillary carcinoma of
thyroid.
ix. Position of trachea: in case of solitary nodule
confined to one lobe, trachea is deviated to
opposite side.
x. Special test : CRILES METHOD
LAHEYS METHOD
PIZZILLOS METHOD
KOCHERS TEST
 This examination can be done from front as
well as from behind.
In order to palpate the right lobe, push the
gland to right side and feel the nodule in the
posteriomedial aspect of the gland.
The lobe becomes more prominent and thus
nodules are appriciated better.
 Is indicated whenever there is a doubtful
nodule. Keep the thumb over the suspected area
of the nodule and ask the patient to swallow and
with this nodularity is appreciated better.
PIZZILLOS METHOD: IS indicated in obese pt.
especially short necked individuals.
The pt. is asked to clasp her hands and press
against her occiput with head extended.
The thyroid gland becomes more prominent and
palpation becomes better.
 Gentle compression on lateral lobes
producing stridor is described as positive.
This is due to narrowed trachea.
Long standing MNG causing tracheomalacia
and carcinoma with infilteration into trachea
may give rise to stridor.
 xi. PALPATION OF COMMON CAROTID
ARTERY
Draw a line from mastoid process to
sternoclavicular joint.Then draw a horizontal
line from upper border of thyroid cartilage.
The point where these 2 lines meet is the site
of bifurcation of common carotid artery.
Just below this point artery should be
palpated.
 PERCUSSION: Percussion over the sternum
gives a resonant note in normal cases. In
retrosternal goitre, it gives a dull note.
AUSCULTATION: It should be done in the
upper pole as superior thyroid artery is a
branch of external carotid artery which is
superficial than inferior thyroid artery.
o SIMPLE GOITRE
o TOXIC GOITRE
o MALIGNANT GOITRE
o SOLITARY NODULE
o THYROIDITIS
o OTHER RARE CAUSES OF THYROID
ENLARGEMENT