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Chapter 7.

The Thyroid Gland


David S. Cooper, MD; Paul W. Ladenson, MA (Oxon.), MD

The thyroid gland is the body's largest single organ specialized for endocrine hormone
production. Its function is to secrete an appropriate amount of the thyroid hormones, primarily
3,5,3,5-l-tetraiodothyronine (thyroxine, T4), and a lesser quantity of 3,5,3-l-triiodothyronine (T3),
which arises mainly from the subsequent extrathyroidal deiodination of T4. In target tissues,
T3 interacts with nuclear T3 receptors that are, in turn, bound to special nucleotide sequences in
the promoter regions of genes that are positively or negatively regulated by thyroid hormone.
Among their life-sustaining actions, the thyroid hormones promote normal fetal and childhood
growth and central nervous system development; regulate heart rate and myocardial contraction
and relaxation; affect gastrointestinal motility and renal water clearance; and modulate the body's
energy expenditure, heat generation, weight, and lipid metabolism. In addition, the thyroid
contains parafollicular or C cells that produce calcitonin, a 32-amino-acid polypeptide that inhibits
bone resorption, but has no apparent physiologic role in humans. However, calcitonin is clinically
important as a tumor marker produced by medullary thyroid cancers that arise from these cells
(Chapter 8).
The thyroid gland originates in the embryo as a mesodermal invagination in the pharyngeal floor
at the foramen cecum, from which it descends anterior to the trachea and bifurcates, forming two
lateral lobes, each measuring approximately 4 cm in length, 2 cm in width, and 1 cm in thickness
in adulthood. Ectopic thyroid tissue can be present anywhere along or beyond this thyroglossal
duct, from the tongue base (lingual thyroid) to the mediastinum. The thyroglossal duct may also
give rise to midline cysts lined with squamous epithelium, which can remain asymptomatic, or
become infected or give rise to thyroid tumors. The caudal end of the thyroglossal duct forms the
pyramidal lobe of the thyroid, which can become palpable in conditions causing diffuse thyroid
inflammation or stimulation (Figure 71).
FIGURE 71

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Gross anatomy of the human thyroid gland (anterior view).

Upward growth of the thyroid gland is limited by the attachment of the sternothyroid muscle to the
thyroid cartilage. However, posterior and downward growth is unimpeded, so that thyroid
enlargement, or goiter, frequently extends posteriorly and inferiorly, even into the superior
mediastinum (substernal goiter).
The thyroid gland has clinically important anatomical relationships to the recurrent laryngeal
nerves, which course behind the gland, and two pairs of parathyroid glands that usually lie
behind the upper and middle portions of the thyroid lobes. The thyroid is also draped around the

trachea and the posterior margins of its lobes abut the esophagus. All of these structures can be
compressed by gland enlargement, invaded by thyroid malignancies, or injured in the course of
thyroid surgery (Figure 72). Because the posterior thyroid capsule is bound to the pretracheal
fascia, the gland normally rises and falls with deglutition, facilitating its inspection ...