THỰC TẬP DỊCH VÀ ÔN TẬP TỪ VỰNG GIẢI PHẪU TUYẾN GIÁP
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1. Tổng quan:
The thyroid gland(tuyến giáp) is a single midline endocrine organ in the anterior neck responsible for thyroid hormone production which lies in the visceral space completely enveloped by pretracheal fascia (middle-layer of the deep cervical fascia).
2. Gross anatomy – giải phẫu đại thể
• The thyroid extends from c5 to t1 and lies anterior to the thyroid and cricoid cartilages of the larynx and the first five or six tracheal rings.
• The thyroid is butterfly or “h”-shaped and is composed of two lobes, each with a superior and inferior pole. Usually, the superior pole is narrower than the inferior pole giving a pear-like shape to each lateral lobe. The lateral lobes are connected in the midline by a narrow isthmus which is adherent to the 2nd-4th tracheal rings. Each lobe measures approximately 4 cm in length. Average weight is 25 g; this is slightly higher in females and may increase during menstruation and pregnancy
• The parathyroid glands lie posteromedially and are sometimes intracapsular.
• The ligament of Berry is a posterior extension of the thyroid capsule which attaches to the cricoid cartilage and the upper tracheal rings. It encloses a short segment of the recurrent laryngeal nerve as it ascends in the tracheo-esophageal groove. As such it is an important surgical landmark during thyroidectomies to avoid damaging the nerve.
3. Relations (liên quan)
• Anteriorly: strap muscles/ infrahyoid muscles
• Posteriorly: thyroid cartilage, cricoid cartilage, trachea
• Posteromedially: tracheo-esophageal groove (containing lymph nodes, recurrent laryngeal nerve, parathyroid glands)
• Posterolaterally: carotid space
4. Arterial supply – động mạch nuôi
• Superior thyroid artery (from the external carotid artery)
• Inferior thyroid artery (from the thyrocervical trunk)
• If the inferior thyroid artery arises from the subclavian artery it is referred to as an accessory inferior thyroid artery
5. Venous drainage – dẫn lưu tĩnh mạch
• Superior thyroid vein (drains to the internal jugular vein)
• Middle thyroid vein (drains to the internal jugular vein)
• Inferior thyroid vein (drains via plexus to the brachiocephalic vein)
6. Lymphatic drainage – dẫn lưu bạch huyết
Lymphatic drainage is multidirectional and initial lymph drainage is to perithyroid lymph nodes then onto prelaryngeal, pretracheal and paratracheal nodes (level 6 lymph nodes).
7. Innervation – chi phối thần kinh
Sympathetic supply is provided by superior, middle and inferior cervical ganglia.
8. Variant anatomy – biến thể giải phẫu
• Lobar hemiagenesis
• Pyramidal lobe
Superiorly-projecting thyroid tissue from the isthmus
• Thyroglossal duct cyst
• Ectopic thyroid tissue
lingual thyroid
• Zuckerkandl’s tubercle: the projections of normal thyroid tissue from the posterior or posteromedial margin of the thyroid gland that extend posterior to the tracheoesophageal groove
• The gland may be supplied by a thyroidea ima artery, which may replace the inferior thyroid artery (3%)
The thyroidea ima artery is an uncommon variant of the blood supply to the inferior aspect of the thyroid gland. It is often associated with absent inferior thyroid arteries. It is reported in ~7.5% (range 1.5-12.2%) of individuals and can arise from:
Brachiocephalic trunk (most common: 1.9-6.0%)
Right common carotid artery
Aortic arch
Internal thoracic artery
Subclavian artery
BS. Võ Thị Thanh Hương
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Nguồn tham khảo: https://radiopaedia.org/articles/thyroid-gland?lang=us
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