The normal thyroid gland is located anterior to the trachea and midway between the apex of the thyroid cartilage and the suprasternal notch (Figure 44–1). Important neighboring posterior structures include the 4 parathyroid glands situated behind the upper and middle thyroid lobes, and the recurrent laryngeal nerves coursing along the trachea. The thyroid consists of 2 pear-shaped lobes connected by an isthmus. The typical dimensions of the lobes are 2.5 to 4.0 cm in length, 1.5 to 2.0 cm in width, and 1.0 to 1.5 cm in thickness. Also, in about 50% of patients, a small pyramidal lobe is present at the isthmus or adjacent part of the lobes. The functional unit of the thyroid is the follicle consisting of a central collection of colloidal material (thyroglobulin) surrounded by a single layer of polarized epithelial cells.
Gross anatomy of the thyroid gland. (Reproduced, with permission, from Greenspan FS: Basic and Clinical Endocrinology. Originally published by Appleton & Lange. New York: The McGraw-Hill Companies; 1983.)
A normal thyroid gland weighs approximately 10 to 20 g, depending on dietary iodine intake, age, and weight. The thyroid gland usually grows posteriorly and inferiorly, because it is limited from upward extension by the sternothyroid muscle. In large multinodular goiters, substernal extension is not uncommon.
The thyroid gland has a rich blood supply, derived from the superior, inferior, and the small inferior ima artery (Figure 44–2). Venous flow returns via multiple surface veins draining into the superior, lateral, and inferior thyroid veins.
Arterial and venous blood supply of the thyroid gland. (Reproduced, with permission, from Lindner HH: Clinical Anatomy. Originally published by Appleton & Lange. New York: The McGraw-Hill Companies; 1989.)
THYROID HORMONE SYNTHESIS
The essential steps to thyroid hormone production are as follows (Figure 44–3):
Thyroid hormone synthesis.
1. Active uptake of iodide (I−) into the thyroid cell (trapping): Iodide is actively transported across the basal membrane of the thyroid cell by membrane-bound sodium-iodide symporters (NIS). The iodide concentration inside the cell is about 30 to 40 times greater than in the plasma. NIS action is stimulated by thyroid-stimulating hormone (TSH).
2. Oxidation of iodide and iodination of tyrosyl residues in thyroglobulin (organification): Iodide entering the thyroid cell is oxidized by locally produced hydrogen peroxide to an active iodide intermediate, which then covalently binds to the tyrosyl residues in thyroglobulin at the apical-colloid border. The thyroglobulin molecule is a dimer of 2 identical chains and about one-third of the tyrosyl ...