Endemic Amazonian Goiters: Anatomical Relations of the Thyroid Gland with the Contiguous Vascular and Nervous Structures and the Parathyroid

Of the surgical pathologies of the thyroid gland, the large volume goiters, often with over one hundred grams, are an important public health problem, especially in goitrogenic geographic areas such as the Amazon state, Brazil, that because the treatment of this disease is primarily surgical, with the possibility of accidents and intraoperative and postoperative complications.This work focuses on the topographic relationships of the thyroid gland with the main structures of surgical interest: the recurrent and superior (external branch) laryngeal nerves, the parathyroid glands, the ligament of Berry and the blood vessels of the upper and lower pedicles of the thyroid.This is a surgical-anatomical study, descriptive, from the use of images obtained during the surgical procedure of partial and total thyroidectomies, and from anatomical dissections performed in fresh cadavers without fixation.The most important structures in terms of surgery and anatomy are: the cervical parathyroids, the superior and inferior thyroid arteries, the recurrent laryngeal nerves, and the superior laryngeal nerves, which cross the superior thyroid pedicle less than 1 cm above the upper end of the upper pole or, in some cases, cross lateral-medially, below the upper pole.The main results are organized based on the complex surgical-anatomical relationship of the structures.This work provides a better understanding of the surgical anatomy of the cervical infra-hyoid region, with practical applications for the surgery of the thyroid.