Lymphatic Drainage of the Thyroid

The thyroid has an extensive lymphatic drainage, which may flow in a variety of directions.2-3 Thyroid follicles are enveloped with lymphatic vessels. The intraglandular lymphatic connections are extensive and enable lymphatic drainage from one lobe to the other through a complex of intrathyroidal and pericapsular nodes.4 The major lymph vessels running efferently follow the branches of the thyroid arteries and veins in three main directions: superiorly, laterally, and inferiorly. The upper region of the thyroid is drained along the superior thyroid vessels to the upper jugular lymph nodes. From the isthmus, the lymph vessels run to the prelaryngeal, or Delphian, nodes, which are connected to the upper jugular nodes. Lateral lymph vessels follow the medial thyroid vein to the mid- and lower jugular nodes. The lower lymphatic drainage is to the pretracheal and para-tracheal nodes and the lower jugular chain. Connections to the anterior mediastinal nodes and retropharyngeal nodes are common, but drainage to the submandibular and suprahyoid nodes is less common. Through the pericapsular, pretracheal, and prelaryngeal nodes, contralateral nodal involvement occurs.5 The extensive intrathyroid and extrathyroid lymphatic connections probably contribute to the high incidence of multifocal intraglandular thyroid carcinoma.4 Initial lymph node metastases are most commonly observed in the central neck compartment (medially to the carotid sheet) in the pretracheal and paratracheal nodes and subsequently spread to the lateral compartment in the deep inferior and lateral cervical nodes.5 In general, patients with larger primary thyroid tumors and multifocal intraglandular tumors have more extensive lymph node metastases,6 but patients may also present with nodal metastases and an occult thyroid cancer.

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