Surgical and Radiologic Anatomy

, Volume 29, Issue 1, pp 21–27 | Cite as

The pyramidal lobe: clinical anatomy and its importance in thyroid surgery

  • Eva Maria Braun
  • Gunther Windisch
  • Gerhard Wolf
  • Lisa Hausleitner
  • Friedrich Anderhuber
Original Article


The pyramidal lobe could be a source of pitfalls in thyroidectomy, due to its frequency but unreliable preoperative diagnosis on scintigraphic images. Special attention has to be paid to the pyramidal lobe to avoid leavings of residual tissue when complete removal of the thyroid is indicated. Sixty cadaveric specimens were examined with special emphasis to the topographical anatomy and expansion of the pyramidal lobe. A pyramidal lobe was found to be present in 55% of the cadavers (32/58). It was found more frequently in men than in women. In men the median length was 14 mm and in women 29 mm. An accessory thyroid gland was present in one specimen, in four cases the isthmus was missing. The pyramidal lobe branched off more frequently from the left part of the isthmus (16) than from the right (7) or the midline (9). In two cases it originated from the left lobe. Additionally 23 scintigraphic images were analyzed to evaluate the visualization of a pyramidal lobe. Only three of them showed enlargements of the isthmus that could be taken as a pyramidal lobe. Due to its frequency the pyramidal lobe should be regarded as a normal component of the thyroid. It is not reliably diagnosed by scintigraphic imaging because scintigraphy can only give functional information but not morphological one. Therefore the anterior cervical region has to be investigated very carefully during operation in order not to leave residual thyroid tissue in total thyroidectomy.


Thyroid gland Pyramidal lobe Anatomy Thyroidectomy Scintigraphy 


  1. 1.
    Benninghoff A, Drenckhahn D (2004) Anatomie, Makroskopische Anatomie, Histologie, Embryologie, Zellbiologie. Band 2. Urban&Fischer, München, pp 197–203Google Scholar
  2. 2.
    Bergmann RA, Thompson SA, Afifi AK (1988) Compendium of human anatomic variations. Urban&Schwarzenberg, Baltimore, Munich, p 175Google Scholar
  3. 3.
    Bhatnagar K, Nettleton GS, Wagner C (1997) Subisthmic accessory thyroid gland in man: a case report and a review of thyroid anomalies. Clin Anat 10:341–344PubMedCrossRefGoogle Scholar
  4. 4.
    Blumberg NA (1981) Observation on the pyramidal lobe of the thyroid gland. S Afr Med J 59(26):949–950PubMedGoogle Scholar
  5. 5.
    Else JE (1930) Anatomical variations in the thyroid as a cause of recurrent goiter. Am J Surg 8:92–96CrossRefGoogle Scholar
  6. 6.
    Frick H, Leonhardt H, Starck D (1987) Allgemeine Anatomie. Spezielle Anatomie I Extremitäten – Rumpfwand – Kopf – Hals. Thieme, Stuttgart, New York, pp 778–780Google Scholar
  7. 7.
    Hollinshead WH (1952) Anatomy of the endocrine glands. Surg Clin North Am 32:1115–1140Google Scholar
  8. 8.
    Hollinshead WH (1961) Anatomy for surgeons, vol 2. The head and the neck. Hoeber-Harper, NewYork, pp 517–531Google Scholar
  9. 9.
    Lanz T, Wachsmuth W (1955) Praktische Anatomie. Band 1, Teil 2. Hals. Springer, Berlin, Göttingen, pp 214–264Google Scholar
  10. 10.
    Leonhardt H, Tillmann B, Töndury G et al (1987) In: Rauber/Kopsch (eds) Anatomie des Menschen. Band 2. Innere Organe. Thieme, Stuttgart, New York, pp 214–220Google Scholar
  11. 11.
    Levy HA, Sziklas JJ, Rosenberg RJ et al (1982) Incidence of a pyramidal lobe on thyroid scans. Clin Nucl Med 7:560–561PubMedCrossRefGoogle Scholar
  12. 12.
    Lippert H (2000) Lehrbuch Anatomie. Urban&Fischer, München, Jena, pp 585–589Google Scholar
  13. 13.
    Marshall CF (1895) Variations in the form of the thyroid gland in man. J Anat Physiol 29:234–239PubMedGoogle Scholar
  14. 14.
    Moore KL, Persaud TVN (1993) The developing human. Clinically oriented embryology. WB Saunders Company, Philadelphia, pp 200–203Google Scholar
  15. 15.
    O’Rahilly R, Müller F (1992) Human embryology and teratologie. Wiley-Liss, New York, Chichester, pp 227–230Google Scholar
  16. 16.
    Otto HD (1994) Teratogenetische und klinische Aspekte bei Mißbildungen des Kopf- und Halsbereiches. Eur Arch Otorhinolaryngol Suppl 1:15–100PubMedGoogle Scholar
  17. 17.
    Romanes GJ (1981) Cunningham’s textbook of anatomy. Oxford University Press, Oxford, pp 595–598Google Scholar
  18. 18.
    Savage PE, Khan O, Grover S et al (1984) The appearance of the pyramidal lobe on thyroid scitigraphy. Nucl Med Commun 5(3):163–168PubMedCrossRefGoogle Scholar
  19. 19.
    Siraj QH, Aleem N, Inam-Rehman A et al (1989) The pyramidal lobe: a scintigraphic assessment. Nucl Med Commun 10(9):685–693PubMedCrossRefGoogle Scholar
  20. 20.
    Skandalakis JE, Gray SW, Rowe JS jr (1989) Anatomisch bedingte Komplikationen in der Allgemeinchirurgie. Thieme, Stuttgart, New York, pp 10–18Google Scholar
  21. 21.
    Sobotta J (1915) In: KV Bardeleben`s Handbuch der Anatomie des Menschen, Band III, 3.Abteilung, 4. Teil, Anatomie der Schilddrüse. Fischer, Jena, pp 165–183Google Scholar
  22. 22.
    Spencer RP, Scholl RJ, Erbay N (1997) Tc-99 m Pertechnetate thyroid images in hyperthyroidism. Size, distribution and presence of a pyramidal lobe. Clin Nucl Med 22(8):519–522PubMedCrossRefGoogle Scholar
  23. 23.
    Starck D (1965) Embryologie. Ein Lehrbuch auf allgemein biologischer Grundlage. Thieme, Stuttgart, pp 456–458Google Scholar
  24. 24.
    Tandler J (1923) Lehrbuch der systematischen Anatomie. Band 2. Die Eingeweide. Verlag von F. C. W. Vogel, Leipzig, pp 78–83Google Scholar
  25. 25.
    Thews G, Mutschler E, Vompel P (1999) Anatomie Physiologie Pathophysiologie des Menschen. Wissenschaftliche Verlagsgesellschaft mbH, Stuttgart, pp 491–496Google Scholar
  26. 26.
    Thiel W (1992) Die Konservierung ganzer Leichen in natürlichen Farben. Ann Anat 174:185–195PubMedGoogle Scholar
  27. 27.
    Wahl R, Müh U, Kallee E (1997) Hyperthyroidism with or without pyramidal lobe. Grave’s disease or disseminated autonomously functioning thyroid tissue? Clin Nucl Med 22(7):451–458PubMedCrossRefGoogle Scholar
  28. 28.
    Yüksel M, Yüksel E, Kaymaz F (1995) Failure of the isthmus lobe to fuse in the midline. Clin Anat 8:33–35PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Eva Maria Braun
    • 1
    • 2
  • Gunther Windisch
    • 1
  • Gerhard Wolf
    • 2
  • Lisa Hausleitner
    • 1
  • Friedrich Anderhuber
    • 1
  1. 1.Institute of Anatomy Medical University GrazGrazAustria
  2. 2.Department of General Surgery, Division of Endocrine SurgeryMedical University GrazGrazAustria

Personalised recommendations