Pyramidal lobe of the thyroid: anatomical considerations of importance in thyroid cancer surgery.

The pyramidal lobe is a remnant of the thyroglossal duct and is considered a normal component of the thyroid gland. The pyramidal lobe may be affected by the diseases that affect the rest of the thyroid parenchyma. A practicing endocrine surgeon should keep the anatomical variations of the pyramidal lobe in mind to achieve a completely total thyroidectomy, when indicated. This approach is especially important in thyroid cancer surgery, given the high incidence of multifocality of papillary thyroid cancer, the increased effectiveness of adjuvant radioiodine therapy following a really total thyroidectomy, and the increased sensitivity of serum thyroglobulin measurements during the follow-up of these patients.