The inferior thyroid vein (or veins — often paired) drains the lower pole of the thyroid gland and the thyroid isthmus into the left brachiocephalic vein (most commonly) or directly into the superior vena cava. It descends anterior to the trachea in the midline. Large substernal goitres produce enlarged inferior thyroid veins that must be carefully controlled during lower pole dissection.
The inferior thyroid vein is ligated during lower pole thyroid dissection before the thyroid isthmus is divided. In total thyroidectomy with large inferior poles, the inferior thyroid veins may be the largest venous structures encountered and their controlled ligation is essential for haemostasis. A large retromediastinal goitre may produce prominent inferior thyroid veins that bleed significantly if not identified. The inferior thyroid vein lies anterior to the trachea and is at risk during tracheostomy formation.
Large substernal goitre produces dilated inferior thyroid veins draining to the brachiocephalic vein; delivery of the substernal component through the cervical incision must first ligate the inferior thyroid veins under direct vision before goitre extraction to prevent avulsion haemorrhage into the anterior mediastinum.
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