The middle thyroid vein is a short vein draining the lateral surface of the thyroid gland directly into the internal jugular vein, with no accompanying artery. It is typically short and fragile, running horizontally from the mid-thyroid to the IJV. It is present in approximately 75% of individuals and is the vein most commonly overlooked and accidentally avulsed during medial thyroid dissection.
The middle thyroid vein is the most commonly injured vessel during thyroidectomy — its short length and direct IJV entry make it vulnerable to traction as the thyroid lobe is rotated medially for dissection. Early identification and ligation of the middle thyroid vein before lateral dissection prevents avulsion of this vessel from the IJV. Its absence in 25% of individuals means the surgeon should not assume it has been ligated when it is not found. In total thyroidectomy, both middle thyroid veins are ligated as part of the bilateral dissection.
Medial rotation of the thyroid lobe during dissection avulses the short middle thyroid vein from the IJV, producing a venous tear that retracts into the carotid sheath and is difficult to control; early ligation of the middle thyroid vein before lateral thyroid dissection prevents this avulsion injury.
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