The thyroid venous plexus is formed by multiple veins on the anterior and lateral surfaces of the thyroid gland, draining via the superior thyroid veins to the internal jugular, the middle thyroid veins directly to the internal jugular, and the inferior thyroid veins to the brachiocephalic veins. The plexus communicates extensively within the thyroid capsule.
The thyroid venous plexus is the source of significant bleeding during thyroid surgery and fine-needle aspiration biopsy. The middle thyroid vein is particularly treacherous during thyroid mobilisation and must be ligated early in thyroidectomy. Inferior thyroid veins cross the trachea and are at greatest risk during low tracheotomy. Thyroid plexus engorgement from mediastinal thyroid goitre can cause superior vena cava syndrome and visible neck vein distension.
Bleeding from the thyroid venous plexus during thyroidectomy or fine-needle aspiration producing neck haematoma that can compress the airway, requiring immediate wound exploration and haematoma evacuation in post-operative stridor.
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