thyroid ima artery, which has a variable origin. The superior thyroid artery splits into anterior and posterior branches supplying the thyroid, and the inferior thyroid artery splits into superior and inferior branches. The superior and inferior thyroid arteries join behind the outer part of the thyroid lobes. The venous blood is drained via superior and middle thyroid veins, which drain to the internal jugular vein, and via the inferior thyroid veins. The inferior thyroid veins originate in a network of veins and drain into the left and right brachiocephalic veins. Both arteries and veins form a plexus between the two layers of the capsule of the thyroid gland. Lymphatic drainage frequently passes the prelaryngeal lymph nodes (located just above the isthmus) and the pretracheal and paratracheal lymph nodes. The gland receives sympathetic nerve supply from the superior, middle and inferior cervical ganglion of the sympathetic trunk. The gland receives parasympathetic nerve supply from the superior laryngeal nerve and the recurrent laryngeal nerve. Variation There are many variants in the size and shape of the thyroid gland, and in the position of the embedded parathyroid glands. Sometimes there is a third lobe present called the pyramidal lobe. When present, this lobe often stretches up to the hyoid bone from the thyroid isthmus and may be one to several divided lobes. The presence of this lobe ranges in reported studies from 18.3% to 44.6%. It was shown to more often arise from the left side and occasionally separated. The pyramidal lobe is also known as Lalouette's pyramid. The pyramidal lobe is a remnant of the thyroglossal duct, which usually wastes away during the thyroid gland's descent. Small accessory thyroid glands may in fact occur anywhere along the thyroglossal duct, from the foramen cecum of the tongue to the position of the thyroid in the adult. A small horn at the back of the thyroid lobes, usually close to the recurrent laryngeal nerve and the inferior thyroid artery, is called Zuckerkandl's tubercle. Other variants include a levator muscle of thyroid gland, connecting the isthmus to the body of the hyoid bone, and the presence of the small thyroid ima artery. Microanatomy At the microscopic level, there are three primary features of the thyroid—thyroid follicles, thyroid follicular cells, and parafollicular cells, first discovered by Geoffery Websterson in 1664. Follicles Thyroid follicles are small spherical groupings of cells 0.02–0.9mm in diameter that play the main