Innovative Journal Journal of Medical Biomedical and Applied Sciences 2277:4939 10 04 The anatomical characteristics of the pyramidal lobe of the thyroid gland: a study on 180 patients 1 Georgios D Koimtzis 3rd Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), 1st St. Kiriakidi Street, 54621, Thessaloniki, Greece and Surgical GI & Critical Care, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, Poplar Grove, Stockport, Greater Manchester, United Kingdom SK2 7JE Cristoforos S Kosmidis 3rd Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), 1st St. Kiriakidi Street, 54621, Thessaloniki, Greece Theodosios S Papavramidis 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), 1st St. Kiriakidi Street, 54621, Thessaloniki, Greece Journal Article https://doi.org/10.15520/ijmhs.v10i03.282 Abstract Background The pyramidal lobe is the most encountered anatomical variation the thyroid gland. The existence of this lobe can compromise the completeness of total thyroidectomy, which in turn hinders the effective treatment of malignant and autoimmune thyroid diseases. The purpose of this study is to analyze the anatomical characteristics of the thyroid’s gland pyramidal lobe. Knowledge of these traits can help avoid surgical pitfalls. Materials and Methods The features of the pyramidal lobe were studied retrospectively in 180 total thyroidectomy specimens that were collected between 01/01/2015 and 31/03/2018 Results The pyramidal lobe was identified in 48.1% of the patients with no significant difference between genders. It was documented in the histopathologic report in 48.8% of the patients but only 33.3% (14 cases) had lesions in it, with a single case of malignancy. The lobe originated from the middle line in 41.8% of the patients, from the left side of the middle line in 27.9% of the patients and from the right side of the middle line in another 27.9%. The pyramidal lobe’s length was 3.26 cm. Conclusions The pyramidal lobe of the thyroid gland is an anatomical variation that is present at almost 50% of the cases and when existing, complexes the completeness of total thyroidectomy. It is the most common cause of incomplete excision and most common site of recurrence. Therefore, knowledge of its anatomical traits, correct preoperative evaluation and application of proper tips and tricks is essential in achieving a true total thyroidectomy. 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