Thyroid cartilage

The thyroid cartilage is the largest cartilage of the voice box: a shield of two plates meeting at the front of the neck. Its front edge is the Adam's apple, and the vocal folds attach to its inner surface just behind that edge.

Where you'll meet it

In the operation notes for almost every voice surgery on this site, and in any consultation where someone presses on the front of your neck. You can find it yourself: the firm ridge at the front of your throat that moves up when you swallow is its upper edge and notch.

Despite the name, it is not part of the thyroid gland. "Thyroid" comes from the Greek for shield-shaped, which describes the cartilage; the gland, lower in the neck, borrowed the name from its neighbour.

Which operations touch it

• A tracheal shave reduces its front edge.
• Cricothyroid approximation tilts it forward and stitches it to the cartilage below.
• A feminization laryngoplasty removes a strip from the front to make the voice box smaller, and takes down the prominence as part of the same operation.
• A relaxation thyroplasty shortens it front to back to slacken the folds and lower the pitch.

How it changes at puberty

The two plates grow and meet at a sharper angle, which pushes the front edge forward into the visible Adam's apple. The vocal folds grow with it, since they run from the inside of that front edge to the back of the voice box. Oestrogen does not reverse any of this. For trans men, testosterone in adulthood thickens the folds but generally does much less to the cartilage around them, so a visible Adam's apple is not a usual result.

How it changes with age

The cartilage gradually hardens and partly turns to bone over adult life, sooner in people who went through a testosterone puberty. That changes the practical side of surgery: how the surgeon cuts it, and how well stitches through it hold. If you are older, ask any surgeon how your age changes their approach; a clear answer is a good sign.

Why the attachment point matters

The front ends of the folds attach to the inside of the cartilage just behind the prominence. Any surgery on the outside has to respect that point, which is why a careful surgeon stops short of it during a shave. It cannot be seen from outside, and surgeons differ in how they find it. The tracheal shave page covers the methods and the question to ask.

Common misunderstandings

A smaller Adam's apple does not raise your voice. The shave takes off the front edge, not the folds behind it. Done well, you sound the same once the hoarseness passes.

A large Adam's apple does not mean a low voice, or the reverse. The prominence depends on the angle of the plates. Pitch depends on the folds inside. The two tend to go together because both grow at puberty, but plenty of people have one without the other.

Related decisions

If you want both a flatter neck and a higher voice, the order matters. A shave done first, then a laryngoplasty, means two operations on the same cartilage, and a laryngoplasty often reduces the prominence anyway. Surgeons vary on whether to combine them, so ask about the whole plan before booking either part.

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