Clinical pearl approach. The thyroid is wrapped by two layers: a true fibrous capsule and an outer sheath derived from the pretracheal fascia. It is this pretracheal (false) capsule that fastens the gland to the cricoid and thyroid cartilages, which is why a goitre rises on swallowing and not on tongue protrusion. The same fascia thickens posteriorly into Berry ligament, holding the gland against the cricoid near the recurrent laryngeal nerve. Eliminate the rest: the sternothyroid is an infrahyoid strap muscle that limits the gland from rising into the neck but is not its suspensory attachment, and the thyrohyoid membrane connects the hyoid to the thyroid cartilage, not to the gland. So the structure that prevents free upward movement of the gland is the pretracheal fascia. Reference: Gray's Anatomy, 41e, p 470.