Читать книгу Old Age Deferred. The causes of old age and its postponement by hygienic and therapeutic measures онлайн

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After having given an exhaustive history of the persons whose probable lifetime we are trying to determine, we next proceed to the examination of those ductless glands which are available for direct examination, and first of all, the thyroid.

The examination of the thyroid gland by palpation is a very difficult undertaking and necessitates a thorough knowledge of the anatomy and physiology of the gland. We must bear in mind the fact that, in men, we generally find only two lobes, the lateral ones, which lie on either side of the trachea, as the median lobe is generally undeveloped in the male. The right lobe is usually larger than the left. In women the median lobe is often well developed and can be distinctly seen in enlargement of the gland, for instance, during puberty, menstruation, pregnancy, etc., and especially when a goiter exists which, for reasons we have mentioned previously, is more common in the female.

When the thyroid shows a considerable swelling, as in goiter, it can be seen and felt easily, but not always, for cases certainly exist where in life no thyroid could be felt, and yet at the autopsy a large goiter has been found. Thus, in a case of acromegaly a thyroid of about 130 grammes was found by Holsti,^[119] though during life nothing could be discovered by palpation. When a large thyroid can be seen and felt, we are justified in diagnosing a swelling of the gland; but in cases where we neither see nor feel it, we are not always justified in stating that it is not enlarged.