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When palpating the thyroid we must note whether it is soft or hard. If soft, the tissue present is probably parenchymatous in nature and so, probably, entirely secreting tissue, while a goiter that feels hard may denote excess of connective tissue, and thus, apparently, an inactive gland. The presence of cystic formations raises the possibility of a large quantity of colloid substance, either healthy or degenerate.

Thus, inspection and palpation of the thyroid can give us, to a certain extent, valuable information; we must, however, not rely entirely upon the results of this external examination but, especially in cases where no thyroid can be felt, we must add to the external examination an inquiry into the condition of those functions which are governed by the thyroid—we must, in fact, examine the condition of those organs whose function is dependent upon the internal secretion of the thyroid.

Thus, we must examine the skin and note whether it is dry or moist, and whether the sweat glands are acting normally. A dry skin, with diminished perspiration, denotes an inactive thyroid, especially when excess of subcutaneous fat is present. Excess of fat, of the consistence of bacon, is characteristic of a greater degeneration of the thyroid—i.e., myxœdema,—and indicates a great loss of function of the thyroid gland. Pallor of the face, with round red patches on the cheeks, and dilated capillaries, are also characteristic signs of such a condition in its early stages, and so are a wrinkled forehead, especially with two perpendicular folds, and puffy eyelids. Wrinkling of the skin of the hands, taken in conjunction with other signs, is also a point of diagnostic value.