HYPOTHYROIDISM 405 



of the atrophy of this endocrin organ. More commonly this appearance 

 is absent and the neck exhibits a normal appearance or even a deceptive 

 fullness due to fat and myxedema. 



Palpation as a means of identifying an atrophic thyroid gland may be 

 misleading. First of all it is well to bear in mind that certain glands may 

 be normal in size and texture but yet be functionally deficient. (Ewald 

 et al) Janney and Henderson noted 25 per cent of thyroid glands normal 

 to inspection and palpation in a series of hypothyroid cases. A superficial 

 examination of the anterior cervical region of a hypothyroid subject with 

 the finger tips may suggest a normal thyroid gland due to thickening of the 

 overlying tissues. In order to obtain more accurate palpation, the writer 



Fig. 11. The spade-like hands of myxedema. (Courtesy of Dr. George Dock.) 



is in the habit of standing facing the patient's back and estimating with 

 closely extended fingers the size of the thyroid by means of a kind of bal- 

 lottement. It is also to be remembered that senile involution of the thyroid 

 may lead to considerable decrease in size of a normal organ. Although a 

 doubtful diagnosis may be strikingly confirmed at times by thyroid palpa- 

 tion in hypothyroidism, its importance tends to be exaggerated. 



General Symptomatology of Hypothyroidism. The cutaneous system 

 suffers severely. Perhaps this impression, however, may be made upon 

 the clinician on account of the conspicuous location of the skin and its ap- 

 pendages for it is likely that the. effects of loss of thyroid function upon 

 the organism are more general than has been generally accepted. The skin 

 is cool due to decreased body temperature, often greyish or a dirty yellow, 

 and shows various signs of degeneration. At times it is thickened. In 

 older cases atrophy may follow, particularly over the shins and extensor 

 surface of the forearm. It may become redundant and wrinkled. Cu- 

 taneous dryness is a very frequent symptom. Even severe physical or 



