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. Footnote 119: Holsti: Zeitschrift für klin. Medicin, p. 272, 1892. 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.