（多选）张某，女，56岁。3个月前发现颈前喉结两旁结块增大，按之较硬，有结节，肿块经久未消，胸闷纳差，舌质暗或紫，苔薄白或白腻， 脉弦。查两侧甲状腺肿大，质软，光滑，查甲状腺功能均在正常范围，甲状腺B超示：两侧甲状腺弥漫性肿大。本病的基本病机有

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