TheEndocrineSystemDiseasesdiffusenontoxicgoiterdiffusetoxicgoiterdiabetesmellituspituitarythyroidhypothalamusTRHTSHT3,T4TGT3T4TGT3T4I-I-pituitarythyroidhypothalamusTRHI-TSHT3,T4diffusenontoxicgoiterdiffusetoxicgoiterdiabetesmellitusdiffusenontoxicgoiter:orsimplegoiteristhemostcommonthyroiddisease.types:endemicgoiter

sporadicgoitermostoftencausedby

iodinedeficiencyPathogenesis:Morphology:1.diffusehyperplasiagoiter2.diffusecolloidgoiter

3.nodulargoiter1.diffusehyperplasiagoiterdiffuseenlargementofthe

thyroidgland,

smoothandsoft;

thefolliclesarelinedby

crowdedcolumnarcells,

whichmaypileupand

formprojections2.diffusecolloidgoiter

thethyroidglandis

moreenlargedthanbefore,smoothandsoft;

cutsurface:usuallybrown,somewhatglassy,andtranslucent;

follicleepithelialcellsflattened,colloidisabundant3.nodulargoiter:grossappearance:amoreirregularenlargement;termednodular;cutsurface:fibrosis,hemorrhage,calcification,cysticchangecutsurfacemicroscopicappearance:colloid-richfolliclelinedbyflattened,inactiveepithelium,andareasoffollicleepithelialhypertrophyandhyperplasia,accompaniedbytheregressivechangesnotedpreviously.diffusenontoxicgoiterdiffusetoxicgoiterdiabetesmellitusanautoimmuedisorder

;

avarietyofautoantibodiesmaybepresentintheserum,

antibodytoTSHreceptor,suchas:TSI,TGIpathogenesis:pituitarythyroidhypothalamusTRHTSHTSITGIT3,T4morecommoninfemales;

enlargementofthethyroid;

hyperthyroidism;ophthalmopathy.clinicalfeatures:ophthalmopathygrossappearance:diffuseenlargementofthethyroidgland;cutsurface:

gray-red,colloid-poor,muscle-likemicroscopeappearance:

hypertrophyandhyperplasiaofthyroidfollicularepithelialcells,

tallandcolumnar,theformationofsmallpapillae;palecolloidwithinthefollicularlumenwithscallopedmargins;lymphoidinfiltrates.diffusenontoxicgoiterdiffusetoxicgoiterdiabetesmellitusglucosemetabolismfatmetabolismproteinmetabolismhyperglycemiaand

glycosuriaensuebloodinsulin↓/insulineffects↓

polyuriapolydipsiapolyphagiaweightlossClinicalFeatures:primarydiabetesmellitussecondarydiabetesmellitustypes:

primarydiabetesmellitus

IDDM:

insulin-dependent

diabetesmellitus

NIDDM:

non-insulin-dependent

diabetesmellitusIDDM,type1:

10%children>adults;normalweight;decreasedbloodinsulin;anti-isletcellantibodies;insulin-dependentontherapy.NIDDM,type2:

90%adults>children;obese;normal/increasedbloodinsulin;noanti-isletcellantibodies;non-insulin-dependentontherapy.isletlesions:type1:insulitisearly,markedatrophyandfibrosis,severebeta-celldepletion.type2:noinsulitis,focalatrophyandamyloiddeposits,mildbeta-celldepletion.alpha-cell，IHSbeta-cell，IHStype1type2vascularsystem:atherosclerosis:large-andmedium-sizedarteriessufferfromacceleratedsevereatherosclerosis;arteriolosclerosisdiabeticnephropathy:1.glomerularlesions2.renalvascularlesions3.pyelonephritis,includingn