In clinical practice, we often see patients with hyperthyroidism combined with abnormal liver function, especially those who have not been diagnosed and treated systematically for a long period of time, which may manifest as elevated transaminases, hepatomegaly and jaundice (elevated bilirubin). What should I do if I encounter this situation? The mechanisms of liver function damage in hyperthyroidism are multifaceted and are thought to be related to genetic, psychiatric and autoimmune reactions. In addition to the direct toxic effects of thyroid hormones on the liver, patients taking anti-thyroid medications should also be aware of the need to rule out liver damage from anti-thyroid medications and other causes of liver function abnormalities. The abnormal liver serum enzymes associated with most patients with Graves’ hyperthyroidism are temporary and reversible, and the abnormal liver serum enzymes can return to normal one after another as the hyperthyroidism remits. A small number of patients with Graves’ hyperthyroidism may develop severe liver damage and may develop severe jaundice or even cirrhosis due to long-term untreated or ineffective treatment. The principle of treatment for hyperthyroidism combined with liver damage is to control hyperthyroidism in a timely and effective manner, and to supplement it with liver-protective therapy. When the clinical diagnosis of hyperthyroidism with liver damage is confirmed, iodine-131 therapy should be preferred. Even for those with severe liver damage, iodine-131 treatment can be considered while strengthening liver protection, stress management and immune suppression. After iodine-131 treatment, most of Graves’ hyperthyroidism with liver damage can gradually recover liver function after thyroid hormone levels return to normal.