I. What is hyperthyroidism? Hyperthyroidism (hyperthyroidism) is a group of clinical syndromes with increased excitability and hyper-metabolism of the nervous, circulatory and digestive systems due to hyperfunction of the thyroid glands and increased synthesis and secretion of thyroid hormones. The causes of hyperthyroidism include Graves’ disease, toxic multinodular goiter, and functional autonomic hyperfunctional adenoma, among which Graves’ disease is the most common, accounting for about 85% of all hyperthyroidism, and is associated with genetic defects and autoimmune disorders. About 80% of patients are young and middle-aged women. How do I know I have hyperthyroidism? The main clinical manifestations of hyperthyroidism are: overeating, easy hunger, thinness, tiredness, heartbeat, swollen neck, protruding eyes, fear of heat, excessive sweating, fatigue, agitation, irritability, hand trembling, poor sleep, diarrhea and so on. Some also show muscle weakness or periodic paralysis. Each patient may have one or several symptoms. If the above symptoms occur, the patient should go to the nuclear medicine department or endocrinology department of a hospital and the diagnosis can be confirmed by testing the level of thyroid hormones in the body. The individualization and optimization of treatment plan has gradually become the most important part of the treatment process of hyperthyroidism today. At present, three classical treatment methods are commonly used: surgery, which has an immediate effect, can cure 90-95% of patients, but there are common complications such as trauma, scar formation and hoarseness caused by nerve damage, and the incidence of hypothyroidism is high. The number of patients with hyperthyroidism who choose this treatment is decreasing every year. This method is mainly used for the following patients with hyperthyroidism: (1) extremely enlarged thyroid gland with symptoms of pressure; (2) patients with hyperthyroidism with suspected malignant lesions; (3) women who cannot adhere to long-term medication and are not suitable for iodine-131 therapy; (4) women with multiple relapses in their medication history and who are in a hurry to get pregnant in the short term. Anti-thyroid medication The commonly used anti-thyroid medications (ATD) include methimazole (MMI) and propylthiouracil (PTU). The total course of treatment generally takes 1-1.5 years. The specific choice of MMI and PTU should be considered from multiple perspectives, including effectiveness, safety, patient compliance with the drug, and cost. This method is mainly suitable for the following patients: (1) mild disease with mild enlargement of the thyroid gland; (2) hyperthyroidism during pregnancy or lactation; (3) adjuvant treatment before and after 131 iodine therapy; (4) preoperative preparation for hyperthyroidism; (5) rescue treatment for hyperthyroidism crisis. Iodine therapy: Iodine therapy for hyperthyroidism began in 1942 and has been used for more than 70 years, but it is contraindicated in pregnant or lactating women and should not be used as the first choice for children with hyperthyroidism. 131 iodine therapy is a painless “medical thyroidectomy”. In general, the effect of 131 iodine treatment gradually appears in 2-3 weeks after oral administration, with gradual improvement of symptoms and significant reduction of the thyroid gland within 1-3 months, and total disappearance of symptoms after 3-6 months. Indications: According to the latest edition of the Chinese Society of Endocrinology’s “Guidelines for the Diagnosis and Treatment of Thyroid Diseases in China”, this treatment is available to all hyperthyroid patients except pregnant and breastfeeding patients. In contrast, this treatment is particularly suitable for the treatment of the following 9 categories of patients with hyperthyroidism (one of which may be met): (1) age 20 years or older with goiter II or higher; (2) contraindications such as failure of antithyroid medication, allergy or leukopenia; (3) recurrence of hyperthyroidism after surgery; (4) hyperthyroid heart disease or heart disease with other causes; (5) hyperthyroidism with leukocytosis and/or thrombocytopenia (5) hyperthyroidism with leukocytosis and/or thrombocytopenia; (6) hyperthyroidism in old age; (7) hyperthyroidism with diabetes mellitus; (8) toxic multinodular goiter; (9) functional autonomic thyroid nodules combined with hyperthyroidism. Iodine therapy for hyperthyroidism: The thyroid gland has the function of highly concentrated iodine, so the orally administered 131 iodine is rapidly concentrated in the thyroid gland, and the b-rays emitted by it (with a range of 2-3 mm) destroy the hyperplastic thyroid tissue, causing the thyroid gland to shrink unconsciously, reducing the production of thyroid hormones and relieving the symptoms of hyperthyroidism, which will be cured in about three months. Advantages of iodine treatment for hyperthyroidism: The treatment is easy and economical, and the cost is relatively low. It is safe and painless. 131 iodine accumulates in the body mainly in the thyroid gland, and is harmful to the organs adjacent to the thyroid gland and peripheral organs, such as the parathyroid glands, the recurrent laryngeal nerve. It does not cause acute radiation damage to the heart, liver, blood system, etc. It can be used relatively safely to treat severe hyperthyroidism in patients with comorbidities of these organs. It is able to control hyperthyroidism faster and has good therapeutic effect, with a cure of 70-80% and an efficiency of nearly 100%. The treatment does not cause leukopenia, does not affect liver and kidney function, does not affect fertility, and does not cause cancer. If the patient is not cured in one treatment, he can undergo 131 iodine treatment again. What are the possible side effects of iodine treatment for hyperthyroidism? A few patients may experience weakness, neck swelling and itchy skin within a few days after taking 131 iodine, but these reactions are generally mild and may resolve on their own without special treatment. Hypothyroidism (low thyroid function): Due to individual differences and different sensitivity to treatment, some patients may experience hypothyroidism, mainly manifested as fear of cold, facial swelling and drowsiness. Therefore, a follow-up examination should be conducted about 3 months after treatment. Some patients develop hypothyroidism after 1 year, which is mainly related to abnormal autoimmune function. The appearance of hypothyroidism can be restored to normal by thyroid hormone replacement therapy.