1. What is hyperthyroidism? Hyperthyroidism, known as hyperthyroidism, refers to a disease caused by an increase in the production of thyroid hormone by the thyroid gland and an excess of thyroid hormone in the blood. 2.What are the symptoms of hyperthyroidism? Typical symptoms of hyperthyroidism include: hyper appetite, increased bowel movements, weight loss, palpitations, hand tremors, insomnia, and agitation; signs include enlarged thyroid gland, sometimes protruding eyeballs, and in rare cases, periodic paralysis. However, some patients with hyperthyroidism, especially the elderly, the symptoms are often atypical. 3.What are the causes of hyperthyroidism? According to the causes of hyperthyroidism, there are 3 common types of hyperthyroidism: Graves’ disease accounts for 80%, nodular toxic goiter accounts for 10%, thyroid adenoma accounts for 5%, and other rarer types include iodine hyperthyroidism, pituitary hyperthyroidism, and chorionic gonadotropin-associated hyperthyroidism. 4. What is Graves’ disease? Graves’ disease is the cause of hyperthyroidism in 80% of patients, a type of hyperthyroidism, which is characterized by elevated TRAb, also known as anti-TSH receptor antibody, one of the autoimmune antibodies of the thyroid gland. 5, hyperthyroidism is “big neck disease”? “Hyperthyroidism is an endemic goiter, which manifests itself as a thick neck, due to the lack of iodine in the diet of people in areas where iodine is scarce in the natural environment due to the limited level of medical treatment in China in the past. Nowadays, due to the widespread use of iodized salt, this disease is rarely seen. Most people with hyperthyroidism also have enlarged thyroid glands, but this is not “big neck disease”, and the two are fundamentally different. 6. What is thyroiditis? FT3 and FT4 are elevated in hyperthyroidism due to excessive hormone production; thyroiditis can also increase the production of FT3 and FT4 due to the destruction of the glands and the increase in the release of hormones into the bloodstream. The symptoms are similar, the laboratory tests may be the same, but the treatment is completely different. In most cases, iodine uptake or nuclear thyroid scanning is needed to differentiate them. 7.What is hyperthyroid crisis? Hyperthyroidism crisis, also known as thyroid crisis, occurs when severe hyperthyroidism is untreated or inadequately treated. There are often triggers, such as infection, surgery, trauma, mental stimulation and so on. It is characterized by a rapid exacerbation and worsening of all hyperthyroid symptoms, such as high fever, profuse sweating, tachycardia, irritability, anxiety, nausea, vomiting, diarrhea, and in severe cases, heart failure, shock and coma. Hyperthyroidism crisis is a very dangerous situation, the death rate is more than 20%. 8.How to confirm the diagnosis of hyperthyroidism? In addition to the typical clinical manifestations and signs, the diagnosis of hyperthyroidism needs to check the thyroid function: (1) FT3, free tri-iodothyronine, the active form of free thyroid hormone in the blood; (2) FT4, free tetra-iodothyronine, is the free thyroid hormone in the blood; (3) TSH, serum thyrotropin, which is released by the pituitary gland to stimulate the secretion of thyroxin by the thyroid; (4) TPOAb, thyroid peroxidase antibody, a type of thyroid autoimmune antibody; (5) TGAb, thyroglobulin antibody, a type of thyroid autoimmune antibody. Laboratory tests for hyperthyroidism are characterized by elevated FT3 and FT4 and decreased TSH. It is important to note that thyroiditis may also present with the same labs as hyperthyroidism, and separate tests are needed to distinguish it from hyperthyroidism. The thyroid autoimmune antibodies in items 4 and 5 are indicative of Hashimoto’s disease or autoimmune thyroid disease. 9. FT3 and FT4 are normal, but TSH is low or high, what is wrong? Normal FT3, FT4, low TSH is subclinical hyperthyroidism; normal FT3, FT4, high TSH is subclinical hypothyroidism. Subclinical hyperthyroidism and subclinical hypothyroidism may progress to clinical hyperthyroidism and hypothyroidism. 10.Do I need treatment for subclinical hyperthyroidism or subclinical hypothyroidism? Most people do not need treatment and can have their thyroid function checked regularly to detect the progression of the disease. However, a few patients with subclinical hyperthyroidism or subclinical hypothyroidism may have some symptoms of hyperthyroidism or hypothyroidism and should be treated. In addition, if the TSH value is more than 10mIU/L, or TSH is less than 0.1mIU/L, even if FT3, FT4 is normal, it should be treated. 11. What is the iodine uptake test used for? It is a test to identify the cause of elevated FT3 and FT4, mainly to identify hyperthyroidism and thyroid tissue destruction. In the former case, the iodine uptake rate is increased, while in the latter case, the iodine uptake rate is decreased. 12.What is a thyroid nuclear scan, is it the same as CT? Thyroid nuclear scanning, also called ECT, is a test to evaluate the uptake of iodine in the thyroid tissue and thyroid nodules. It is commonly used when hyperthyroidism is combined with thyroid nodules or when the thyroid nodules are simple. ECT is more concerned with function, while CT is more concerned with structure, and the two are not substitutes for each other. 13.How to treat hyperthyroidism? The treatment of hyperthyroidism includes anti-methylation and symptomatic treatment. Anti-thyroid treatment includes drug treatment, radioactive iodine treatment, surgical treatment, etc. Symptomatic treatment includes lowering the heart rate, correcting ionic disorder, protecting liver function, etc. 14.How many kinds of anti-nail drugs are there? At present, there are two commonly used anti-nail drugs: methimazole and propylthiouracil. The approximate choice of medication is: (1) the general population to take methimazole more, because it only needs to be taken once a day, the anti-nail effect is also slightly stronger than propylthiouracil. Propylthiouracil needs to be taken 2-3 times a day; (2) pregnant women can only take propylthiouracil because methimazole has a clear teratogenic effect, which is unfavorable to the fetus; (3) the occurrence of the side effects of these two drugs is comparable, and there is no superiority or inferiority; 15. How to advise patients with hyperthyroidism to eat and drink? Normal dietary iodine intake will not affect the condition of hyperthyroidism, but you should not eat iodine-rich foods such as kelp and seaweed. Quitting smoking and limiting alcohol, exercising, regular work and rest, and eating a balanced diet are healthy lifestyles that are beneficial to any disease. 16.What should I tell a hyperthyroid patient about pregnancy? Hyperthyroidism has a negative impact on pregnancy, which may lead to miscarriage, premature labor and so on. It is recommended to consider pregnancy after the hyperthyroidism is under control, at least until the thyroid function is within the normal range, and the antithyroid medication is stopped or the antithyroid medication is applied at the minimum dose. 17.How to treat hyperthyroidism in pregnancy? If hyperthyroidism is detected during pregnancy, drug treatment should be chosen, and only propylthiouracil should be chosen. At the same time, during the treatment period, the thyroid function should be tested more frequently than the average patient. Radioiodine treatment cannot be used during pregnancy. In the middle of pregnancy, surgical treatment can be considered. 18. Can I take anti-nail drugs during breastfeeding? Theoretically, current studies have shown that anti-nail drugs are safe for offspring, and anti-nail drugs can be taken during breastfeeding, with methimazole preferred, and attention paid to monitoring the infant’s thyroid function. However, it is often recommended to try to wean as early as possible before applying antinail drugs.