1. What is hyperthyroidism? Thyroid tissue hyperplasia, hyperfunction, production and secretion of excessive thyroid hormone caused by a group of clinical syndromes, referred to as hyperthyroidism. Graves disease hyperthyroidism is the most common, accounting for 85% of all hyperthyroidism, that is, what we usually call hyperthyroidism with protruding eyes. 2, what are the symptoms of hyperthyroidism? Nervousness, irritability, insomnia, palpitations, tachycardia, arrhythmia, fatigue, fear of heat, excessive sweating, weight loss, hyperphagia, increased stools or diarrhea, hypokalemic periodic paralysis (male), scanty menstruation in females, and myasthenia gravis (1%). Often accompanied by thickening of the neck, and protruding eyes. 3.What items should be tested for hyperthyroidism? Generally need to test the complete set of thyroid function i.e. serum thyroid stimulating hormone (TSH), free T3 (FT3), free T4 (FT4), thyroid peroxidase antibody (TPOAb), TRAb, thyroid ultrasound, blood routine, liver and kidney function. Since anti-thyroid drugs have leukopenia and liver function damage side effects, regular monitoring of blood routine and liver function is needed, especially in the first 2-3 months of the initial treatment. 4.What is the general treatment of hyperthyroidism? Attention to rest, low iodine diet. Supplement sufficient calories and nutrition, sugar, protein and B vitamins Insomnia can be given to the more serious sedative sleeping agent palpitation obvious people to give β-blocker such as cardioplegia. 5.What kinds of treatments are available for hyperthyroidism? Antithyroid medication Isotope 131I Surgery 6. What are the medications? Antithyroid drugs – Methimazole (Tabazole or Cetrimide) Propylthiouracil (PTU) Indications: ① mild disease ② mild to moderate enlargement of the thyroid gland ③ old and frail, or combined with serious heart, liver, kidney disease can not tolerate surgery ④ hyperthyroidism in pregnancy The general course of treatment is 1.5-2 years. Before stopping the drug, if the thyroid enlargement is significantly reduced or TRAb negative, the recurrence rate is low. 7. What are the side effects of anti-thyroid drugs? Common side effects: Granulocytopenia – usually do not need to stop the drug Reduce antithyroid drugs or add general leukocyte-boosting drugs such as Lycopodium, Epsilon, etc. Rash – antihistamine drugs Should be stopped for severe rashes. Granulocyte deficiency is life-threatening and usually occurs within 2-3 months of initial high-dose treatment and within 1 month of re-dosing. Prevention – Weekly white blood cell checks should be performed early in treatment. Discontinuation of the drug should be considered if white blood cells are less than 3.0 x 109/L and neutrophils are less than 1.5 x 109/L. Inform patients – if symptoms such as sore throat, fever, generalized discomfort occur during the course of medication, they should go to the hospital for examination promptly. Liver damage Low incidence (0.1%-0.2%) Tabazole mainly causes bile depletion PTU hepatocellular damage Mild cases can be recovered after stopping the drug Severe cases can cause liver necrosis 8, which patients are suitable for isotope therapy? Hyperthyroid patients with obvious enlargement of the thyroid gland, especially elderly patients. Patients with allergic or toxic reaction to antithyroid drugs, patients who can not guarantee multiple doses, patients with poor results of long-term drug treatment. 9. What are the complications of isotope therapy? The main complication of RAI treatment is hypothyroidism, which can be permanent and requires lifelong thyroid hormone replacement therapy. 40-80% of patients treated with RAI eventually develop hypothyroidism. 10. Which patients are suitable for surgical treatment? Indications: ① moderate to severe hyperthyroidism, long-term drug treatment is ineffective or recurrence after stopping the drug ② large thyroid gland ③ nodular goiter with hyperthyroidism ④ autonomous high-functioning adenomas ⑤ suspected and coexisting with thyroid cancer ⑥ children’s hyperthyroidism with the effect of poor antithyroid drug treatment ⑦ hyperthyroidism in pregnancy requires a large dose of antithyroid drugs to control the symptoms of the patient can be surgical treatment in the mid-pregnancy. 11, what are the complications of the surgery? Complications: Hypoparathyroidism Laryngeal nerve injury Hypothyroidism may occur if too much thyroid gland is removed Hyperthyroidism may recur if not enough thyroid gland is removed.