Anti-thyroid medications, radioactive 131 iodine therapy and subtotal thyroidectomy are the three main treatments for hyperthyroidism. Among them, drug therapy is the most widely used in clinical practice because it is effective, simple and non-invasive, with few complications and does not cause permanent “hypothyroidism”. The disadvantage of this method is that it has a long course of treatment and is prone to relapse after stopping medication. The following is a brief description of some key issues involved in drug treatment: ◆The indications for drug treatment of hyperthyroidism for patients with suitable drug treatment are: ① those with mild disease and less serious goiter; ② those who are under 20 years old, pregnant women, old and weak or combined with serious heart, liver and kidney diseases and are not suitable for surgery; ③ those who relapse after surgery and are not suitable for treatment with radioactive 131 iodine; ④ those who are treated with radioactive 131 iodine. Adjuvant treatment. ◆Features of anti-thyroid drugs Thioureas are the basic drugs for treating hyperthyroidism, and the drugs commonly used in clinical practice are propylthiouracil (PTU) and tapazole (MM). Their effects are: ①These drugs can inhibit the synthesis of thyroid hormone, but they do not work on the synthesized thyroid hormone, nor can they prevent the release of thyroid hormone. Therefore, it takes 1 to 2 weeks after taking these drugs for the hormones stored in the thyroid gland to be depleted to a certain extent before the effect can be seen, and 4 to 8 weeks to reduce the high metabolic state to normal levels. (TSAb) production and improve the long-term remission rate of hyperthyroidism. The half-life of propylthiouracil is only 2 hours and its effect is short, so it needs to be taken 3 times a day; while the half-life of tabazol is 4-6 hours and its effect can be maintained for 24 hours, so it can be taken once a day in the morning and its effect is equivalent to 3 times a day by mouth. The side effects of antithyroid drugs mainly include leukopenia and drug rash, and occasionally impaired liver function. Therefore, patients need to review their blood tests during the medication period. When leukocytes are lower than 4×109/L and neutrophils are lower than 2×109/L, additional leukocyte-raising drugs (e.g. reserpine, shark liver alcohol, vitamin B4) should be administered. If, after the above treatment, leukocytes are still lower than 3×109/L and neutrophils are lower than 1.5×109/L, along with fever, sore throat, arthralgia and other symptoms of granulocyte deficiency, the patient should immediately stop the drug, and at the same time give granulocyte colony-stimulating factor, plus effective broad-spectrum antimicrobial symptomatic treatment, the patient should be sterilized and isolated if possible, otherwise it will lead to serious infection and even life-threatening. For drug rash, anti-allergic drugs can be added or replaced with other thioureas, but discontinuation is generally not necessary. If the rash is serious and deteriorates into exfoliative dermatitis, the medication should be stopped immediately and glucocorticoids should be used for treatment. The first choice of medication for hyperthyroidism is tabazol (methimazole), which has strong and stable effects and good patient compliance; the first choice for T3 hyperthyroidism and hyperthyroidism in pregnancy is propylthiouracil. In addition, propylthiouracil is also recommended for hyperthyroidism with leukopenia. The dosage of anti-thyroid drugs can be adjusted at the right time. The drug treatment of hyperthyroidism can be divided into three stages: “control”, “reduction” and “maintenance”. In the “control phase”, propylthiouracil 100-150 mg three times a day or tabazol 10-15 mg three times a day can be given according to the severity of the patient’s condition. After 4-8 weeks, the symptoms of hyperthyroidism can be relieved and T3 and T4 can be normalized. The “reduction phase” refers to the reduction of propylthiouracil 50-100 mg and tabazol 5-10 mg once every 2-3 weeks. After 2-3 months, when the patient’s disease is well controlled, with a daily dose of 25-100 mg of propylthiouracil and 2.5-10 mg of tapazole, the patient can be transferred to the “maintenance phase”, which should last at least 1.5-2 years. It should be noted that the dosage should be increased at any stage of medication, especially when the patient suffers from infection or mental trauma, and then gradually reduced after the condition is stabilized. The adjuvant drugs for hyperthyroidism mainly include β-blockers (such as “Tretinoin”), thyroxine preparations and iodine, among which iodine is mainly used for preoperative preparation of hyperthyroidism and rescue of hyperthyroidism crisis, and is generally not used as a regular drug. Here we will focus on the application of the first two drugs: 1. Beta-blockers: These hyperthyroid drugs can improve the patient’s sympathetic excitation symptoms and effectively counteract the hypermetabolic manifestations (palpitations, tachycardia, excitement, shivering and other symptoms) caused by excessive thyroid hormone. It is generally used as an adjuvant drug in the “control phase”. Used together with thioureas, it is effective in improving the clinical symptoms of patients, especially during the first one to two weeks of treatment, when the antithyroid drugs have not yet taken effect. However, these drugs are not fundamental drugs for the treatment of hyperthyroidism and cannot correct the cause of the disease, so they should not be used as long-term treatment. It should be noted that these drugs should not be used in patients with hyperthyroidism combined with bronchial asthma or severe heart failure. 2. Thyroid hormone preparations: In clinical practice, thyroid hormone preparations are usually added from the dose reduction stage to stabilize the function of the hypothalamic-pituitary-thyroid axis, inhibit the secretion of thyrotropic hormone (TSH), and avoid goiter and hyperthyroidism. aggravation of the patient’s goiter and proptosis symptoms. In addition, it also leads to a significant reduction in the recurrence rate of hyperthyroidism. The dose used is 20-60 mg/day of thyroid tablets or 50-100 mcg/day of levothyroxine (euthyroxine), which can be taken for a long time until it is discontinued together with anti-thyroid drugs. Most scholars believe that pregnancy does not worsen the condition of hyperthyroidism. Therefore, hyperthyroidism is not an absolute contraindication to pregnancy. However, there are differences in medication compared to non-pregnant hyperthyroidism. Propylthiouracil is the first choice of medication for hyperthyroidism in pregnancy, because it is the least toxic of the thioureas that crosses the placental barrier (only 1/3 of tabazol and metoclopramide) and therefore has little effect on the fetus. In addition, the dose of medication for hyperthyroidism during pregnancy should be reduced appropriately. This is because a woman’s basal metabolic rate is inherently high during pregnancy, and her basal heart rate and thyroid hormone levels are slightly higher than those of a non-pregnant normal person. Therefore, it is advisable to choose the smallest effective dose to maintain thyroid function at a normal high level so as not to cause hypothyroidism in mother and child and affect the normal development of the fetus. Also, since anti-thyroid drugs can be secreted from breast milk and affect the thyroid function of infants, those who need to continue taking medication after delivery should not breastfeed. Hyperthyroidism is an autoimmune disease, and thyroid stimulating antibodies (TSAb) are the main cause of the disease. Although antithyroid drugs can normalize thyroid function in a short period of time (2-3 months), it takes a long time to turn the blood TSAb negative. The indications for discontinuation of hyperthyroidism include the following: (1) the symptoms of hyperthyroidism are relieved, thyroid gland shrinks, vascular murmur disappears, and proptosis improves; (2) T3, T4 and TSH are normal, TRH excitation test returns to normal, and TSAb is negative; (3) the course of treatment reaches more than 2 years; (4) the maintenance dose of drugs is small. If the above requirements are not met, the course of anti-thyroid medication should be extended, or even lifelong medication should be used, or radioactive 131 iodine or surgery should be used instead. Those who relapse after stopping the medication can be treated with anti-thyroid medication again, or switch to radioactive 131 iodine or surgery. ◆Indicators that need to be monitored during the treatment of hyperthyroidism In the course of treatment, thyroid function (T3, T4, TSH) test should be done once every 2 to 4 weeks, and the changes in the enlarged thyroid gland and proptosis of the patient should be used as a reference basis for adjusting the dose of medication. In addition, antithyroid drugs can lead to leukopenia and, in severe cases, granulocyte deficiency. This mostly occurs 2 to 3 months after the patient’s initial dose or 1 to 2 weeks after re-dosing. Therefore, patients should have routine blood tests at least once a week during the beginning control phase to ensure safety. In addition, liver function test should be done before and after treatment. If there is abnormal liver function before medication, it is mostly due to hyperthyroidism itself, so there is no need to stop the medication at this time. Factors affecting the recovery and relapse of hyperthyroidism Factors affecting the recovery and relapse of hyperthyroidism are summarized as follows: 1. Inappropriate medication and inadequate course of treatment: too rapid reduction of medication, intermittent medication and premature discontinuation of medication are the most common reasons for recurrence of the disease. At present, it is advocated to continue the maintenance treatment for 1.5 to 2 years after the thyroid function has returned to normal, and to stop the medication only after the thyroid stimulating antibody (TSAb) has turned negative. If the TSAb is positive, the course of treatment should be extended until it is completely negative, so that it is not easy to relapse. 2. Strong mental stimulation, severe infection, overwork, pregnancy and other stressful conditions, as well as a high iodine diet, are also important factors that cause the relapse of hyperthyroidism. In addition, the recurrence of hyperthyroidism is also related to age and gender. Generally speaking, younger patients and men are more likely to relapse than older patients and women.