There are three main methods of treatment for hyperthyroidism: antithyroid medication, isotope therapy and surgery. Each of these methods has its own advantages and disadvantages, and should be chosen based on a comprehensive analysis of factors such as the cause of hyperthyroidism, the patient’s age, the size of the thyroid gland, the history of recurrent hyperthyroidism, the presence of pregnancy, the presence of proptosis, the presence of hyperthyroid heart disease, the patient’s attitude toward treatment, and the patient’s medical condition. Generally speaking, the advantages of antithyroid drug therapy are: ● The indications for drug therapy are wide, from children to the elderly and pregnant women can be treated with drug therapy; ● Drug therapy is effective, and it is rare to encounter patients with ineffective drug therapy in clinical practice, unless the patient cannot adhere to the drug or the dosage is insufficient; ● Drug therapy is flexible, and the dosage can be adjusted according to the patient’s condition, so that permanent hypothyroidism does not occur; ● Drug therapy is inexpensive, regardless of the size of the tabacum, the history of recurrence, the absence of pregnancy, the presence of proptosis, the patient’s attitude toward treatment, and the patient’s medical condition ● Medications are inexpensive, both tabazol and propylthiouracil are very cheap and easily accepted by patients. However, the biggest weaknesses of drug therapy are: ● High recurrence rate of hyperthyroidism after stopping the drug, up to about 50%; ● Secondly, the drug causes granulocyte deficiency. Once this happens, there is a high risk that other drugs cannot be used. The crossover between thioureas and imidazoles causing granulocyte deficiency is great. ● Drugs can cause liver function damage, the incidence of which is less common than the former. Some patients have allergy to drugs: e.g. rash, etc. Radical treatment: surgery and isotope iodine For patients with complications of hyperthyroidism, such as hyperthyroid heart disease and hyperthyroidism with nodular enlargement, radical treatment should be adopted in principle. Both isotopes and surgery are radical treatment methods. Because hyperthyroidism relapse often induces the recurrence of these complications or aggravates the complications. Most patients with hyperthyroidism come to the clinic months or even years after the onset of hyperthyroidism, which can easily delay the disease and make some complications uncorrectable. Patients who are poorly treated and cannot adhere to medication should be treated with isotope therapy. The majority of foreign countries use isotope therapy for hyperthyroidism. In the United States, more than 90% of hyperthyroidism patients are treated with isotope therapy; in China, most of the treatment for hyperthyroidism is drug therapy. The difference in the treatment of hyperthyroidism between the two countries is not only due to the difference in academic and experience, but also due to the cost of consultation. In China, the cost of outpatient visits is very low and patients are willing to take medication for multiple visits and take a conservative approach to treatment. In the U.S., the cost of outpatient visits is high, and patients do not want to take medication for multiple visits, preferring to solve the problem at once, so they mostly use isotope therapy. Although the one-time cost of isotope therapy is high, the total cost is not high and the patient does not need to visit the doctor once every 2-4 weeks. The indications for isotope treatment of hyperthyroidism are relatively broad. Many patients with hyperthyroidism can be treated with isotopes, except for women who are pregnant or breastfeeding. For example, patients with hyperthyroid heart disease, moderate enlargement of the thyroid gland, unwillingness to take long-term medication, or allergy to antithyroid drugs, or those who already have significant side effects: reduced white blood cells, liver function impairment, etc. Isotope therapy is inappropriate for patients with a very significant enlargement of the thyroid gland or a short effective half-life of 131 iodine in the thyroid gland v an effective half-life of <3 daysw. This is because such patients require a large dose of isotope therapy, which may have some adverse effects on the organism; secondly, the treatment is less effective. The adverse effect of isotope therapy is the high incidence of hypothyroidism after treatment. Foreign reports show that the incidence of hypothyroidism in the first year is 15%-20%, and the incidence of hypothyroidism after 10 years is 30%, and after 20 years is as high as 70%-80%. In China, the incidence of hypothyroidism after isotope treatment is 5% in the first year and increases by 1% to 2% each year thereafter, and the incidence of hypothyroidism is 15% to 25% after 10 years. Surgery For patients with hyperthyroidism who have very obvious enlargement of the thyroid gland or clinical suspicion of thyroid tumor (especially for cold nodules on thyroid scan), surgery should be actively undertaken; of course, the patient's attitude toward treatment is also important. Patients who require a quick cure for hyperthyroidism can be treated with radical therapy; some patients tend to be conservative in their treatment and can be treated with medication. Generally speaking, most patients with first-episode hyperthyroidism are treated with medication. Those whose thyroid gland remains significantly enlarged after medication should seek surgical treatment. Of course, no treatment is 100% and there is a possibility of recurrence or hypothyroidism, only to varying degrees.