Re-evaluation of ATD The biggest controversy over ATD in recent years has been the decrease in cure rates compared to the previous ones. It is thought that this may be related to factors such as widespread salt iodization and increased iodine content in food. However, throughout the reports and related studies after the use of ATD, there has been a wide variation in the reported cure rates of ATD. The main factors contributing to these differences are: First, there is a clear relationship with the choice of indications for drug therapy. The cure rates are generally lower if drug therapy is used indiscriminately, due to the fact that a proportion of those with significantly enlarged thyroid glands are less likely to be eventually cured by drugs. Second, it is related to the treatment method and the course of treatment, etc. Very early studies have come to the clear conclusion that a long course of treatment is needed for ATD in Graves’ hyperthyroidism of more than 2 years, and a shorter course of treatment, especially shorter than 6 months, is sure to have a very low rate of lasting remission. The treatment course up to 2 years should also be carefully evaluated before considering whether to discontinue the drug, otherwise recurrence is likely. For those whose thyroid gland is still significantly enlarged, who require a higher maintenance dose of ATD to control hyperthyroid symptoms, and who have positive thyroid stimulating antibodies (I’SAb), treatment should be extended further. It has been observed that the longer the course of treatment, the higher the cure rate, so longer treatment is likely to further improve the cure rate. Thirdly, it is related to the drug chosen. The drugs commonly used clinically are imidazoles and thioureas, and although both have the same mechanism of antithyroid action, there are major differences in half-life and efficacy. Propylthiouracil has a short half-life, and its efficacy against thyroid hormone synthesis is 1/10 of that of imidazoles. Although it is used clinically at 10 times the dose of imidazoles, the actual therapeutic effect is still clinically poor due to the short half-life, and the clinical efficacy of propylthiouracil is weaker than that of imidazoles. In addition to the above factors, individualized factors are also important, such as the presence of stress factors, overexertion, irregular life, etc. Complications of hyperthyroidism such as cardiac and hepatic impairment may lead to hyperthyroid heart disease, heart failure and abnormal liver function if hyperthyroidism is not well controlled for a long time. This is mainly due to the failure to control hyperthyroidism and is not directly related to the treatment method used. Except for individual patients who are resistant to ATD, ATD can effectively control the thyroid function of most hyperthyroid patients, and the abnormal heart function and liver function caused by hyperthyroidism can be gradually restored. Clinically, there are indeed some patients who have been treated with ATD for many years, but not only have their hyperthyroidism not been effectively controlled, but also have hyperthyroid heart disease and abnormal liver function. The main reason for these cases is that these patients take medication irregularly and are not monitored regularly, resulting in ineffective control of thyroid function. If the patients are treated regularly, monitored regularly and the dosage is adjusted at the right time, these conditions will not occur.