Insufficient awareness of the diversity of hyperthyroidism symptoms Patient, female, 68 years old. She was usually cheerful and diligent. However, in the past 2 months, she had been suffering from weakness, lazy speech, loss of appetite and weight loss. At first, he suspected that he might have a tumor in the digestive tract, but after a comprehensive examination in the hospital, he ruled out digestive tract lesions and was finally diagnosed with hyperthyroidism. Expert comment: Hyperthyroidism is mainly manifested as a high metabolic state and sympathetic excitation symptoms, and its typical symptoms include polyphagia, emaciation, fear of heat, excessive sweating, panic, insomnia, agitation, diarrhea, etc. On physical examination, there are signs of protruding eyes, enlarged thyroid gland, and trembling hands, etc. However, there are also many patients with hyperthyroidism who are unable to speak, and they are unable to speak. However, there are many patients with hyperthyroidism whose symptoms are not typical enough, which is especially common among elderly patients with hyperthyroidism. 1, many elderly patients with hyperthyroidism are mainly manifested as panic, chest tightness, premature beats, atrial fibrillation, cardiac insufficiency and other cardiovascular symptoms, without obvious protruding eyes and goiter, which are often misdiagnosed as “coronary heart disease. 2, some elderly patients with hyperthyroidism symptoms and even the typical symptoms of hyperthyroidism is completely opposite, highlighting anorexia poor, depressed, progressive wasting, often misdiagnosed as “digestive tract tumors”. 3, some young women with hyperthyroidism have prominent mental symptoms, mainly manifested as insomnia, nervousness and anxiety, dizziness, menstrual disorders, often misdiagnosed as “menopausal syndrome” or “depression. 4, some to diarrhea as the prominent manifestations of hyperthyroidism patients are often misdiagnosed as “chronic colitis” or “irritable bowel syndrome. 5, a small number of male hyperthyroidism patients manifested as periodic episodes of muscle weakness, lower extremity symptoms are more serious, can be accompanied by low blood potassium. In summary, the symptoms of hyperthyroidism patients are both typical and many atypical, we must have enough knowledge of the diversity of symptoms of hyperthyroidism, in order to reduce and avoid misdiagnosis and underdiagnosis. Rapid diagnosis of “hyperthyroidism” based on the results of laboratory tests of thyroid function alone The patient is a 20-year-old female university student. Half a month ago, she suffered from a cold, and since then she has always felt a sore throat, persistent fever, night sweats, and panic, which was ineffective after antibiotic treatment in the school hospital. She went to a district hospital for examination, and her thyroid function tests showed high T3 and T4, and she was diagnosed as hyperthyroidism, and was given antithyroid medication. Soon afterward, the patient developed hypothyroidism symptoms such as chills, generalized weakness, and bradycardia. After further examination (I rate, thyroid fine needle aspiration cytology, etc.) at a higher hospital, subacute thyroiditis was finally diagnosed. Antithyroid drugs were immediately stopped, and small doses of glucocorticoids and non-steroidal anti-inflammatory drugs were given for symptomatic treatment, and the patient recovered quickly. Expert comment: hyperthyroidism has a broad and narrow sense. From a broad sense, any cause of elevated levels of thyroxine can be called hyperthyroidism (also known as “thyrotoxicosis”); but we usually say hyperthyroidism usually refers to a narrow sense of hyperthyroidism, that is, the synthesis of their own thyroid tissue and the secretion of thyroid hormone (T3, T4) increase in a group of clinical syndromes (also known as “thyrotoxicosis”). “thyrotoxic hyperthyroidism”), including diffuse goiter with hyperthyroidism (i.e., Graves’ disease), toxic multinodular goiter (i.e., Plummer’s disease), and iodine hyperthyroidism. It should be noted that some other causes of disease can also cause T3, T4 elevation, such as: subacute thyroiditis patients, early due to the destruction of its thyroid tissue by inflammation, which leads to an increase in the release of thyroid hormones; hypothyroidism replacement therapy, due to the oversupply of exogenous thyroid hormone supplementation can also lead to T3, T4 elevation. For the two cases mentioned above, although the patient’s thyroid function level is abnormally elevated, it is not at all the same thing as hyperthyroidism in our usual sense, and its clinical management is also different. Therefore, to diagnose hyperthyroidism, it is not enough to rely only on the results of thyroid function tests, but also to combine with the patient’s clinical symptoms, as well as the uptake rate of 1, thyroid B ultrasound and radionuclide scanning and other comprehensive judgment. Do not diagnose hyperthyroidism easily by looking at the elevated T3 (or FT3) and T4 (or FT4) in the laboratory, which is obviously inappropriate. Inappropriate choice of treatment Patient, female, 22 years old, senior student. Due to excessive pressure from graduate school and employment, she often suffers from insomnia. After the Chinese New Year, she found that her temper had changed and she was often angry, which was completely different from her previous shy and quiet character. Recently, the patient inadvertently found that his eyeballs were obviously protruding, so he went to the hospital for examination and was diagnosed with hyperthyroidism. The doctor recommended internal medicine treatment, which would take at least 1.5 to 2 years. The patient’s graduation was approaching, and she hoped to find a short-term and complete cure, so she went to another hospital and underwent radioactive I treatment. 2-3 months later, her thyroid function returned to normal, but her protruding eyes worsened significantly, and she had difficulty in closing her eyelids, and even half-opened her eyes when she slept. Expert’s comment: There are three kinds of treatments for hyperthyroidism: drug treatment, radioactive iodine treatment and surgery, each of which has its own specific indications. Each method has its own specific indications. Which method to choose depends not only on whether the method is simple and fast, but also on whether the method is suitable for the patient’s specific condition. 1. For patients with mild hyperthyroidism and mild enlargement of the thyroid gland (especially young patients <20 years of age) and hyperthyroidism during pregnancy, drug treatment is generally preferred. 2. Surgery is preferred for patients with severe diffuse goiter or hyperthyroidism accompanied by thyroid carcinoma (or nodules) that have produced compression symptoms. 3, although the indications of radioactive iodine treatment are relaxed at home and abroad, not every hyperthyroidism patient is suitable for this treatment, where there is iodine allergy, obvious protruding eyes, as well as pregnant or lactating hyperthyroidism patients are not suitable for this treatment, this method is not only the risk of permanent hypothyroidism, but also may lead to the worsening of protruding eyes of the patient.