The thyroid gland is the largest endocrine organ in the human body and the only endocrine gland that stores its products outside the cells. Thyroxine is essential for maintaining normal human development, with the help of which it regulates the metabolic activity and growth of tissues and organs throughout the body. In the human body, neither too much nor too little thyroid hormone is produced! If too much thyroid hormone is secreted, you will get hyperthyroidism, and you will become short-tempered, panicky, have a thick neck and protruding eyes, etc. If not enough thyroid hormone is secreted, you will get hyperthyroidism. If you don’t produce enough thyroid hormone, you’ll get hypothyroidism, and you’ll become lethargic, with swollen eyes and legs. If a pregnant woman has hypothyroidism, the fetus will be prone to dementia after birth. If infants and young children develop hypothyroidism, they may become short in stature and mentally retarded. Therefore, the thyroid gland is very important to human growth and development. I. Diagnosis of hyperthyroidism: cases with typical symptoms are easy to diagnose. Misdiagnosis: Early or mild cases are easily misdiagnosed as cardiovascular system neurosis due to heartbeat, excessive sweating, etc. However, the latter’s heart rate is not accelerated during sleep and the basal metabolic rate is normal. There are three ways to measure thyroid function: basal metabolic rate, thyroid iodine 131 absorption rate, and serum T3 and T4 levels. The content of T3 and T4 in serum has a definite value for diagnosis, especially T3 is more sensitive. Second, what are the treatments for hyperthyroidism? Primary hyperthyroidism is treated with antithyroid drugs, radioactive iodine therapy and surgery, each with its own advantages and disadvantages. （Advantages and disadvantages of antithyroid medication: Advantages: After taking the medication, symptoms other than protruding eyeballs can be reduced. Disadvantages: 1, can not cure hyperthyroidism, and can not replace surgery. 2, for primary hyperthyroidism effective rate of about 50-60%, secondary hyperthyroidism and high-functioning adenoma effective rate of about 33%. 3.The treatment course is long and the recurrence rate is high. 4.It is necessary to take medicine for half a year to one and a half years. 5.Taking medicine causes enlargement and congestion of thyroid gland, causing adhesion between the gland and surrounding tissues, which increases the difficulty of surgical operation. 6, there are allergic and toxic reactions. Which hyperthyroid patients can not be treated with anti-thyroid drugs? Compression of the trachea, retrosternal goiter. Highly protruding eyes. Pregnant or lactating women. Antithyroid drugs can be excreted through the placenta or with breast milk, impairing the thyroid function of the fetus or infant. （Advantages and disadvantages of radioactive iodine therapy: Principle of treatment: Hyperactive thyroid tissue can absorb 70-80% of the iodine 131 into the body, which releases B-rays in the thyroid gland and destroys hyperactive thyroid tissue, thus reducing the synthesis and secretion of thyroid hormones. Advantages: 80% of patients can be relieved of hyperthyroidism with a very small dose. Disadvantages: the dose can not be controlled, easy to cause hypothyroidism; can not rule out the carcinogenic effect of iodine 131, such as leukemia, thyroid cancer. Which hyperthyroid patients cannot be treated with radioactive iodine? Pregnancy and breastfeeding: impair the thyroid function of fetus or baby. Mild hyperthyroidism: predisposes to hypothyroidism, which can lead to persistent mucous edema. Young patients around puberty:avoid damage to the gonads. (iii) Surgical treatment of hyperthyroidism: Surgery for hyperthyroidism is a classic standard procedure in general surgery. Although drug therapy and isotope treatment of hyperthyroidism has made greater progress, most mild to moderate hyperthyroidism by isotope treatment can achieve better results, but surgical treatment still has an irreplaceable position. Advantages and disadvantages of surgical treatment of hyperthyroidism: Advantages: the cure rate of surgery reaches 90-95%, and all other symptoms of hyperthyroidism can disappear or be reduced after the surgery, except for the symptoms of protruding eyeballs. Rapid, definitive and long-lasting treatment for hyperthyroidism. Assists in the differential diagnosis of comorbid malignant lesions. Can avoid antithyroid drugs and radioactive 131I treatment. Disadvantages: There are certain complications, and 5% of patients may have recurrence of hyperthyroidism or hypothyroidism after surgery. Indications for surgical treatment: recurrence after antithyroid drug treatment, and goiter of II degree or above. The enlarged thyroid gland compresses the neighboring organs, and the symptoms of compression appear. Moderate or severe hyperthyroidism that has been ineffective or inefficiently treated with long-term medication. Suspected of coexisting with thyroid cancer. Adolescent patients who cannot adhere to medication and have unsatisfactory symptom control, which affects study, work and rest. Those who have poor control of hyperthyroidism medication during pregnancy, or have allergic reactions to antithyroid medication, can be treated surgically in the middle of pregnancy (13th to 24th week). How is hyperthyroidism treated by surgery? Bilateral subtotal thyroidectomy. Subtotal resection of one side + total resection of the other side. Bilateral total thyroidectomy. The main surgical question: What is the optimal amount of thyroid tissue to be preserved during surgery in order to cure the disease and to maintain normal thyroid function after surgery without hypothyroidism or recurrence? It is generally considered appropriate to retain 6 to 8 g of thyroid tissue, which is approximately equivalent to the size of the retained thumb on each side. Technically, ensuring blood supply to the residual thyroid gland is also important to maintain postoperative function. What are the options for thyroid surgery? Conventional open neck surgery. Low neck small incision surgery. Lumpectomy thyroid surgery.