Hyperthyroidism, short for hyperthyroidism, is a group of common endocrine disorders caused by excessive secretion of thyroid hormones from various causes. The main clinical manifestations of hyperthyroidism are hyperphagia, lethargy, fever, excessive sweating, palpitations, agitation and other hypermetabolic syndromes, enhanced neurological and vascular excitation, as well as varying degrees of goiter, ophthalmoplegia, hand tremors and vascular murmurs in the shins, etc. In severe cases, hyperthyroidism may lead to critical phases, coma or even life-threatening. Hyperthyroidism (Graves’ disease) is most common between the ages of 20 and 40. Excessive secretion of T3 and T4 can accelerate the oxidation of human tissues, causing disorders in the metabolism of sugar, protein, fat, water, calcium, zinc, iodine and vitamins in the dielectric medium, resulting in changes in the function of various organs of the body, including the reproductive system. Symptoms Due to the hyper-metabolism, patients may be afraid of heat, sweating, warm and moist skin; the nervous system may show excitement, nervousness, easily agitated, talkative, insomnia, inattentive, anxious and irritable; the cardiovascular system may show palpitations, shortness of breath, arrhythmia, increased pulse pressure, enlarged heart over time, and even hyperthyroid heart disease, resulting in heart failure; the digestive system may show hyper-appetite, easy to The digestive system is characterized by hyperphagia, easy hunger, increased food intake, increased bowel movements, and dyspeptic diarrhea; the eyes may show infiltrative or non-infiltrative proptosis; the thyroid gland may be diffusely and symmetrically enlarged to varying degrees, soft and moving up and down with swallowing; the reproductive system is mainly characterized by decreased menstruation or amenorrhea in women, decreased libido and impotence in men, occasionally accompanied by gynecomastia, and some patients may become sterile. Laboratory tests 1. FT3 and FT4 are the active part of thyroid hormones in circulating blood, which are not affected by changes in TBG in blood and directly respond to the functional status of the thyroid gland. It has been widely used in clinical practice in recent years, and its sensitivity and specificity are significantly higher than that of total T3 (TT3) and total T4 ((TT4). TBG is also affected by pregnancy, estrogen, viral hepatitis and other factors that increase, and by androgens, hypoproteinemia (severe liver disease, nephrotic syndrome), prednisone and other factors that decrease. Care must be taken when analyzing. 3, serum total triiodothyronine (TT3) serum T3 and protein binding of more than 99.5%, also affected by TBG, TT3 concentration changes are often parallel to changes in TT4, but the early stage of hyperthyroidism hyperthyroidism relapse, TT3 often rises very quickly, about 4 times the normal, TT4 rise more slowly, only 2.5 times the normal, so the measurement of TT3 for the diagnosis of the disease more sensitive indicators; for It is especially sensitive to the diagnosis of T3 hyperthyroidism, and should be noted that TT3 may not be high in elderly indifferent type hyperthyroidism or long-standing disease when analyzing the diagnosis. 4, serum anti-T3 (revrseT3, rT3) rT3 is not biologically active, it is the degradation product of T4 in peripheral tissues, its change in blood concentration maintains a certain ratio with T4 and T3, especially consistent with the change of T4, it can also be used as an indicator to understand thyroid function, part of the early stage of the disease or early relapse only has rT3 elevation and as a more sensitive indicator. In severe malnutrition or certain systemic disease states rT3 is significantly higher, while TT3 is significantly lower, which is an important indicator for the diagnosis of low T3 syndrome. 5.TSH immunoradiometric analysis (sTSH IRMA) The level of sTSH in normal blood circulation is 0.4-3.0 or 0.6-4.0μIU/ml. It is also called sTSH (“sensitive” TSH) because of its high sensitivity. It is widely used in the diagnosis and treatment monitoring of hyperthyroidism and hypothyroidism. 6.Thyroid hormone releasing hormone (TRH) excitation test The TSH is not excited by TRH because of the increase in serum T4 and T3 of hyperthyroidism and the feedback inhibition of TSH. It should be noted that TSH is not increased in Graves’ ophthalmopathy with normal thyroid function, pituitary lesions with insufficient TSH secretion, etc. This test has few side effects and is safer than the T3 suppression test for people with coronary heart disease or hyperthyroid heart disease. This method has a 90% compliance rate for the diagnosis of hyperthyroidism. The iodine-deficient goiter may also be elevated, but there is generally no forward shift of the peak, and it can be used to differentiate the T3 suppression test. It should be noted that this method is affected by a variety of foods and iodine-containing drugs (including herbal medicines), such as antithyroid contraceptives, which can increase the rate. Normal values: 3 and 24h values are 5%-25% and 20%-45% respectively, with a peak at 24h, as determined by Geiger counting tubes. In hyperthyroidism: 3h>25%, 24h>45%: and the peak is shifted forward. 8.Triiodothyronine suppression test Abbreviated as T3 suppression test. It is used to identify goiter with increased 131I uptake rate caused by hyperthyroidism or simple goiter. Method: After the basal 131I uptake rate is measured, T320μg is administered orally 3 times daily for 6 d (or 60mg of dry thyroid tablets are administered orally 3 times daily for 8 d, followed by 131I uptake rate. Compare the two results, normal people and patients with simple goiter swelling 131I rate decreased by more than 50%, hyperthyroid patients can not be suppressed so 131I rate decreased by less than 50%, this method is prohibited for people with coronary heart disease or hyperthyroid heart disease, so as not to induce cardiac arrhythmia or angina pectoris. 9. Thyroid stimulating antibody (TSAb) measurement The detection rate of positive TSAb in the blood of GD patients can be more than 80%-95%, which not only has early diagnostic significance for the disease, but also has value in determining the activity of the disease and whether it is relapsing, and can be used as an important indicator for treatment discontinuation. Diagnosis Typical cases can be diagnosed by detailed medical history and clinical manifestations, but early mild cases, children or elderly people with atypical hyperthyroidism are often confirmed by necessary thyroid function tests. Those with elevated serum FT3, FT4, (TT3, TT4) are consistent with hyperthyroidism; those with elevated FT3 or TT3 and normal FT4 and TT4 can be considered as T3 hyperthyroidism; those with elevated FT4 or TT4 and normal FT3 and TT3 are T4 hyperthyroidism; those with suspicious results can further undergo sTSH measurement and/or TRH excitation test. On the basis of the diagnosis of hyperthyroidism, other causes of hyperthyroidism should be excluded, and the diagnosis of GD can be made by combining the patient’s ocular signs, diffuse goiter and other features, and if necessary, by testing serum TSAb. The latter usually has no proptosis, mild hyperthyroidism, heat nodules on thyroid scan, and suppressed function of thyroid tissue outside the nodules. The latter usually has no proptosis, mild hyperthyroidism, heat nodules on thyroid scan, suppressed function of thyroid tissue outside the nodules, reduced thyroid uptake of 131I in subacute thyroiditis with hyperthyroidism, increased microsomal antibody level in blood in Hashimoto’s thyroiditis with hyperthyroidism, iodine hyperthyroidism with history of iodine intake, reduced thyroid uptake of 131I, sometimes with elevated T4 and rT3, but not high T3. Treatment: 1. General treatment After diagnosis, when hyperthyroidism is not yet under control, it is necessary to obtain full understanding and close cooperation from the patient as much as possible, to arrange diet reasonably, which requires high calorie, high protein, high vitamin and low iodine diet; to relax mentally; to rest properly and to avoid heavy physical activities, which is necessary and should not be neglected. 2.Medication Thiouracil drugs, which is the main treatment method adopted by China and many countries in the world for hyperthyroidism at present. The characteristics of this treatment method are: oral medication, which is easily accepted by patients; it does not cause irreversible damage after treatment; however, the medication course is long and requires regular follow-up; the recurrence rate is high. Even if the drugs are used reasonably and regularly, there is still a recurrence rate of more than 20% after treatment. The order of clinical selection is often: methimazole (tabazol, MMI), propylthiouracil (PTU), carbimazole (methoxypin) and methylthiouracil. PTU and methylthiouracil are 10 times less potent than others and should be used in 10 times larger doses. Drug selection: Different doctors in different regions have different choices according to their habits and experiences. In the United States, PTU is often chosen, while in Europe, MMI is preferred more often. In China, both PTU and MMI are chosen. The former is considered to reduce the conversion of circulating T4 to T3, which is safer for pregnant women, while the latter is considered to have fewer side effects and a longer inhibition of thyroid hormone synthesis, and experience shows that the drug can be given once a day, with better patient compliance. Adjuvant drugs: propranolol (Takayasu), iodine and the use of thyroid preparations. This method is safe and convenient, with a cure rate of 85%-90% and a low recurrence rate, and has been used in more and more countries in recent years to treat hyperthyroidism. The symptoms disappear slowly after treatment, and about 10% of patients have permanent hypothyroidism. 2.Surgical treatment After medication, subtotal thyroidectomy is effective, with a cure rate of more than 90%, but there is a certain chance of complications.