1. Clinical manifestations of typical cases: 1. slow development, long duration of disease, early stage may be asymptomatic, when the goiter appears, the average duration of disease has reached 2-4 years. 2. Common symptoms are generalized weakness, many patients have no throat discomfort, 10%-20% of patients have local pressure or vague pain in the thyroid area, and occasional light pressure pain. The thyroid gland is mostly bilaterally symmetrical and diffusely enlarged, and the isthmus and conus lobe are often enlarged at the same time, or unilaterally. The thyroid gland tends to increase in size gradually as the disease progresses, but rarely compresses the neck and causes difficulty in breathing and swallowing. On palpation, the thyroid gland is tough, with a smooth or fine sandy surface, or nodules of varying sizes, generally without adhesions to surrounding tissues, and can move up and down during swallowing movements. 4. The lymph nodes in the neck are usually not enlarged, but a few cases may be accompanied by enlarged lymph nodes in the neck, but the texture is soft. In principle, surgery is not recommended. After clinical diagnosis, treatment should be decided depending on the size of the thyroid gland and the presence or absence of symptoms of pressure. If the thyroid gland is small and there are no obvious symptoms of pressure, it can be observed without treatment for the time being. Non-surgical treatment 1. Thyroxine treatment: If the enlarged thyroid gland is obvious or accompanied by hypothyroidism, thyroxine treatment can be given, using L-T4 or thyroid powder (tablets). Generally start with a small dose of thyroxine tablets 40-60mg/d and L-T450-100μg/d, and gradually increase the dose to 120-180mg/d or 100-200μg/d respectively until the gland starts to shrink and TSH levels drop to normal. Thereafter, the dose is gradually adjusted on a person-by-person basis, and the dose is reduced to a maintenance dose according to thyroid function and TSH levels, and the course of treatment is usually 1-2 years. After the goiter improves and thyroid function returns to normal, the drug can be discontinued. In general, the more pronounced the goiter, the more significant the treatment effect. Most patients with CLT have a tendency to develop into hypothyroidism, so attention should be paid to follow-up review and treatment when hypothyroidism occurs. 2. Anti-thyroid treatment: Hashimoto’s hyperthyroidism should be treated with anti-thyroid treatment. Methimazole or propylthiouracil can be used, but the dose should be less than the dose used for Graves’ disease, and the dosing time should not be too long. In case of transient hyperthyroidism (clinically manifest), only β-blockers, such as propranolol or metoprolol, can be used for symptomatic treatment. 3. Glucocorticoid therapy: For subacute onset, when thyroid pain and enlargement are obvious, prednisone (15-30mg/d) can be used for treatment, and the dosage will be gradually reduced after symptoms improve for 1-2 months. Glucocorticoids can increase T3 and T4 levels by suppressing the autoimmune response. However, the efficacy of prednisone is not long-lasting, and it is often easy to relapse after stopping the drug. Prednisone can be used again if the pain recurs. However, hormone use is generally not recommended for cases with significant hypothyroidism. After non-surgical treatment, the enlarged thyroid gland may gradually return to normal, and the thyroid nodules palpated during physical examination may disappear and shrink, while the tough thyroid gland may become soft, but the thyroid antibody titer may remain high for a long time. III. Surgical treatment After CLT is diagnosed, surgical treatment is rarely required. Many surgeries for CLT are performed for clinical misdiagnosis of other thyroid disorders. A study on the effect of surgical treatment of CLT found that the incidence of clinical hypothyroidism and subclinical hypothyroidism in the surgical group was 93.6%, while the incidence in the non-surgical group was 30.8%, indicating that surgery aggravates the destruction of thyroid tissue and promotes the occurrence of hypothyroidism, so it is important to strictly control the indications for surgery.