Page 9 of the Thyroid Disease Guidelines, Thyroid uptake 131I function test section: Contraindicated in women during pregnancy and lactation. Change to Breastfeeding women are generally not recommended for this test, but if the test is very necessary, milk can be expressed and discarded within 3 days of the test and breastfeeding can continue after day 4. Page 14, etiology, line 1, “graves’ disease, multinodular goiter with hyperthyroidism” should be changed to “graves’ disease, multinodular goiter with hyperthyroidism”, same as the penultimate line of this page, with the word multinodular added before multinodular goiter with hyperthyroidism. (1) We should not write the diagnostic criteria of graves’ disease right away, because the title is “Hyperthyroidism”, so we should write the diagnosis of hyperthyroidism in the diagnostic section, and diagnose hyperthyroidism first, and then write the diagnosis of graves’ hyperthyroidism, which is the most common cause of hyperthyroidism; (2) We should also analyze the thyroid function tests, which are the most important indicators for the diagnosis of hyperthyroidism. (2) The analysis of thyroid function tests, which is the main indicator for the diagnosis of hyperthyroidism, including TSH<0.1miu/L, and the sensitivity requirement of TSH test should also be stated; moreover; (3) The "diagnostic criteria for graves' disease" is not known from where it comes from, and obviously excludes subclinical hyperthyroidism from the diagnosis of hyperthyroidism; (4) Graves' disease is a diagnosis of etiology, not function. It seems to include both hyperthyroidism and graves' disease with normal thyroid function, and it seems to be more accurate to become graves' hyperthyroidism. Page 17 Anti-thyroid medication The treatment is: MMI 30-45mg/day or PTU 300-450mg/day in 3 oral doses, changed to MMI 30-45mg/day in 3 oral doses or PTU 300-600mg/day in 8 hourly doses, depending on the severity of the disease, the size of the thyroid gland, and the urgency of treatment. PTU has a short half-life and must be given once every 8 hours. 3 times a day is not effective. Page 17 Anti-thyroid medication; total duration of treatment is generally 1-1.5 years This statement is not substantiated, as the ATA 1995 guidelines state that there is no fixed cut point for duration of treatment, although it can be longer, generally 6 months to 2 years; P24, line 2 backwards, literature reports prevalence of this disease ....... Our scholars report prevalence .... It should be indicated whether the TSH cut point for diagnosis is TSH <0.1m IU/L or <0.4m IU/L, because the diagnostic criteria are different and cannot be compared, and it is better to indicate the source of the literature P25, line 7: ③ Osteoporosis. It mainly affects menopausal women, causing osteoporosis and fractures. It should read: ③ Bone loss: bone loss increases in subclinical hyperthyroidism, causing bone loss and increasing the risk of osteoporosis and fracture. Because bone loss is a process that results in osteoporosis, bone loss increases in menopausal women, postmenopausal women are prone to osteoporosis, and subclinical hyperthyroidism promotes bone loss. Pregnancy and hyperthyroidism should reflect the principle of not using antithyroid drugs if possible and using them sparingly. In the section on hypothyroidism on page P30, primary hypothyroidism corresponds to secondary hypothyroidism, while central hypothyroidism corresponds to extraperipheral hypothyroidism. It is suggested that after central hypothyroidism, those caused by pituitary lesions are called secondary hypothyroidism, and those caused by pituitary or above are called tertiary hypothyroidism. The diagnosis of hypothyroidism on page P30 only mentions primary hypothyroidism, but not central hypothyroidism, which is very common and has serious consequences. History part: history of hypothalamic and pituitary tumors, surgery, external irradiation and postpartum hemorrhage is beneficial for the diagnosis of central hypothyroidism, when there is often involvement of other endocrine gland axis (such as gonads and adrenal glands), attention should be paid to ask about related symptoms, such as postpartum absence of breast, amenorrhea in women and hypogonadism in men suggesting involvement of gonadal axis. Lastly, in the clinical manifestations section: lighter skin pigmentation and loss of axillary and pubic hair suggest possible adrenal and gonadal involvement. Lastly, in the laboratory section: the evaluation of other endocrine axis functions should be performed if other endocrine axis involvement is suspected. Treatment: Central hypothyroidism should be preceded by adrenal corticosteroid replacement and gonadal hormone replacement in younger patients. In the section on differentiating central hypothyroidism from primary hypothyroidism on page P36, it should be added that, in addition to this, central hypothyroidism is often associated with involvement of other endocrine axes, most commonly the gonadal and adrenal axes, so attention should be paid to evaluating the functional status of other endocrine axes. The last paragraph on page 14 and the first paragraph on page 15, the section on ocular manifestations of hyperthyroidism and the section on infiltrative proptosis on p22 should be rewritten because: The ocular manifestations of hyperthyroidism are divided into two categories: one is simple proptosis and the other is infiltrative proptosis, which is only found in the domestic textbooks many years ago and does not match the international terminology. The term "infiltrative proptosis" or "graves ophthalmopathy" is incorrect. Graves ophthalmopathy includes many manifestations, definitely not only proptosis, but also periorbital, eyelid, conjunctival and corneal changes. The ATA 1995 guidelines for graves' ophthalmopathy include all thyroid-related ocular changes, not just infiltrative proptosis; the European EUGOGO (The European Group on Graves' Orbitopathy), currently the most authoritative organization for thyroid-related ophthalmopathy, is called Graves' Orbitopathy. The European Group on Graves' Orbitopathy (EUGOGO) is currently the most authoritative organization on thyroid-related ophthalmology, called Graves' Orbitopathy, and also includes all thyroid-related ophthalmology. There is no need to mention how many mm of proptosis alone. ATA's NOSPECS classification of GO was published in 1977, which seems backward, and EUGOGO's classification and management of GO is now internationally recognized, including the most authoritative online monograph on the thyroid gland, Thyroid Disease Manager (edited by De Groot), and therefore there is no reason why our clinical guidelines should not apply EUGOGO's classification and management opinions, which can be obtained through the http://www.eugogo.org/ link. The EUGOGO classification is divided into mild, moderate and severe according to the degree of soft tissue swelling, proptosis, persistence of diplopia, and involvement of the cornea and optic nerve, and the clinical activity score to determine the degree of clinical activity. The clinical activity score includes spontaneous retrobulbar pain, eastern eye pain, eyelid erythema, conjunctival congestion, conjunctival water,, caruncle swelling, eyelid edema or fullness 7 items, each item 1 point, more than 3 is considered active GO. Risk factors for the occurrence and progression of GO include smoking, hyper- and hypothyroidism, hyperthyroidism after radioactive iodine treatment and TRAB positive, treatment should also include the corresponding risk factor management, and The treatment should also include the management of the appropriate risk factors and have the appropriate etiology and symptomatic management according to the severity of the symptoms. The thyroid crisis component The thyroid crisis component: In addition, a small number of patients with hyperthyroidism have short term exacerbation of symptoms after 131I therapy and present with crisis. In the treatment part, PTU is preferred, but the first dose of 600mg, followed by 200mg , every 8 hours, is changed to every 6 hours Oxygen should be administered Correction of causative factors, such as infection antibiotics should be applied Those with heart failure use digitalis and its diuretics, at this time the main problem is often increased sympathetic excitability caused by insufficient blood volume and high hormone levels, rapid heart rate, diuretics should not be emphasized, and beta receptor blockers must be highlighted for application, those with heart failure should also be applied, and definitely not prohibited, digitalis type drugs are poor for hyperthyroidism heart failure and should not be recommended Dexamethasone is better than hydrocortisone in hyperthyroidism crisis as the first choice, hydrocortisone preparations contain alcohol at a large content (1 ml/25 mg dissolved in anhydrous alcohol) and should not be recommended at this time. Should dexamethasone 2 mg every 6 hours Suggested reference Thyroid Disease Manager content http: //www.thyroidmanager.org/Chapter12/12-frame.htm Main references: (these sources should be absolutely authoritative), I noticed in the original manuscript references Chapter 12. Graves'; Disease: Complications . Updated: February 20, 2007 http: //www.thyroidmanager.org/Chapter12/12-frame.htm American Thyroid Association guidelines for use of laboratory (PDF File 115 KB). Martin I. Surks, Inder J. Chopra, Cary N. Mariash, John T. Nicoloff, David H. Solomon. Journal of the American Medical Association (JAMA) 1990;263:1529- 1532. 1532. 3 .Treatment guidelines for patients with hyperthyroidism and hypothyroidism.(PDF File 88KB). Peter A. Singer, David S. Cooper, Elliot G. Levy, Paul W. Ladenson, Lewis E. Braverman, Gilbert Daniels, Francis S. Greenspan, I. Ross McDougall, Thomas F. Nikolai. Journal of the American Medical Association (JAMA) 1995;273:808-812. 4. American Thyroid Association guidelines for detection of thyroid dysfunction. (PDF File 107KB). Paul W. Ladenson, Peter A. Singer, Kenneth B. Ain, Nandalal Bagchi, S. Thomas Bigos, Elliot G. Levy, Steven A. Smith, Gilbert H. Daniels. Archives of Internal Medicine (Arch Intern Med) 2000;160:1573-1575. 5. http://www.eugogo.org