Primary hyperthyroidism is a clinical syndrome caused by excessive secretion of thyroid hormones by the thyroid gland itself, referred to as hyperthyroidism (professionally referred to as Graves’ disease, or hyperthyroidism in general). There are various treatment methods for hyperthyroidism, but three basic treatment options are widely accepted at home and abroad: internal antithyroid medication, surgical treatment and nuclear medicine iodine-131 treatment. Each of the three options has its own advantages and disadvantages, and their relationships are complementary and not mutually exclusive. 1. Internal anti-thyroid medication: It is the most basic treatment method and is suitable for mild hyperthyroidism, preoperative or postoperative treatment with iodine-131 or surgical treatment of hyperthyroidism to ensure its treatment safety. It is also suitable for patients with hyperthyroidism who are pregnant or need to breastfeed. Due to the long treatment time (about 2 years or longer), low cure rate (30-40%), high recurrence rate (40-60%), and a certain percentage of toxic side effects such as bone marrow and liver, the proportion of treated patients is now on the decline. 2. Surgical treatment: Surgery can rapidly relieve hyperthyroidism and cure it. However, due to its invasive nature and the high risk associated with numerous surgical complications, it is generally not preferred. It is suitable for patients who urgently want to get pregnant within 4-6 months at the shortest possible time, hyperthyroidism with giant goiter, hyperthyroidism combined with thyroid tumors especially suspected or diagnosed as malignant, and hyperthyroidism requiring surgery in the middle of pregnancy. At present, the proportion of patients requiring surgery for hyperthyroidism has decreased significantly. 3. Iodine-131 treatment in nuclear medicine: It is the safest treatment option at present and can cure hyperthyroidism. It has a one-time cure rate of about 85% and an overall cure rate of more than 95%. It is suitable for primary hyperthyroidism, recurrence of hyperthyroidism after hyperthyroidism surgery, or hyperthyroidism that has not been cured by internal medicine programs for a long time. Because of its high cure rate, low recurrence rate (1-2%), safe and easy treatment method, and although about 10%-30% or more patients develop hypothyroidism after treatment, the proportion of patients treated with iodine 131 for hyperthyroidism has been on the rise for more than 20 years, especially in large medical institutions, because hypothyroidism is easy to diagnose, simple to treat, and there are no obvious side effects of treatment drugs. At present, the international treatment status of hyperthyroidism is that North America mostly chooses iodine 131 treatment, for example, the proportion of the United States is about 70%, while Europe and Japan choose drug treatment with a high proportion, and the proportion of surgical treatment in each country is decreasing. In China, the treatment of hyperthyroidism is still dominated by internal medicine, but in large medical institutions, the proportion of iodine 131 treatment is higher and even dominant. I was inspired by the exchange with my American counterpart (Stanford University School of Medicine) regarding the choice of treatment options for hyperthyroidism. Doctors have the responsibility and obligation to inform their hyperthyroid patients of the three treatment options, i.e., the recommended approach and the alternative approach, in the interest of the patient and respecting the patient’s final choice. Hyperthyroidism is a complex disease that affects the whole body, and can develop in newborns to 70- to 80-year-olds. It is almost unanimously agreed in academic circles at home and abroad that iodine 131 treatment is the first choice for hyperthyroidism in the elderly. The indications for iodine 131 treatment of hyperthyroidism in the Clinical Practice Guidelines of the Ministry of Health of China have removed the age restriction in the previous textbook (according to the 2011 ATA AACE guidelines for the treatment of hyperthyroidism in the United States, iodine 131 treatment is avoided in children younger than 5 years old). The final choice of treatment plan for hyperthyroidism depends on the patient’s condition, medical history, cultural background, wishes, and environmental conditions, especially the skills and treatment habits of the regional hospital and physicians in which the patient is seen.