1, how to treat hyperthyroidism There are three main treatments for hyperthyroidism, including internal medicine anti-thyroid drug (ATD) treatment, nuclear medicine iodine-131 treatment, and surgical treatment. The internal medicine ATD treatment process can be adjusted in time. The disadvantage is that the course of treatment is long, usually requiring 1-2 years of standardized treatment; during the treatment period, ATD can cause allergy, liver, kidney function and hematopoietic system damage, and it is often difficult to adhere to it once it occurs. It is easy to relapse when stopping or reducing the dosage of ATD, and the relapse rate of ATD treatment has been reported to be around 40-60%. Some studies have reported that if ATD treatment is still relapsed after 2 years, then drug control is usually ineffective. Iodine-131 treatment is easy to administer. Usually, after one dose of iodine-131, hyperthyroidism symptoms start to improve about 4 weeks after treatment, and the remission rate of hyperthyroidism can reach 75-80% in about one year. Iodine-131 treatment does not cause allergy, liver, kidney function and hematopoietic function damage. Those patients with hyperthyroidism who have allergies, abnormal liver and kidney function or lowered blood cells due to ATD treatment can still be treated. Some patients with no significant improvement in symptoms or incomplete relief after six months of iodine-131 treatment can be retreated with iodine-131 again. Surgical treatment should be preferred for patients with hyperthyroidism with severe proptosis. Surgical treatment usually adopts subtotal thyroidectomy to treat hyperthyroidism, which relieves the symptoms of hyperthyroidism rapidly, especially suitable for patients with obvious enlargement of the thyroid gland and protruding eyes as well as patients with hyperthyroidism and nodules, but its shortcoming is that it is traumatizing; in individual cases, it may result in laryngeal recurrent nerve damage, parathyroid hypoparathyroidism and other surgical complications. Some patients still have recurrence of hyperthyroidism after surgery. At present, in the United States, iodine-131 treatment has become the preferred treatment for adult hyperthyroidism patients, about 80% of patients with iodine-131 treatment, in Europe hyperthyroidism iodine-131 treatment is also very important. In China, with the improvement of people’s understanding of hyperthyroidism and the comprehensive understanding of radioactive iodine treatment of hyperthyroidism, more and more doctors and patients choose iodine-131 treatment of hyperthyroidism. 2.What kind of hyperthyroidism is suitable for radioactive iodine-131 treatment? It is suitable for all diagnosed hyperthyroidism patients, especially for hyperthyroidism patients with the following conditions: abnormal liver function, leukopenia, unsuitable for antithyroid drug (ATD) treatment; allergic to ATD drugs; relapse after ATD treatment; relapse after surgery or unwilling to surgery. Nodular goiter with hyperthyroidism; chronic lymphocytic thyroiditis (Hashimoto’s disease) with hyperthyroidism and high 131-I uptake test; simple goiter from the cosmetic point of view can also be used iodine-131 treatment. 3.What preparations should be made for hyperthyroid patients before Iodine-131 treatment? Since iodine-containing foods, medicines and anti-thyroid drugs will have an effect on the uptake of iodine-131 by the thyroid gland, anti-thyroid drugs and iodine-containing foods and medicines should be discontinued for more than 4-6 weeks before treatment. During the withdrawal period, the patient’s hyperthyroidism symptoms such as panic, low white blood cells, liver function abnormalities, etc. should continue to actively treat the symptoms. 4.What should be checked before taking Iodine-131 treatment for hyperthyroidism? Before taking Iodine-131 treatment, patients with hyperthyroidism should have the measurement of iodine-131 uptake rate of the thyroid gland, the measurement of biochemical indexes of thyroid function, such as FT3, FT4, TSH, the measurement of thyroid antibodies, such as A-Tg, A-TPO, and the measurement of antibodies to the TSH receptor (TRAb, TBII, etc.), the thyroid gland ECT imaging or ultrasound to clarify the size of the thyroid gland and the preliminary determination of the nature of the thyroid nodules. As well as blood routine, liver and kidney function, electrocardiogram and so on. 5.What kind of drug is Iodine-131? What is its use in medicine? Iodine-131 is a radioactive drug, an isotope of iodine, which decays by half every 8 days (half-life of 8 days); the beta rays it can emit are utilized to play a therapeutic role. Iodine-131 only accumulates in thyroid tissue and is not taken up by other tissues. Iodine-131 sends out beta rays in the thyroid gland range of only 1 mm, it releases energy can destroy the hyperfunction of the thyroid tissue, so that the enlarged thyroid gland shrinks, can achieve the same effect as surgical resection, the impact on the surrounding tissues is very small. 6, the thyroid’s nuclear medicine examination is safe Thyroid iodine-131 iodine absorption rate determination of iodine-131 used in the chemical amount of very small, commonly used 2 microcolonies of the chemical amount of radioactive dose of 1.6 × 10-11 grams, the human body does not have any impact and harm. Thyroid imaging commonly used radiopharmaceutical 99mTcO4- , its half-life is only 6 hours. The radioactive dose received by the patient is much lower than that of an X-ray. Iodine-131 can also be used for diagnostic imaging, but is only limited to the search for ectopic thyroid or looking for thyroid cancer metastases and other special circumstances. 7.Can hyperthyroidism cause hypothyroidism after treatment with Iodine-131? The three current methods of hyperthyroidism treatment (antithyroid drugs, iodine-131, surgery) can cause hypothyroidism. Hyperthyroidism is more likely to be caused by autoimmunity, which does not recur after treatment, and hypothyroidism occurs in a certain percentage of cases every year. Therefore, hypothyroidism is not caused only by iodine-131 treatment. Iodine-131 treatment of hyperthyroidism due to the incidence of hypothyroidism at home and abroad hospitals reported different, the domestic more than 10%, and there is a tendency to increase year by year, hypothyroidism is easy to diagnose and treat. 8, Iodine-131 to hyperthyroidism treatment, can still have children in the iodine-131 treatment after six months of hyperthyroidism symptoms, thyroid function biochemical indicators back to normal, you can get pregnant. Even if hypothyroidism occurs after the treatment of hyperthyroidism, those who have normal thyroid function and biochemical indexes after the drug (oral eugenol) substitution therapy can also get pregnant, and they can continue to take eugenol during the period of pregnancy and breastfeeding, but they need to be regulated by the doctor to take the dosage. 9, not all hyperthyroidism patients are suitable for iodine-131 treatment Being pregnant and breastfeeding, as well as acute myocardial infarction patients in the acute stage of patients can not be used iodine-131 treatment; severe renal impairment can not be used in iodine-131 treatment, this time, because in addition to the thyroid gland to take up iodine-131, the rest of the body from the urinary excretion. If the kidney function is not good, iodine-131 can not be eliminated in the body in time, iodine-131 accumulates in the body, especially in the kidneys for a long time so that the patient is subjected to unnecessary irradiation. Iodine-131 treatment can be used after the kidney function is relieved. At the same time, patients with severe liver function abnormalities are also relative contraindications to iodine-131 treatment. 10.Can anti-thyroid drugs and iodine-131 treatment be taken together for hyperthyroid patients? Because anti-thyroid drug treatment will affect the uptake of iodine-131 by the thyroid gland as well as the results of biochemical determination of thyroid function, generally, anti-thyroid drugs (ATD) should be discontinued and iodine-containing foods and drugs should be avoided for more than 2-4 weeks before relevant nuclear medicine examination and treatment, and after the treatment, no more ATD treatment can be used, and only symptomatic treatment can be used. However, in patients with severe hyperthyroidism, due to the poor general state of the patient, in order to prevent exacerbation of the condition or the emergence of hyperthyroidism crisis, generally only in the determination of iodine uptake rate of the thyroid gland three days before the suspension of the drug, and in the service of iodine-131 three days after the continuation of the ATD treatment for 2-4 weeks, and later in the guidance of the doctor to reduce the dosage or stop taking. 11.Can the protruding eyes disappear after iodine-131 treatment? There are three kinds of hyperthyroidism with protruding eyes: some appear before the onset of hyperthyroidism, some appear during the treatment of hyperthyroidism, and a few patients may appear after the control of hyperthyroidism or even during hypothyroidism. There is a lack of effective treatment for hyperthyroidism with protruding eyes. Generally, after iodine-131 treatment, most of the hyperthyroidism protruding eye degree has been reduced, a very small number of patients with hyperthyroidism symptoms control protruding eye degree is still aggravated, this situation should go to the ophthalmology department for further symptomatic treatment. 12.What should I do if I have low thyroid? Once diagnosed with low thyroid, the treatment is relatively simple, using thyroid hormone (eugenol) replacement therapy, the patient’s thyroid hormone level can be adjusted to normal. Since this treatment only replenishes the insufficient thyroid hormones in the patient’s body, as long as the level of thyroid hormones in the body is adjusted to the normal range, it will not cause any damage to the patient’s liver and kidney functions and hematopoietic system; it will also not affect the pregnancy and breastfeeding. It is just like the reason that you can’t grow your own food, but buy food to eat.