Useful clinical tips: 1. Clarify hyperthyroid heart disease first Before initiating anti-hyperthyroid heart disease combined with heart failure treatment, it is necessary to clarify whether the diagnosis of hyperthyroid heart disease is established and exclude other heart diseases, but it is necessary to pay attention to the possibility that other diseases can be combined at the same time. 2. What kind of beta-blocker to choose Studies have confirmed that among many beta-blockers, propranolol has the effect of blocking the conversion of T4 to T3 and counteracting the effect of catecholamines, thus rapidly relieving tachycardia, eye and face cramps, tremor, anxiety and other symptoms of hyperthyroidism, and these effects are strongest with propranolol. Atenolol and metoprolol may also mildly reduce T3 levels, but are generally not used as long-term and stand-alone medications for hyperthyroidism. Controversies in the use of propranolol: A few people and a few textbooks (8-year internal medicine textbook, 1st edition) list the use of propranolol as a contraindication to the treatment of hyperthyroidism, but unfortunately do not state the specific reasons why propranolol use is contraindicated. This view may be based on the following considerations: first, the use of ponerol in acute heart failure is generally not advocated; second, ponerol may induce or aggravate acute heart failure in hyperthyroid heart disease. However, most scholars and most textbooks and monographs advocate the appropriate use of pranolol in hyperthyroidism combined with heart failure. The reason for this is that the continued and excessive activation of the adrenergic receptor pathway in systolic heart failure is harmful to the heart. The concentration of norepinephrine in the failing heart is sufficient to produce cardiomyocyte damage and the activation of the chronic adrenergic system mediates myocardial remodeling, which is the main pathophysiological mechanism for the development of heart failure, which is the basis for the use of beta-blockers in the treatment of chronic heart failure. The main reason is that ponerol can block catecholamine-like effects and reduce the toxic effects of thyroxine on the heart. In addition, ponerol can also inhibit the conversion of T4 to T3, which plays a better role in controlling heart rate. 3. How to deal with hyperthyroidism combined with congestive heart failure (1) In general, the treatment of hyperthyroidism combined with heart failure is more difficult to correct. (2) In acute attacks of heart failure, weighing the pros and cons, if there is an urgent need to use Prenalol, it is necessary to control acute heart failure first or simultaneously with digitalis preparations. (3) When hyperthyroid heart disease combined with heart failure, the sensitivity to digoxin is reduced, and the dose can be increased rather than reduced when using it. (4) Iodine 131 therapy After heart failure is controlled, early control of hyperthyroidism is recommended. Iodine 131 therapy is not recommended for long-term treatment with anti-hyperthyroid drugs.