Typical hyperthyroidism has symptoms of hypermetabolism, enlarged thyroid gland and protruding eyes, which are not difficult to diagnose. In particular, some patients have insidious symptoms of hyperthyroidism, but some symptoms are more prominent, which can be easily misdiagnosed as another systemic disease. Wang Yongfei, General Surgery Department, Zhengzhou University First Affiliated Hospital Common atypical manifestations of hyperthyroidism are as follows 1. Cardiovascular type Cardiovascular symptoms are prominent, such as tachycardia, arrhythmia, angina pectoris or heart failure. It is mostly seen in women or older patients and toxic nodular hyperthyroidism patients, and is often clinically diagnosed as coronary heart disease, hypertensive heart disease, arrhythmia and other diseases. In this type of hyperthyroidism, cardiovascular symptoms can only be relieved by anti-thyroid drug treatment, and the effect of cardiovascular drug treatment alone is poor. 2. Neurological type The patient’s neuropsychiatric symptoms are prominent, including hypersensitivity, inattention, agitation, fidgeting, insomnia, and hallucinations, mostly in women, and easily misdiagnosed as neurosis or menopausal syndrome. 3, gastrointestinal type is often highlighted by diarrhea several times a day or even dozens of watery diarrhea. No pus and blood stool, often misdiagnosed as enteritis, chronic colitis. Some patients have abdominal pain as the main symptom, diffuse or limited abdominal pain, can be similar to biliary colic, renal colic, ulcer disease, pancreatitis, appendicitis, often diagnosed as acute abdominal disease and admitted to the body surgical treatment. Occasionally, a few patients have severe vomiting as the main symptom, or even obstinate vomiting and misdiagnosed as gastroenteritis. This type is mostly seen in middle-aged and young people. 4. Muscle type The prominent manifestation is muscle weakness, loss of strength and periodic paralysis, often without protruding eyes, hyperthyroidism signs and symptoms such as goiter, or symptoms appear later, mostly seen in middle-aged men, mostly occurring after the patient has eaten a full meal and consumed a large amount of sugar-based food. 5. Cachexia type With wasting as the prominent symptom, rapid weight loss, muscle atrophy, reduction or disappearance of subcutaneous fat, and even cachexia, often misdiagnosed as malignant tumor, mostly seen in elderly patients. About half of the hyperthyroid patients have hypothermia, with body temperature <38℃. Some patients have hypothermia as the main symptom for a long time, accompanied by wasting and palpitations, which are easily misdiagnosed as rheumatic fever, typhoid fever, tuberculosis, malignant acute bacterial endocarditis, etc., mainly seen in young people. This type of hypothermia is characterized by an increase in body temperature not proportional to the accelerated heart rate, and a more significant fast heart rate, the application of antipyretic antibiotic treatment is ineffective, while the effect of anti-thyroid drug treatment is obvious. 7, liver disease type With jaundice, epigastric distension, large liver, elevated transaminases, leukopenia as the main symptoms, often misdiagnosed as liver disease. In addition to the above atypical symptoms, there are some atypical signs, such as hyperthyroidism acromegaly, gynecomastia, vitiligo, separation of nail and nail bed, local often pigmentation, hyperglycemia, polydipsia and polyuria, liver palm, hypercalcemia, etc. All of these require further awareness to avoid misdiagnosis.