Hyperthyroidism (hyperthyroidism) is a group of clinical syndromes with increased excitability and hyper-metabolism of the nervous, circulatory and digestive systems due to hyperfunction of the thyroid gland itself and increased synthesis and secretion of thyroid hormones. The causes of hyperthyroidism include Graves’ disease, toxic multinodular goiter, functional autonomic hyperfunctional adenoma, iodine hyperthyroidism, pituitary hyperthyroidism, etc. Among them, Graves’ disease is the most common, accounting for about 85% of all hyperthyroidism, and research has found that the onset of Graves’ disease is mainly related to autoimmune and genetic factors. The prevalence of hyperthyroidism in Shanghai has increased from 1% to 2% 10 years ago, and 80% of the patients are young and middle-aged women. The common symptoms of hyperthyroidism include panic attacks, fear of heat, hyperphagia, lethargy, fatigue, agitation, insomnia, etc. It is often accompanied by thick neck, protruding eyes, hand tremor, anterior tibial mucinous edema, hypogonadism, etc. Male patients may also develop hyperthyroid periodic paralysis (TPP). In recent years, the University of Hong Kong has reviewed the epidemiology, clinical manifestations, pathogenesis and treatment of TPP in the Journal of clinical endocrinology and metablism. The article concluded that the occurrence of TPP is not limited to Asian patients, but is also found in Western countries, and that early restoration of normal thyroid function with effective treatment can effectively alleviate TPP and prevent serious cardiopulmonary complications. Although hyperthyroidism is no stranger to complications such as heart disease, osteoporosis and liver damage, Taiwanese researchers have recently found that the incidence of stroke in young people with hyperthyroidism is 44% higher than that in those with normal thyroid function, making it a new risk factor for ischemic stroke in young people. The results were published in the recent Journal of the American heat association. Of course, some patients in the early stages of the disease or with mild symptoms have signs and symptoms that are not typical, and the diagnosis can usually only be made through hematological and iodine uptake tests. With the accumulation of experience in medical practice, more and more studies have found that different treatment methods are appropriate for patients with different etiologies and conditions of hyperthyroidism, and individualization and optimization of treatment plans have gradually become the most important aspect in the treatment of hyperthyroidism today. The individualization and optimization of the treatment plan has gradually become the most important aspect of the treatment of hyperthyroidism today. The rational selection of effective methods has become one of the most important elements of clinical hyperthyroidism treatment. The following is a brief introduction to the three classical treatment methods commonly used worldwide: Surgery Surgery for hyperthyroidism has an immediate effect and can cure 90% to 95% of patients, with a mortality rate of less than 1%. However, because of the common complications such as trauma, scar formation, hoarseness due to nerve damage, and the high incidence of hypothyroidism, the number of hyperthyroid patients choosing this treatment is decreasing every year. According to the latest statistics from the British Thyroid Association, less than 5% of hyperthyroid patients worldwide currently opt for surgical treatment, mainly in North Korea. In addition, in order to effectively reduce the occurrence of hyperthyroidism crises, adequate preoperative preparation is necessary for hyperthyroid patients who require surgery. At present, this method is mainly used for the following patients with hyperthyroidism: (1) extremely enlarged thyroid glands with symptoms of compression; (2) hyperthyroid patients who also have suspected malignant lesions; (3) women who cannot adhere to long-term medication and are also unsuitable for iodine-131 therapy; (4) women with a history of multiple relapses during medication and who are eager to become pregnant in the short term. In view of the fact that hyperthyroidism can have adverse effects on pregnancy (miscarriage, premature delivery, etc.), and pregnancy may aggravate hyperthyroidism. Therefore, surgery should be considered for patients with hyperthyroidism in early or mid pregnancy who have the above indications. Anti-thyroid medication Commonly used anti-thyroid medications (ATD) include methimazole (MMI) and propylthioxypyrimethamine (PTU). The overall treatment methods can be divided into titration and blocking-substitution methods, both of which have comparable efficacy, and the total course of treatment generally takes 1-1.5 years. The so-called titration method refers to adjusting the dosage of ATD according to the serum thyroid hormone level, increasing the dosage of ATD when the level is high and decreasing it when it is low; while the blocking-replacement method refers to the use of excessive ATD to significantly suppress thyroid function, based on which the final level of serum thyroid hormone is adjusted to the normal range by combining with thyroxine-based drugs (levothyroxine sodium or thyroid tablets). The blocking-substitution method is no longer recommended due to the increased dosage of ATD and the increased risk of side effects such as rash (see below). The specific choice of MMI and PTU should be considered from multiple perspectives, including effectiveness, safety, patient compliance with the drug, and cost. Studies have shown that the initial efficacy of MMI may be greater than or equal to that of PTU, and compliance is higher than that of PTU; the incidence of serious adverse reactions associated with PTU (e.g., drug-related liver disease, ANCA-associated vasculitis) is higher than that of MMI; however, the incidence of granulocyte deficiency is higher with MMI than with PTU; there is no difference between the two in terms of recurrence of hyperthyroidism and cost of treatment. The starting dose, rate of reduction, maintenance dose and total duration of treatment of ATD are individual differences and need to be controlled according to clinical practice. The disadvantage of ATD is that it takes a long time to take the drug, the remission rate is only about 30-70%, and the side effects such as white blood cell decline and drug-related liver damage are obvious. At present, this method is mainly applied to the following patients: (1) mild disease with mild enlargement of thyroid gland; (2) under 20 years old; (3) hyperthyroidism during pregnancy or lactation; (4) adjuvant treatment before and after iodine-131 treatment; (5) preoperative preparation of hyperthyroidism; (6) rescue treatment of hyperthyroidism crisis. Iodine 131 ablation 131I (iodine-131) ablation therapy for hyperthyroidism started in 1942 and has a history of more than 60 years. China started to treat hyperthyroidism with 131I in 1958, and has accumulated hundreds of thousands of cases so far, and has accumulated rich experience in treating refractory severe hyperthyroidism with 131I. Data show that the frequency of using iodine-131 ablation for hyperthyroidism in Europe and the United States is significantly higher than that in China and other Asian countries. It should be emphasized that: ① This method is safe, simple, inexpensive, and highly effective, with an overall efficiency of 95%, a clinical cure rate of 85% or more, and a recurrence rate of less than 1%. After 3-6 months of the previous 131I treatment, some patients can do the next 131I treatment if their condition requires. ②The method did not increase the incidence of cancers such as thyroid cancer and leukemia in patients. ③The method did not affect the fertility of patients or the incidence of genetic defects. ④131I accumulates in the body mainly in the thyroid gland and does not cause acute radiation damage to organs other than the thyroid gland, such as the heart, liver, and blood system, and can be used relatively safely to treat patients with severe hyperthyroidism who have comorbidities of these organs. ⑤ Our experts are more cautious about the indications for age, and treatment with 131I for hyperthyroid patients under 20 years of age has been repeatedly reported in the United States and other North American countries. In the UK, children with hyperthyroidism over 10 years of age, especially those with goiter and/or poor compliance with ATD therapy, are also treated with 131I. Recently, the Nuclear Medicine Branch of the Chinese Medical Association is preparing an expert consensus on iodine-131 treatment for patients with Graves’ hyperthyroidism, which will provide clinical guidance on specific treatment methods, efficacy evaluation and patient management. Compared with the two aforementioned treatments, Iodine-131 ablation is a painless “internal thyroidectomy”. In general, after 2-3 weeks of oral administration of Iodine-131, the effects of the treatment gradually appear, and within 1-3 months the symptoms gradually improve and the thyroid gland shrinks significantly (showing its unique cosmetic effect, see above), and after 3-6 months all symptoms disappear. After this method of treatment, patients often have regained their health without realizing it. According to the latest version of the Chinese Medical Association Endocrinology Branch’s Guidelines for the Diagnosis and Treatment of Thyroid Diseases in China, this treatment is available to all hyperthyroid patients except pregnant and breastfeeding patients, meaning that most hyperthyroid patients are absolute and relative indications for this treatment. In contrast, this treatment is particularly suitable for the treatment of the following 9 categories of hyperthyroid patients (meeting one of them): (1) age 20 years or older, with goiter II or higher; (2) contraindications such as failure of antithyroid medication, allergy (see below, methimazole for 3 days) or leukopenia; (3) postoperative recurrence of hyperthyroidism; (4) hyperthyroid heart disease or heart disease with other causes; (5 ) hyperthyroidism with leukocytopenia and/or thrombocytopenia or complete blood cytopenia; (6) hyperthyroidism in old age; (7) hyperthyroidism with diabetes mellitus; (8) toxic multinodular goiter; (9) functionally autonomous thyroid nodules combined with hyperthyroidism. In conclusion, any method of treating hyperthyroidism has its advantages and shortcomings, and one method cannot be applied to all hyperthyroid patients. In our clinical work, we need to recommend and select effective treatment according to the objective conditions of hyperthyroidism such as its etiology and condition and the subjective preference of patients, so that the thyroid function can be restored to normal as soon as possible and the occurrence of complications can be minimized.