Hyperthyroidism is the second most common endocrine disease after diabetes. If not controlled properly, it can lead to functional impairment of several systems throughout the body (such as nerve, circulation, digestion, etc.). Treatment for this disease is mainly divided into medication, radioactive iodine treatment and surgery, and which method is adopted mainly depends on the specific condition of the patient and the national situation. In recent years, with the rapid development of the economy and the accelerated pace of life, people are under more and more mental stress, which, together with factors such as increased environmental radiation and unreasonable iodine intake (iodine deficiency or high iodine), has significantly increased the incidence of hyperthyroidism. Although hyperthyroidism is a common disease, due to insufficient publicity, both primary care physicians and patients with hyperthyroidism are far less aware of it than diabetes, and misdiagnosis and mistreatment are very common. For this reason, the author summarizes and reviews various misunderstandings of clinical hyperthyroidism diagnosis and treatment, hoping to help primary care physicians and hyperthyroid patients. The typical symptoms of hyperthyroidism include hyperphagia, lethargy, fever, excessive sweating, panic, insomnia, agitation, diarrhea, etc. The physical examination includes protruding eyes, enlarged thyroid gland, hand tremor and other signs. However, there are also many hyperthyroid patients with less than typical symptoms, which are especially common in elderly patients with hyperthyroidism. For example, many elderly hyperthyroid patients mainly present with cardiovascular symptoms such as panic, chest tightness, premature beats, atrial fibrillation and cardiac insufficiency, without obvious proptosis and goiter, which are often misdiagnosed as coronary heart disease; some elderly hyperthyroid patients even have symptoms that are completely opposite to the typical symptoms of hyperthyroidism, such as anorexia and poor appetite, depression and progressive wasting, which are often misdiagnosed as digestive tract tumors. Some young and middle-aged female hyperthyroid patients have prominent psychiatric symptoms, mainly manifesting as insomnia and dreaminess, nervousness and anxiety, dizziness and menstrual disorders, which are often misdiagnosed as “menopause syndrome” or “depression”. Some hyperthyroid patients with diarrhea as the main manifestation are often misdiagnosed as “chronic colitis” or “irritable bowel syndrome”. In addition, a small number of male hyperthyroid patients present with periodic episodes of muscle weakness, with more severe lower extremity symptoms, and may be accompanied by hypokalemia. Therefore, we must have sufficient understanding of the diversity of hyperthyroidism symptoms so as to reduce and avoid misdiagnosis and underdiagnosis. Hyperthyroidism is a group of clinical syndromes caused by increased synthesis and secretion of thyroid hormones (T3 and T4) by the thyroid gland tissue itself, including diffuse These include diffuse goiter with hyperthyroidism (i.e., Graves’ disease), toxic multinodular goiter (i.e., Plummer’s disease), iodine hyperthyroidism, and others. However, there are other causes of elevated thyroid function, such as subacute thyroiditis, in which the thyroid tissue is destroyed by inflammation, resulting in a transient increase in thyroid hormone release; and hypothyroidism replacement therapy, in which exogenous thyroid hormone is oversupplied, resulting in elevated T3 and T4. For example, exogenous thyroid hormone supplementation during hypothyroidism replacement therapy can also lead to elevated T3 and T4. In the latter two cases, we can only call them “thyrotoxicosis”, but not “hyperthyroidism”. Therefore, to diagnose hyperthyroidism, it is not enough to rely on the results of thyroid function tests alone, but also to combine the patient’s clinical symptoms, iodine 131 absorption rate, thyroid ultrasound and nuclear scan. Do not diagnose hyperthyroidism easily by looking at the elevated T3 (or FT3) and T4 (or FT4) on the test results, which is obviously inappropriate. 3, improper choice of treatment methods There are three methods of treatment for hyperthyroidism: drug therapy, radioactive iodine therapy and surgery, each of which has its own specific indications. The choice of method should not only depend on whether the method is simple and fast, but also on whether the method is suitable for the specific condition of the patient. For patients with mild hyperthyroidism and mild enlargement of the thyroid gland (especially for young patients under 20 years old) and for hyperthyroidism during pregnancy, drug therapy is generally preferred; for patients with severe diffuse goiter or hyperthyroidism with thyroid cancer (or nodules) who have developed pressure symptoms, surgery is preferred. All hyperthyroid patients with iodine allergy, obvious proptosis, and those who are pregnant or breastfeeding should not undergo this treatment, because this method not only has a higher risk of permanent hypothyroidism, but also may lead to aggravation of proptosis. 4. The dosage of anti-thyroid drugs (ATD) is constant from the beginning to the end. The medication for hyperthyroidism is usually divided into three different phases: control phase, reduction phase and maintenance phase. The “control phase” requires a larger dose of medication and aims to reduce the patient’s excessive thyroid hormone level to normal within a short period of time, which takes about 4~6 weeks; after the patient’s “thyroid function (FT3, FT4, TSH)” is reduced to normal level, the patient enters the “reduction phase”. After that, the patient enters the “reduction stage”, when the dose of anti-thyroid drugs should be gradually reduced to prevent overkill and “medication hypothyroidism”, generally every two weeks, each time by 1~2 tablets, this process takes about 2~3 months; when the anti-thyroid drugs are reduced to 1 tablet per day, the patient will be able to take more than 1 tablet per day. When the anti-thyroid medication is reduced to about 1~2 tablets per day (Tabazol 5~10mg/day or Propylthiouracil 50~100mg/day) and the thyroid function is still normal, the medication should not be stopped at this time, but should continue to be maintained with small doses for a long time, and the “maintenance phase” takes about 1.5~2 years or even longer. However, some patients, including some non-specialist doctors, do not understand this, but they take the dose according to the initial control phase unchanged for a long time, without reducing the dose of drugs at the right time, which leads to “drug hypothyroidism”. The pharmacological properties of various antithyroid drugs are not understood, and the drug usage is inappropriate. Tabazol and propylthiouracil are two basic drugs for the treatment of hyperthyroidism, but the pharmacokinetic characteristics of the two are different. The half-life of propylthioxypyrimethamine is only 2 hours, so it must be taken three times a day, otherwise it will not be as effective as it should be. It should be reminded that antithyroid drugs (tabazol or propylthiouracil) can only inhibit the synthesis of thyroid hormone, but they do not work on the synthesized thyroid hormone in the body, nor can they prevent the release of thyroid hormone, so they cannot work quickly after taking them. Therefore, it is important not to think rashly that the medication is not effective and change the medication or treatment method at will when the symptoms do not improve significantly after only 2 to 3 days. In the early stage of initial treatment when anti-thyroid drugs are not yet fully effective, sympathetic excitation can be suppressed by taking β-blockers (such as Tretinoin) to relieve the patient’s heartburn, chest tightness and other conscious symptoms.