Patient, male, 40 years old. He was referred to our hepatology department from a local hospital for more than 1 month due to weakness, yellow skin and urine, and itchy skin. Physical examination: clear consciousness, obvious yellow sclera and skin staining, no obvious protrusion of bilateral eyeballs, thyroid gland I enlargement, heart rate 90 beats/min, rhythmical, abdominal softness, no pressure pain. Main laboratory tests: thyroid function: TT3, TT4, FT3, FT4 were elevated, TSH 0.007mIU/L, TPOA 268IU/ml; liver enzymes were basically normal, TB 472μmol/L DB 318μmol/L; hepatitis E antibody was positive. The treatment process: the severely impaired liver function was treated actively and effectively with artificial liver technology, and after the jaundice improved, the patient was treated electively with hyperthyroidism 131I at a dose of 6 mCi; after 131I treatment, the patient continued to be hospitalized (isolated in a single room for one week). One week after treatment, TB 529μmol/L DB 333μmol/L; three weeks later, TB 289μmol/L DB 196μmol/L, thyroid function: TT3, TT4, FT3, FT4 had returned to normal, TSH 0.004mIU/L; one month after treatment, the patient’s liver function was basically normalized and he was discharged. At the follow-up visit in 3 months after treatment, thyroid function: TT3, TT4, FT3, FT4 were normal, TSH 0.605mIU/L, liver function was normal. Clinical hypothyroidism appeared 1 year after treatment, and now Eugenol 50 mcg/day replacement therapy is in progress. Discussion: Viral hepatitis E is an infectious disease with acute onset, jaundice is common, and specific serologic pathogenic tests are the basis for diagnosis. The patient in this case was acute severe hepatitis E combined with hyperthyroidism, so anti-thyroid drugs could not be given to treat hyperthyroidism. After active liver protection and anti-yellowness treatment, the patient was treated with 131I for hyperthyroidism, and gradually improved and was discharged from the hospital.