What is hyperthyroidism? Hyperthyroidism is a disease caused by increased secretion of thyroid hormones in the body due to various causes, resulting in increased excitability and hyper-metabolism of multiple systems, such as nerves, circulation and digestion. Hyperthyroidism is a common endocrine disorder with an incidence of 0.5%-1%. The etiology of hyperthyroidism is complex and generally results from a variety of factors, including genetic background (or susceptibility gene), viral infection, autoimmunity, increased iodine intake, etc. Clinical manifestations of hyperthyroidism Clinical manifestations of hyperthyroidism may include: fear of heat, excessive sweating, easy hunger, excessive eating, weight loss, palpitations, hand tremors, increased number of stools, hair loss, menstrual disorders or even menopause in women, excitement, sexual anxiety, irritability and insomnia, fatigue and even periodic weakness of limbs. It is mostly accompanied by thickening of the neck or protruding eyes, and mucinous edema in front of the tibia. Severe hyperthyroidism may manifest as high fever, nausea, vomiting, diarrhea or depression, poor eating, significant wasting and weakness. The danger of hyperthyroidism: long-term uncontrolled hyperthyroidism may lead to heart enlargement, arrhythmia and heart failure, and liver function damage; in serious cases, hyperthyroid crisis may occur. What kind of tests should be done for suspected hyperthyroidism? 1. Thyroid function: to clarify the presence of hyperthyroidism; 2. Thyroid-related antibodies: to clarify the presence of autoimmune factors in hyperthyroidism and to guide the use and discontinuation of medication; 3. Thyroid iodine absorption rate: to differentiate from thyroiditis and to guide the diagnosis and treatment; 4. 6.Electrocardiogram: to understand the presence of arrhythmia; 7.Cardiac ultrasound: to understand the enlargement of the heart and cardiac function; 8.Thyroid ultrasound: to understand the enlargement of the thyroid gland, the presence of nodules or masses, and the blood flow, which can guide the treatment; 9.Thyroid imaging: to help identify the nature of the masses if there are nodules or masses in the thyroid gland, and to help calculate the amount of 131 iodine for those who intend to carry out 131 iodine treatment. V. Treatment of hyperthyroidism Currently, there are three treatment methods for hyperthyroidism: 1. Internal medication There are two main drugs commonly used: methimazole (Tabazol/Sage) or propylthioxypyrimethamine. Advantages: (1) The efficacy of the drug is certain, and the effect can be seen in about 2 weeks after taking it, and the symptoms can be significantly relieved in about 1-2 months; (2) permanent hypothyroidism usually does not occur. Disadvantages: (1) The course of treatment is long, ideally about 1.5-2 years, longer in some patients; (2) The relapse rate is high after stopping the drug, about 20-40%; (3) There are certain side effects, such as causing leukopenia, liver function damage, rash, etc., but the incidence is relatively low. (3) It is required to follow the doctor’s prescription, and the blood routine should be rechecked weekly in the early stage of treatment, and the nail function and liver function should be rechecked every 1-2 months, and the treatment stabilization period and maintenance period should be rechecked 2-3 months to adjust the dosage, and if WBC <3.0×109 or sore throat, fever, aversion to oil, yellow face, yellow urine, etc. occur, the patient should be admitted to the hospital immediately; (4) Common side effects include: rash, skin itching, with an incidence of about 10%, and rare side effects There are: granulocyte deficiency, the incidence is about 0.3%; toxic liver disease, the incidence is 0.1% - 0.2%; rare side effects are: vasculitis, etc. Adverse reactions should be reported to the doctor immediately. 2.131 iodine treatment Principle: The radioactive 131 iodine is used to destroy the thyroid cells and reduce the secretion of thyroid hormone. Advantages: easy and safe, one-time medication, efficiency up to 90%, low recurrence rate. Disadvantages: (1) It may lead to transient exacerbation of hyperthyroidism in the early stage and even induce thyroid crisis; there is a risk of aggravation of proptosis. Therefore, for severe hyperthyroidism and severe proptosis, 131I therapy is recommended after control and stabilization. (2) Permanent hypothyroidism. The incidence is high, reportedly increasing by 5% per year, reaching 30% in 5 years and up to 40%-70% in 10 years. Once it occurs, it is necessary to take thyroxine replacement therapy for life and cannot be stopped. 3. Surgical treatment Principle: Surgery is used to remove most of the thyroid tissue to reduce thyroid hormone secretion. Advantages: High efficiency, low recurrence rate, mainly for those with lumps or nodules in the thyroid gland, with malignant changes or malignant tendency. Disadvantages: (1) invasive, with certain surgical risks; (2) more expensive, and will leave surgical scars; (3) also has the chance of recurrence and permanent hypothyroidism. The above three treatment methods have their own advantages and disadvantages and can be freely chosen. However, please consult a specialist for liver function impairment, leukopenia, recurrent hyperthyroidism, pregnancy, etc. 6. Because uncontrolled hyperthyroidism increases the incidence of miscarriage, preterm delivery, pre-eclampsia and placental abruption in pregnant women, and increases the risk of preterm birth, intrauterine growth retardation and small full-term babies, and can cause fetal or neonatal hyperthyroidism. (2) If the patient is receiving oral medication, blood FT3 and FT4 reach the normal range, stop oral medication or apply the minimum dose of medication, pregnancy is possible. (3) Internal oral medication is preferred to control hyperthyroidism during pregnancy, and thyroid surgery can also be chosen to be performed in the fourth to sixth month of pregnancy, and 131 iodine therapy is not an option. (4) Those who have 131 iodine treatment for hyperthyroidism should pay attention to contraception for at least 6 months. (5) It is recommended to check thyroid function before the proposed pregnancy. (1) Some patients with hyperthyroidism may have protruding eyes, swollen eyelids, photophobia, lacrimation, dryness, foreign body sensation, diplopia and even loss of vision, etc. In severe cases, the eyes protrude significantly and cannot be closed completely, resulting in corneal ulcers. (2) Some patients with proptosis may have normal nail function, or hyperthyroidism may occur after several years of proptosis. (3) Treatment of proptosis can be hormone shock therapy, orbital radiation therapy or hormone combined with orbital radiotherapy. The following points should be noted after the occurrence of hyperthyroidism: Iodine prohibition: Hyperthyroidism is not iodine deficiency, but iodine intake should be restricted. Quit smoking: smoking can aggravate the disease. Pay attention to rest and avoid overexertion, and you can supplement calories and nutrition appropriately.