Hyperthyroidism is a general term for a disease that is caused by excessive secretion of thyroid hormones from a variety of causes and acts on tissues and organs throughout the body, resulting in increased excitability and hyper-metabolism in the nervous, circulatory, and digestive systems of the body. The most common diseases include toxic diffuse goiter, toxic nodular goiter, functional autonomic thyroid adenoma, thyroiditis, and iodine-induced hyperthyroidism, among which toxic diffuse goiter is the most common. This chapter focuses on toxic diffuse goiter with hyperthyroidism, also known as Graves’ disease (GD). This disease is an organ-specific autoimmune disease. In addition to goiter and hypermetabolic syndrome, the typical case also has proptosis. The disease belongs to the category of “gall disease” (goiter) in Chinese medicine. Etiology and pathogenesis: Western medicine considers this disease to be an autoimmune disease, but its pathogenesis has not been fully elucidated. Etiology: genetic (apparent family aggregation), psychiatric, environmental. Common complications: hyperthyroid crisis, hyperthyroid heart disease, proptosis, hyperthyroid myopathy, hyperthyroid periodic paralysis, etc. General treatment includes low iodine diet, high-calorie, high-protein diet, rest, etc. I. Medication to suppress thyroid hormone production 1. (5) Pre-operative preparation for hyperthyroidism; (6) Adjuvant treatment after radioactive iodine therapy; (7) Recurrence after subtotal thyroidectomy and inappropriate treatment with I131; (8) Those who have the conditions and confidence to take medication for a long time. 2. Advantages: the only therapy that does not damage the thyroid gland and its surrounding tissues, resulting in permanent hypothyroidism is rare; efficacy is certain and effective for most patients; safe, with few serious toxic side effects; easy to use. 3, commonly used drugs ① thiourea including methylthiouracil (MTU) and propylthiouracil (PTU); ② imidazole including methimazole (MM) that is, methimazole (thiamazole) and carbimazole (CMZ). CMZ), also known as methimazole. Mechanism of action: 1) Inhibit the formation of thyroid peroxidase and active iodine; 2) Inhibit complexine iodination; 3) Inhibit the formation of T3 and T4 by diiodine complexine and mono-complexine coupling; 4) Immunosuppressive effect, causing a decrease of TRAb or TSAb in blood circulation. The decrease or disappearance of TRAb or TSAb predicts that a longer remission may be achieved after discontinuation of the drug; ⑤ PTU can also prevent the conversion of T4 to T3, which can be used as the drug of choice for severe hyperthyroidism or thyroid crisis. The treatment can be divided into three stages: symptom control, dose reduction and maintenance. The duration of treatment is 1.5~2 years. 5. Side effects ① Leukopenia: Treatment: Generally, it is not necessary to stop the medication, reduce the antithyroid drugs and add leukocyte-raising drugs. ②Rash: give antihistamines and stop the drug if the rash is severe. (③) drug hypothyroidism; (④) occasional toxic hepatitis, drug jaundice, joint pain, etc. Serious side effects – granulocyte deficiency Treatment: Cell deficiency is life-threatening and usually occurs within 1-3 months of initial high-dose treatment and within 1 month of re-dosing. Leukocytes should be checked once a week during the early stage of treatment and discontinuation should be considered if the leukocytes are less than 2.5×109/L and neutrophils are less than 1.5×109/L. If symptoms such as sore throat, fever and general discomfort occur during the course of medication, you should go to hospital for examination quickly. In the early stage of hyperthyroidism treatment, for those with heavy symptoms, anxiety, palpitations, tremors and tachycardia, these drugs can be added. Propranolol 10-40mg is commonly used, 3-4 times a day. At higher doses, such as 160mg/d, it can inhibit the conversion of T4 to the more active T3. 50mg/d of metoprolol or 5mg/d of bisoprolol can also be used orally. It can also be used for hyperthyroidism crisis, before and after I131 treatment and in preparation for thyroid surgery. Contraindicated in patients with asthma and heart failure. 2. Compound iodine solution (lugol solution) Only for preoperative preparation and hyperthyroidism crisis. Other therapies (a) Radioactive I131 therapy 1. Indications Adult Graves’ hyperthyroidism with goiter II or higher; failure of ATD therapy or allergy; recurrence of hyperthyroidism after surgery; hyperthyroid heart disease or hyperthyroidism with other causes of heart disease; hyperthyroidism with leukocytopenia and/or thrombocytopenia or allohemocytopenia; hyperthyroidism in the elderly; hyperthyroidism with diabetes mellitus; toxic multinodular goiter; autonomic Functional thyroid nodules in combination with hyperthyroidism. Relative indications: adolescents and children with hyperthyroidism who have failed treatment with ATD, refused surgery, or have contraindications to surgery; hyperthyroidism combined with impairment of liver, kidney, and other organ functions; infiltrative proptosis. For mild and stable moderate or severe infiltrative synostosis, 131I alone can be used to treat hyperthyroidism, while for patients in progressive stage, prednisone can be added before and after I131 treatment. 2. Contraindications Absolute contraindications: pregnancy, lactation. Relative contraindications: children; retrosternal goiter and/or giant thyroid; endocrine proptosis. 3. Complications The main complication after I131 treatment for hyperthyroidism is hypothyroidism. Foreign reports of early (within 1 year) hypothyroidism is about 20%, after which it increases by 2% to 3% per year, and reaches about 50% to 70% after 10 years. (2) Surgical treatment 1. Indications: ① Moderate to severe hyperthyroidism that is ineffective with long-term medication or relapse after stopping medication ② Large thyroid gland ③ Nodular goiter with hyperthyroidism ④ Autonomous high-functioning adenoma ⑤ Suspected coexistence with thyroid cancer ⑥ Children with hyperthyroidism that is poorly treated with anti-thyroid medication ⑦ Pregnant hyperthyroidism that requires high doses of anti-thyroid medication to control symptoms can be treated surgically in the middle of pregnancy. 2. Contraindications ① severe infiltrative proptosis; ② serious heart, liver, kidney, lung and other comorbidities, or poor general condition that cannot tolerate surgery; ③ early (first 3 months) and late (second 3 months) pregnancy. 3. Complications ① wound bleeding; ② wound infection; ③ hyperthyroidism crisis; ④ supraglottic and retrolar nerve injury; ⑤ parathyroid gland injury may cause temporary or permanent hypoparathyroidism; ⑥ hypothyroidism, the incidence is about 10%-15%; ⑦ worsening of proptosis.