Every year there are some patients who come to me with protruding eyes due to thyroid disease. I used to not give more help to my patients because of the complicated treatment process and poor results, but finally I have accumulated some experience over the years and have consulted many teachers. Today I will write out my lessons learned for my patients with hyperthyroidism protruding eyes, hoping to give you some help. I. Why do I have hyperthyroidism and proptosis? Many patients go to the ophthalmology department because their eyes protrude. After the ophthalmologist looks at them, he thinks it is related to hyperthyroidism and then tells the patient to go to endocrine treatment for hyperthyroidism, so this disease is one of the important manifestations of hyperthyroidism. When a patient has hyperthyroidism, there are substances in the body that are supposed to protect the body’s functions, but they mistakenly deal with the nerves, muscles and fat of the eye socket, causing these tissues to become very hypertrophic, and as a result, the eyeball is pushed out of the eye socket. One of the most important substances is the high level of thyroid stimulating hormone receptor antibodies (anti-TRAb). As to why it appears that one’s own people do not recognize one’s own people, it is not very clear. Some patients may wonder why the ophthalmologist still says I have hyperthyroidism and proptosis when, after examination, the endocrinologist says that the thyroid function is normal or low, or after treatment, the hyperthyroidism is cured or even hypothyroidism (hypothyroidism) is present. In fact, we have found that in some patients, the onset of eye disease precedes the abnormal thyroid function. Some patients have eye problems 18 months before the abnormal thyroid function, and some patients with hypothyroidism also have protruding eyes. Therefore, we now call this disease uniformly: thyroid-associated ophthalmopathy, or TAO for short. It can be seen that this disease is a very complicated disease, and although it is related to abnormal thyroid function, the exact process is not well understood. Second, what do I need to do if I have this disease of hyperthyroidism and proptosis? After understanding how this disease comes about, it is time to talk about what to do to deal with this disease. The most important and the first thing to do is to quit smoking. All studies now agree that smoking is an important culprit in the rapid aggravation or recurrence of hyperthyroidism. Therefore, if you have hyperthyroidism and proptosis, stop talking about any conditions and quit smoking immediately, I don’t care how to quit smoking. The next thing is to control thyroid function: neither let him be high nor let him be low. This work is there endocrinologist to help you do. However, there is one thing to note: whether it is medication or surgery, it does not affect the eyes very much. However, some patients and doctors are very anxious to control the thyroid function very quickly and use iodine 131 to treat the disease. Therefore, if you want to treat with iodine 131, it is better to contact a knowledgeable ophthalmologist to assist in formulating a treatment plan. It is also important to monitor eye pressure, vision and changes in eye disease. Many ophthalmologists are not in the habit of routinely measuring intraocular pressure in patients with hyperthyroidism and you need to remind your doctor to check it more often. Many patients visit the doctor, the ophthalmologist will let the patient do a CT in order to reduce the cost, in fact, the diagnosis and guide the treatment of this disease is nuclear magnetic (MR), he can distinguish whether it is fat-dominated or muscle-dominated, but also can provide a lot of information for the staging of the eye disease, to develop an effective treatment plan, so I recommend that patients come to do MR. Third, I went to the doctor, the doctor said not very clear, but also I was asked to choose a treatment plan, but I don’t understand it either, so what kind of principles should I base on? Since the treatment process is long, easy to repeat and ineffective, many doctors often ask patients in a consultative tone: I have these treatment options, which one do you think you should choose? At this point the patient is very helpless and overwhelmed. Here I would like to give you some basic principles for your reference: First of all: if you can be conservative, try not to operate. If the eye is protruding very fast, protruding a lot, the cornea is damaged, a short time drugs can not be controlled, you can consider surgery, the development is not fast, the condition is not serious patients, most can rely on drugs to control well, do not need surgery. If surgery is needed, it should also be treated after the condition has been stable for a period of time. Secondly: how should the drug be used: generally speaking the commonly used drug is hormone. If the disease is not heavy, the development is not fast, mainly fatty growth on the side of the eye and have diabetes, hypertension and other diseases, you can inject hormones locally, so the effect is good, the side effects are relatively small, relatively inexpensive; the disease development is fast, the eye muscle proliferation is the main patient, I recommend the systemic application of hormone shock treatment, and then a small amount of maintenance, you can assist the immunosuppressant, can achieve better results; for already stable, there is not much development of proptosis, you can get better results. For patients with stable proptosis, there is no need for hormone therapy. Also, in recent years, some places have carried out radiation therapy, but I personally do not recommend this program, because radiation therapy has the possibility of increasing the occurrence of tumors and can also cause some payment damage, if it must be used, the dose should not be large, 20 Ga is enough. Fourth, how long do I need to persist in order to cure this disease? Many patients are struggling with this question, and many doctors do not have the confidence to give a clear answer. In fact, you do not have to worry a lot, the majority of patients in 3 to 4 years (most in 2 years) will be stable; if early detection, early control, early treatment, the final result is still quite good, do not need to be particularly worried. Finally, to summarize: 1, quit smoking, maintain good habits 2, early detection, early treatment, standardized control 3, have confidence, perseverance will be happy