Recently, during my work in the network, outpatient and ward, I have been seeing and receiving a large number of patients regarding adverse reactions caused by hyperthyroidism treated with iodine 131. After careful understanding, one common response from them is that iodine 131 is the preferred option, or even the first choice, for treating hyperthyroidism. So, is this true? In my opinion: the adverse consequences, even serious ones, caused by this treatment may be ignored by nuclear medicine specialists, some clinical medicine specialists, and even by patients and their families! My opinion is: Iodine 131 is an effective treatment for hyperthyroidism, but it is definitely not a priority, much less the preferred treatment for hyperthyroidism. We cannot ignore the serious consequences of iodine 131 treatment for hyperthyroidism, which are definitely not only hypothyroidism; many patients encountered in the clinic also have inexplicable discomfort and irritability; some of them are close to the phenomenon of severe menopausal syndrome; quite a lot of them show that after supplementation with levothyroxine tablets or common thyroxine tablets, their blood tests for thyroid function are normal, but edema persists in some parts of their body. The indescribable discomfort and discomfort is indescribable, which is manifested by general discomfort and restlessness, and the symptoms cannot be relieved by ordinary Valium tablets, etc. What should be the treatment principle for hyperthyroidism? Or what is the preferred option? Here are some of my suggestions. First of all, the treatment of hyperthyroidism mainly includes three aspects: internal conservative treatment (medication); nuclear therapy with iodine 131; and surgery. The first one is conservative medical treatment. Iodine 131 is only considered when strict internal treatment is ineffective, but before iodine 131 treatment, imaging examinations such as high-frequency ultrasound must be checked, and if ultrasound suggests nodules or occupying lesions, surgery should be considered. Therefore, iodine 131 treatment for hyperthyroidism should be considered only after strict or regular full course of medical medication has failed, and if the thyroid itself has no nodules or occupying lesions except diffuse lesions, or if all medical medications are allergic. In addition, for adolescents and women who have not yet conceived or given birth, iodine 131 treatment should be carefully chosen. Secondly, the main indications for surgical treatment of hyperthyroidism are: those who have ineffective medical treatment of hyperthyroidism and are not suitable for iodine 131 treatment; those who have hyperthyroidism with nodules or occupancy of the thyroid gland, or those who have hyperthyroidism that leads to enlargement of the thyroid gland with significant compression of the trachea and surrounding tissue structures, should choose surgical treatment instead of iodine 131 treatment. Thirdly, the misconceptions that surgery is not recommended include the ease of recurrence after surgery and the high risk of surgery. But this happens for poor surgical conditions and hospital facilities and lack of thyroid surgeon specialists. Conversely, is iodine 131 safe? Therefore, as far as experienced thyroid surgeons or general surgeons are concerned, surgery for hyperthyroidism is safe, and its postoperative recurrence rate is much lower than that in the literature or rumors, and intraoperative and postoperative complications are controllable, especially the complications such as hyperthyroid crisis, which are feared, can be almost controlled in a completely safe state. If, under today’s social conditions, there is still any hospital that causes complications of hyperthyroidism crisis for hyperthyroidism surgery, especially if it leads to life-threatening conditions as a result, it can only be said that this hospital or this medical team has not strictly implemented the surgical specifications for hyperthyroidism! Fourthly, do not ignore that iodine 131 is one of the nuclear treatment methods, and nuclear is radioactive and harmful. For one patient, ten or even a hundred or a thousand patients, that little radiation dose does not cause any harm to the patient, to others or to society! However, if every nuclear medicine department in so many hospitals in China treats most of the hyperthyroidism patients with iodine 131, for example, about 30% or even more, I am afraid that it should attract the attention of experts and scholars in this field, and the corresponding government authorities should also pay attention to it. Don’t simply say how short the half-life of iodine 131 is and how it will not cause big contamination, etc. without detailed and long-term proofs of so-called authoritative views. Fifth, because I am not engaged in nuclear medicine treatment and research, some of my views may not be correct, but I hope that: seniors, teachers and experts who are engaged in nuclear medicine business will pay attention to the hyperthyroidism patients you have treated, and engage in long-term follow-up observation of those patients and the surrounding people after iodine 131 treatment, instead of concluding after a short follow-up of 1 month, several months, 6 months, 1 year, etc. that “It’s safe, it’s fine”, “My patients are fine”, and so on, which are not very respectful of the objective long-term observation indicators. Because, these conclusions are really hard for me to believe and for the general public to believe! I would like to take this opportunity to remind patients and their families to be careful in choosing Iodine 131 for hyperthyroidism, not because it does not work, but only if other relatively safe and effective treatments do not work or cannot be performed. For example, if methimazole or propylthiouracil is ineffective or causes serious side effects, or if thyroid ultrasound indicates no indication for surgery or if surgery is contraindicated, then this method should be considered.