Introduction
Hyperthyroidism is due to excessive secretion of thyroxin, clinically marked by palpitation, excitation, anxiety, polyphagia, emaciation, aversion to heat and profuse sweating, dry mouth and excessive heat, accompanied by thyroid enlargement and exophthalmia. This disease is usually seen among women, especially among young women. It is similar to goiter and palpitation in TCM. Hyperthyroidism is usually caused by interior damage due to emotional changes; or by improper diet that leads to qi stagnation, blood stasis, fire stagnation and phlegm coagulation, the prolonged duration of which results in exuberant fire and consumes yin. This disease involves the heart, liver, spleen, stomach and kidney.

Syndrome differentiation
1. Liver Depression and Phlegm Coagulation
Restlessness and susceptibility to rage, insomnia and dreaminess, dryness and distension of eyes, distension and fullness of chest and hypochondria, exophthalmia, swelling of neck, tremor of hands and tongue, red tongue, yellow and greasy tongue fur, taut and slippery pulse.

2. Liver Fire and Stomach Heat
Polyphagia, thirst and polydipsia, emaciation, aversion to heat and profuse sweating, bitter taste in the mouth and dry throat, dizziness, red tongue, yellow tongue fur with scanty fluid, taut and rapid pulse.

3. Asthenia of Heart and Liver Yin
Palpitation, feverish palms, soles and chest, insomnia and dreaminess, dry throat and mouth, amnesia and susceptibility to fright, red tongue with scanty fur, thin and rapid pulse or slow pulse with irregular intervals and slow regular intermittent pulse.

Treatment
1. Body Acupuncture
Prescription: Naohui (TE 13), Renying (ST 9), Neiguan (PC 6), Shenmen (HT 7), Hegu (LI 4), Fenglong (ST 40), Sanyinjiao (SP 6) and Taichong (LR 3).

Modification: For liver stagnation and phlegm coagulation: Futu (ST 32), Tiantu (CV 22), Qimen (LR 14), Taiyuan (LU 9) and Taibai (SP 3) are added; for liver fire and stomach heat syndrome, Zusanli (ST 36), Neiting (ST 44), Yanglingquan (GB 34) and Qiuxu (GB 40) are added; for asthenia syndrome of heart and liver yin, Qishe (ST 11), Xinshu (BL 15), Ganshu (BL 18), Juque (CV 14), Fuliu (KI 7) and Zhaohai (KI 6) are added; for goiter, Tianding (LI 17), Tianrong (SI 17), Tianjing (TE 10), Qiying [equivalent to Shuitu (ST 10) ] and Pingying [ 0.5 cun lateral to the median line joining 3 - 5 Jiaji (EX-B2)] are added; for severe goiter, local tumescent mass can be needled; for exophthalmia, Fengchi (GB 20), Shangtianzhu [ 0.5 cun above Tianzhu (BL 10) ], Cuanzhu (BL 2), Yangbai (GB 14) and Sizhukong (TE 23) are added; for dryness and distension of eyes, Jingming (BL 1), Zhaohai (KI 6) and Yanglao (SI 6) are added.

Performance: Shallow needling, 0.5 - 0.8 cun, is used to needle acupoints on the neck, such as Futu (ST 32), Tiantu (CV 22), Tianding (LI 17) and Tianrong; for needling Qiying (Goiter Acupoint ), the needle is inserted 0.5 cun lateral to the vessel; for needling Pingying [Goiter-Eliminating Acupoint (CO13)], the needle is inserted 0.8 - 1 cun and the needling sensation is directed to the region below Adam's apple; for larger enlargement of thyroid, 1 - 2 acupoints on the tumescent mass are selected and the needles are inserted obliquely into the base of the tumescent mass and manipulated with rotating, lifting and thrusting techniques within small range.

2. Ear Acupuncture
Prescription: Ear Shenmen (TF4), Endocrine (CO18), Liver (CO12), Kidney (CO10), Spleen (CO13), Stomach (CO4), Subcortex (AT4) and Sympathetic Nerve (AH6a).

Performance: Each time 2 - 3 acupoints are selected and needled once a day. Or 2 - 3 acupoints are selected each time for embedment of needles. Or Wangbuliuxingzi (Semen Vaccariae) is used for ear acupressure. The patient is advised to press the embedment of needles or the sealed Semen Vaccariae several times a day.