The Internet of Things (IoT) is expanding rapidly across industries, such as manufacturing, smart cities, and healthcare, creating new challenges for existing security systems. Traditional cryptographic algorithms like Rivest-Shamir-Adleman (RSA) and Elliptic Curve Cryptography (ECC) are becoming vulnerable due to advances in Quantum Computing (QC), which can efficiently break their encryption. The fusion of QC with IoT, known as the Quantum Internet of Things (QIoT), promises not only stronger security but also faster decision-making and smarter automation. However, being a new and evolving paradigm, QIoT still faces critical challenges in practical security, scalability, and efficiency. This chapter explores the key challenges and opportunities in developing secure and efficient QIoT systems. It focuses on major frameworks such as the Blockchain-based Quantum IoT framework (QIoTChain), the reconfigurable cryptographic processor for low-energy IoT devices (Sapphire), the Quantum-Based Secure and Lightweight Transmission (QSLT), and the Dynamic On-Demand Key Allocation Scheme for Quantum Key Distribution Network (DDKA-QKDN). Each framework demonstrates distinct strategies for tackling issues like scalability, interoperability, and energy efficiency while enhancing quantum security and performance. Through this discussion, the chapter identifies existing gaps and outlines potential pathways to strengthen the practical deployment of QIoT systems across diverse real-world environments.