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Thyroid Diseases: Treatment and Management

 

Thyroid Gland:

The thyroid is a butterfly-shaped gland located in the front of the neck just below the Adams apple. The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly formed by two wings (lobes) and attached by a middle part (isthmus). The thyroid gland works like a tiny factory that uses iodine (mostly from the diet in foods such as seafood and salt) to produce thyroid hormones. These hormones help to regulate the body's metabolism and effects processes, such as growth and other important functions of the body.

The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3), representing 99.9% and 0.1% of thyroid hormones respectively. The hormone with the most biological power is actually T3. Once released from the thyroid gland into the blood, a large amount of T4 is converted to T3 - the active hormone that affects the metabolism of cells throughout our body.

Thyroid Diseases:

The diseases that develop in the thyroid include:

  • Hypothyroidism
  • Goiter/Thyroid Nodules
  • Thyroid Cancer
  • Thyroiditis

 

Hypothyroidism:

Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain important hormones.

Women, especially those older than age 60, are more likely to have hypothyroidism. Hypothyroidism upsets the normal balance of chemical reactions in your body.

When the thyroid gland is underactive, improperly formed at birth, surgically removed all or in part, or becomes incapable of producing enough thyroid hormone, a person is said to be hypothyroid. One of the most common causes of hypothyroidism is the autoimmune disease called Hashimoto's disease, in which antibodies gradually target the thyroid and destroy its ability to produce thyroid hormone.

Causes of Hypothyroidism:

Hypothyroidism results when the thyroid gland fails to produce enough hormones. Hypothyroidism may be due to a number of factors, including:

  1. Autoimmune disease: People who develop a particular inflammatory disorder known as Hashimoto's thyroiditis suffer from the most common cause of hypothyroidism. Autoimmune disorders occur when your immune system produces antibodies that attack your own tissues.  These antibodies affect the thyroid's ability to produce hormones.
  2. Treatment for hyperthyroidism: People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications to reduce and normalize their thyroid function. However, in some cases, treatment of hyperthyroidism can result in permanent hypothyroidism.
  3. Thyroid surgery: Removing all or a large portion of your thyroid gland can diminish or halt hormone production.
  4. Radiation therapy: Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to hypothyroidism.
  5. Medications: A number of medications can contribute to hypothyroidism. One such medication is lithium, which is used to treat certain psychiatric disorders.
  6. Congenital disease: Some babies are born with a defective thyroid gland or no thyroid gland. In most cases, the thyroid gland didn't develop normally for unknown reasons, but some children have an inherited form of the disorder. Often, infants with congenital hypothyroidism appear normal at birth.
  7. Pituitary disorder: A relatively rare cause of hypothyroidism is the failure of the pituitary gland to produce enough thyroid-stimulating hormone (TSH) — usually because of a benign tumor of the pituitary gland.
  8. Pregnancy: Some women develop hypothyroidism during or after pregnancy (postpartum hypothyroidism), often because they produce antibodies to their own thyroid gland. Left untreated, hypothyroidism increases the risk of miscarriage, premature delivery and preeclampsia — a condition that causes a significant rise in a woman's blood pressure during the last three months of pregnancy. It can also seriously affect the developing fetus.
  9. Iodine deficiency: The trace mineral iodine — found primarily in seafood, seaweed, plants grown in iodine-rich soil and iodized salt — is essential for the production of thyroid hormones. Conversely, taking in too much iodine can cause hypothyroidism.

Symptoms of Hypothyroidism:

The signs and symptoms of hypothyroidism vary, depending on the severity of the hormone deficiency. But in general, any problems you have tend to develop slowly, often over a number of years. Hypothyroidism signs and symptom may include:

  • Fatigue
  • Increased sensitivity to cold
  • Constipation
  • Dry skin
  • Unexplained weight gain
  • Puffy face
  • Hoarseness
  • Muscle weakness
  • Elevated blood cholesterol level
  • Muscle aches, tenderness and stiffness
  • Pain, stiffness or swelling in your joints
  • Heavier than normal or irregular menstrual periods
  • Thinning hair
  • Slowed heart rate
  • Depression
  • Anxiety
  • Impaired memory

Tests and Diagnosis of Hypothyroidism:

Blood tests for Hypothyroidism:

Diagnosis of hypothyroidism is based on your symptoms and the results of blood tests that measure the level of TSH and sometimes the level of the thyroid hormone thyroxine. A low level of thyroxine and high level of TSH indicate an underactive thyroid. That's because your pituitary produces more TSH in an effort to stimulate your thyroid gland into producing more thyroid hormone.

Homeopathic Treatment of Hypothyroidism:

Hypothyroidism can be completely cured by homeopathic treatment. There are several medicines which are being used to treat and manage hypothyroidism i.e. calcarea carb, natrum mur, thyroidinum, digitalis, calc iod, iodum, bromium, bryonia etc.

Allopathic treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levothroid, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism but can not cure the sickness.

 

Hyperthyroidism:

Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxin. Hyperthyroidism can accelerate your body's metabolism significantly, causing sudden weight loss, a rapid or irregular heartbeat, sweating, and nervousness or irritability.

When the thyroid gland becomes overactive and produces too much thyroid hormone, a person is said to be hyperthyroid. The most common cause of hyperthyroidism is the autoimmune condition known as Graves' disease, where antibodies target the gland and cause it to speed up hormone production.

Causes of Hyperthyroidism:

A number of conditions, including Graves' disease, toxic adenoma, Plummer's disease (toxic multinodular goiter) and thyroiditis, can cause hyperthyroidism.

Reasons for too much thyroxin (T-4):

Normally, your thyroid releases the right amount of hormones, but sometimes it produces too much T-4. This may occur for a number of reasons, including:

  1. Graves' disease: Graves' disease, an autoimmune disorder in which antibodies produced by your immune system stimulate your thyroid to produce too much T-4, is the most common cause of hyperthyroidism. Normally, your immune system uses antibodies to help protect against viruses, bacteria and other foreign substances that invade your body. In Graves' disease, antibodies mistakenly attack your thyroid and occasionally attack the tissue behind your eyes (Graves' ophthalmopathy) and the skin, often in your lower legs over the shins (Graves' dermopathy).
  2. Hyper functioning thyroid nodules (toxic adenoma, toxic multinodular goiter, Plummer's disease): This form of hyperthyroidism occurs when one or more adenomas of your thyroid produce too much T-4. An adenoma is a part of the gland that has walled itself off from the rest of the gland, forming noncancerous (benign) lumps that may cause an enlargement of the thyroid.
  3. Thyroiditis: Sometimes your thyroid gland can become inflamed for unknown reasons. The inflammation can cause excess thyroid hormone stored in the gland to leak into your bloodstream. One rare type of thyroiditis, known as subacute thyroiditis, causes pain in the thyroid gland. Other types are painless and may sometimes occur after pregnancy (postpartum thyroiditis).

Symptoms of Hyperthyroidism:

Hyperthyroidism can mimic other health problems, which may make it difficult for your doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:

  • Sudden weight loss, even when your appetite and the amount and type of food you eat remain the same or even increase
  • Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute — irregular heartbeat (arrhythmia) or pounding of your heart (palpitations)
  • Increased appetite
  • Nervousness, anxiety and irritability
  • Tremor — usually a fine trembling in your hands and fingers
  • Sweating
  • Changes in menstrual patterns
  • Increased sensitivity to heat
  • Changes in bowel patterns, especially more frequent bowel movements
  • An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
  • Fatigue, muscle weakness
  • Difficulty sleeping
  • Skin thinning
  • Fine, brittle hair

Tests and Diagnosis of Hyperthyroidism:

Hyperthyroidism is diagnosed using:

Medical history and physical exam: During the exam your doctor may try to detect a slight tremor in your fingers when they're extended, overactive reflexes, eye changes and warm, moist skin. Your doctor will also examine your thyroid gland as you swallow.

 

Blood tests: A diagnosis can be confirmed with blood tests that measure the levels of thyroxine and TSH in your blood. High levels of thyroxin and low or nonexistent amounts of TSH indicate an overactive thyroid. The amount of TSH is important because it's the hormone that signals your thyroid gland to produce more thyroxin. These tests are particularly necessary for older adults, who may not have classic symptoms of hyperthyroidism.

Treatment of Hyperthyroidism:

Several treatments for hyperthyroidism exist. The best approach for you depends on your age, physical condition and the severity of your disorder:

Homeopathic Treatment of Hyperthyroidism:

Hyperthyroidism can be successfully cured by homeopathic treatment. the frequentally prescribed medicines are iodum, thyroidinum, spongia, carcinosin, bromium etc.

Radioactive iodine: Taken by mouth, radioactive iodine is absorbed by your thyroid gland, where it causes the gland to shrink and symptoms to subside, usually within three to six months. Because this treatment causes thyroid activity to slow considerably, causing the thyroid gland to be underactive (hypothyroidism), you may eventually need to take medication every day to replace thyroxine. Used for more than 60 years to treat hyperthyroidism, radioactive iodine has been shown to be generally safe.

Anti-thyroid medications: These medications gradually reduce symptoms of hyperthyroidism by preventing your thyroid gland from producing excess amounts of hormones. They include propylthiouracil and methimazole (Tapazole). Symptoms usually begin to improve in six to 12 weeks, but treatment with anti-thyroid medications typically continues at least a year and often longer

Beta blockers: These drugs are commonly used to treat high blood pressure. They won't reduce your thyroid levels, but they can reduce a rapid heart rate and help prevent palpitations.

Surgery (thyroidectomy): If you're pregnant or otherwise can't tolerate anti-thyroid drugs and don't want to or can't have radioactive iodine therapy, you may be a candidate for thyroid surgery, although this is an option in only a few cases. In a thyroidectomy, your doctor removes most of your thyroid gland.

 

Goiter:

Sometimes the thyroid becomes enlarged -- due to Hashimoto's disease, Graves' disease, nutritional deficiencies, or other thyroid imbalances. When the thyroid becomes enlarged, this is known as a goiter.

Some people develop solid or liquid filled cysts, lumps, bumps and tumors both benign and cancerous in the thyroid gland. These are known as thyroid nodules.

A number of factors can cause your thyroid gland to enlarge. Among the most common are:

  1. Iodine deficiency: Iodine, which is essential for the production of thyroid hormones, is found primarily in seawater and in the soil in coastal areas. In the developing world, people who live inland or at high elevations are often iodine-deficient and can develop goiter when the thyroid enlarges in an effort to obtain more iodine. The initial iodine deficiency may be made even worse by a diet high in hormone-inhibiting foods, such as cabbage, broccoli and cauliflower. Although a lack of dietary iodine is the main cause of goiter in many parts of the world, this is not the case in countries where iodine is routinely added to table salt and other foods.
  2. Graves' disease: Goiter can sometimes occur when your thyroid gland produces too much thyroid hormone (hyperthyroidism). In Graves' disease, antibodies produced by your immune system mistakenly attack your thyroid gland, causing it to produce excess thyroxine. This overstimulation causes the thyroid to swell.
  3. Hashimoto's disease: Goiter can also result from an underactive thyroid (hypothyroidism). Like Graves' disease, Hashimoto's disease is an autoimmune disorder. But instead of causing your thyroid to produce too much hormone, Hashimoto's damages your thyroid so that it produces too little. Sensing a low hormone level, your pituitary gland produces more TSH to stimulate the thyroid, which then causes the gland to enlarge.
  4. Multinodular goiter: In this condition, several solid or fluid-filled lumps called nodules develop in both sides of your thyroid, resulting in overall enlargement of the gland.
  5. Solitary thyroid nodules: In this case, a single nodule develops in one part of your thyroid gland. Most nodules are noncancerous (benign) and don't lead to cancer.
  6. Thyroid cancer: Thyroid cancer is far less common than benign thyroid nodules. Cancer of the thyroid often appears as an enlargement on one side of the thyroid.
  7. Pregnancy: A hormone produced during pregnancy, human chorionic gonadotropin (HCG), may cause your thyroid gland to enlarge slightly.
  8. Inflammation: Thyroiditis is an inflammatory condition that can cause pain and swelling in the thyroid.

Signs and Symptoms of Goiter:

Some patients may have goiter and not know it because they have no symptoms.

The main symptom for a person with goiter is swelling of the thyroid gland. This may eventually become a noticeable lump in the throat. The patient may be more aware of it - a visible swelling at the base of the neck - when looking in the mirror and shaving or putting on makeup.

There are two types of Goiter:

  • Diffuse small goiter - the whole thyroid gland swells. When touched it feels smooth.
  • Certain parts of the thyroid gland - nodules - swell. The gland may feel lumpy when touched.

The following symptoms may also exist when a person has goiter:

  • Hoarseness (voice)
  • Coughing more frequently than usual
  • A feeling of tightness in the throat
  • Swallowing difficulties (less common)
  • Breathing difficulties (less common)

 

Tests and Diagnosis of Goiter:

Diagnosing goiter may also involve:

A hormone test: Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands. If your thyroid is underactive, the level of thyroid hormone will be low. At the same time, the level of thyroid-stimulating hormone (TSH) will be elevated because your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone. Goiter associated with an overactive thyroid usually involves a high level of thyroid hormone in the blood and a lower than normal TSH level.

An antibody test: Some causes of goiter involve production of abnormal antibodies. A blood test may confirm the presence of these antibodies.

Ultrasonography: A wand-like device (transducer) is held over your neck. Sound waves bounce through your neck and back, forming images on a computer screen. The images reveal the size of your thyroid gland and whether the gland contains nodules that your doctor may not have been able to feel.

A thyroid scan: During a thyroid scan, you'll have a radioactive isotope injected into the vein on the inside of your elbow. You then lie on a table with your head stretched backward while a special camera produces an image of your thyroid on a computer screen. The time needed for the procedure may vary, depending on how long it takes the isotope to reach your thyroid gland. Thyroid scans provide information about the nature and size of your thyroid, but they're more invasive, time-consuming and expensive than are ultrasound tests.

A biopsy: During a fine-needle aspiration biopsy, ultrasound is used to guide a needle into your thyroid to obtain a tissue or fluid sample for testing.

Homeopathic Treatment of Goiter: Homeopathy is very effective in the treatment of goiter. Frequentlly indicated medicines are iodum, bromium, calc flour, thyroidinum.

Allopathic Treatment for Goitre: If you have hypothyroidism, thyroid hormone replacement with levothyroxine (Levothroid, Synthroid) will resolve the symptoms of hypothyroidism as well as slow the release of thyroid-stimulating hormone from your pituitary gland, often decreasing the size of the goiter. For goiters associated with hyperthyroidism, you may need medications to normalize hormone levels.

 

Surgery for Goiter: Removing all or part of your thyroid gland (total or partial thyroidectomy) is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing, or in some cases, if you have nodular goiter causing hyperthyroidism.

Radioactive iodine Treatment for Goiter: In some cases, radioactive iodine is used to treat an overactive thyroid gland. The radioactive iodine is taken orally and reaches your thyroid gland through your bloodstream, destroying thyroid cells. The treatment results in diminished size of the goiter, but eventually may also cause an underactive thyroid gland. Hormone replacement with the synthetic thyroid hormone levothyroxine then becomes necessary, usually for life.

 

Thyroiditis:


When the thyroid becomes inflamed, due to bacterial or viral illness, this is known as thyroiditis.

Causes of Thyroiditis:

Thyroiditis is generally caused by an attack on the thyroid, resulting in inflammation and damage to the thyroid cells. This disease is often considered a malfunction of the immune system. Antibodies that attack the thyroid are what causes most types of thyroiditis. It can also be caused by an infection, like a virus or bacteria, which works in the same way as antibodies to cause inflammation in the glands. Some drugs, such as interferon and amiodarone, can also cause thyroiditis because they have a tendency to damage thyroid cells.

Symptoms of Thyroiditis:

Symptoms are usually mild and may include:

  • Fatigue
  • Frequent bowel movements
  • Heat intolerance
  • Increased appetite
  • Increased sweating
  • Irregular menstrual periods
  • Irritability
  • Muscle cramps
  • Nervousness, restlessness
  • Palpitations
  • Weakness
  • Weight loss

Types of thyroiditis:

Hashimoto’s thyroiditis –Patients usually present with hypothyroidism, which is usually permanent.

Painless and post-partum thyroiditis – These disorders are similar and follow the same general clinical course of thyrotoxicosis followed by hypothyroidism. The only real difference between them is that post-partum thyroiditis occurs after the delivery of a baby while painless thyroiditis occurs in men and in women not related to a pregnancy. Not all patients demonstrate evidence of going through both phases; approximately 1/3 of patients will manifest both phases, while 1/3 of patients will have only a thyrotoxic or hypothyroid phase. The thyrotoxic phase lasts for 1-3 months and is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. The hypothyroid phase typically occurs 1-3 months after the thyrotoxic phase and may last up to 9 – 12 months. Typical symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance

Subacute thyroiditis – Subacute thyroiditis follows the same clinical course as painless and post-partum thyroiditis, but is often accompanied by thyroidal pain. The thyroidal pain in patients with subacute thyroiditis usually follows the same time-frame of the thyrotoxic phase (1-3 months). However, not all patients with thyroidal pain necessarily have thyrotoxicosis.

Drug-induced and radiation thyroiditis – Both thyrotoxicosis and hypothyroidism may be seen in these disorders. The thyrotoxicosis is usually short-lived. Drug-induced hypothyroidism often resolves with the cessation of the drug, while the hypothyroidism related to radiation thyroiditis is usually permanent.

Acute Infectious thyroiditis – Symptoms may include thyroidal pain, systemic illness, painless enlargement of the thyroid and hypothyroidism. The symptoms usually resolve once the infection resolves.

Treatment of Thyroiditis:

Treatment depends on the type of thyroiditis and the clinical presentation.

Thyrotoxicosis – Beta blockers to decrease palpitations and reduce shakes and tremors may be helpful. As symptoms improve, the medication is tapered off since the thyrotoxic phase is temporary.

Hypothyroidism – Treatment is initiated with thyroid hormone replacement for hypothyroidism due to Hashimoto’s thyroiditis (see Thyroid Hormone Treatment brochure). In patients who are symptomatic with the hypothyroid phase of subacute, painless and post-partum thyroiditis, thyroid hormone therapy is also indicated. If the hypothyroidism in these latter disorders is mild and the patient has few, if any, symptoms, then no therapy may be necessary.

Thyroidal pain – The pain associated with subacute thyroiditis usually can be managed with mild anti-inflamatory medications such as aspirin or ibuprofen. Occasionally, the pain can be severe and require steroid therapy with prednisone.

 

Thyroid Cancer:

Thyroid cancer is a malignant neoplasm originating from follicular or parafollicular thyroid cells.

Causes of Thyroid Cancer

It's not clear what causes thyroid cancer. Thyroid cancer occurs when cells in your thyroid undergo genetic changes (mutations). The mutations allow the cells to grow and multiply rapidly. The cells also lose the ability to die, as normal cells would. The accumulating abnormal thyroid cells form a tumor. The abnormal cells can invade nearby tissue and can spread throughout the body.

Symptoms of Thyroid Cancer:

Thyroid cancer typically doesn't cause any signs or symptoms early in the disease. As thyroid cancer grows, it may cause:

  • A lump that can be felt through the skin on your neck
  • Changes to your voice, including increasing hoarseness
  • Difficulty swallowing
  • Pain in your neck and throat
  • Swollen lymph nodes in your neck

Types of Thyroid Cancer:

The type of thyroid cancer determines treatment and prognosis. Types of thyroid cancer include:

  • Papillary thyroid cancer:The papillary type of thyroid cancer is the most common, making up about 80 percent of all thyroid cancer diagnoses.
  • Follicular thyroid cancer: Follicular thyroid cancer also includes Hurthle cell cancer.
  • Medullary thyroid cancer: Medullary thyroid cancer may be associated with inherited genetic syndromes that include tumors in other glands. However, most medullary thyroid cancers are sporadic, meaning they aren't associated with inherited genetic syndromes.
  • Anaplastic thyroid cancer:The anaplastic type of thyroid cancer is very rare, aggressive and very difficult to treat.
  • Thyroid lymphoma: Thyroid lymphoma begins in the immune system cells in the thyroid. Thyroid lymphoma is very rare.

Treatment of Thyroid Cancer:

Your thyroid cancer treatment options depend on the type and stage of your thyroid cancer

Surgery of Thyroid Cancer:

Most people with thyroid cancer undergo surgery to remove all or most of the thyroid. Operations used to treat thyroid cancer include:

  • Removing all or most of the thyroid (thyroidectomy):Surgery to remove the entire thyroid is the most common treatment for thyroid cancer. In most cases, the surgeon leaves small rims of thyroid tissue around the parathyroid glands to reduce the risk of parathyroid damage.
  • Removing lymph nodes in the neck: When removing your thyroid, the surgeon may also remove enlarged lymph nodes from your neck and test them for cancer cells.

Thyroid hormone therapy:

After thyroid cancer surgery, you'll take the thyroid hormone medication levothyroxine (Levothroid, Synthroid, others) for life. This pill has two benefits: It supplies the missing hormone your thyroid would normally produce, and it suppresses the production of thyroid-stimulating hormone (TSH) from your pituitary gland. High TSH levels could conceivably stimulate any remaining cancer cells to grow.

Radioactive iodine Therapy:

Radioactive iodine treatment uses large doses of a form of iodine that's radioactive. Radioactive iodine treatment is often used after thyroidectomy to destroy any remaining healthy thyroid tissue, as well as microscopic areas of thyroid cancer that weren't removed during surgery. Radioactive iodine treatment may also be used to treat thyroid cancer that recurs after treatment or that spreads to other areas of the body.

External radiation therapy:

Radiation therapy can also be given externally using a machine that aims high-energy beams at precise points on your body. Called external beam radiation therapy, this treatment is typically administered a few minutes at a time, five days a week, for about six weeks. During treatment, you lie still on a table while a machine moves around you. External radiation therapy is generally used to treat thyroid cancer that has spread to the bones.

Chemotherapy for Thyroid Cancer:

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is typically given as an infusion through a vein. The chemicals travel throughout your body, killing quickly growing cells, including cancer cells.

Chemotherapy is not commonly used in the treatment of thyroid cancer, but it may benefit some people who don't respond to other, more standard therapies.

Homeopathic Treatment of Thyroid Diseases:

Homeopathy considers a disease to be the result from emotional distress and frustration, which blocks the life force energy into various different organs or glands. Homeopathy considers thyroid problem as one such autoimmune glandular dysfunction. Homeopathy offers better chances of a cure since the treatment is based on the person's individual constitution. Homeopathic treatment may be useful as a supportive therapy for regulating both "hyper" and "hypo" conditions of the thyroid. Conventional treatment of thyroid dysfunction relies mainly on drugs and surgery, whereas homeopathic treatment improves the function of the thyroid gland through natural means. Homeopathic remedies work by stimulating the body's own healing power. Homeopathic remedies stimulate the body to reactivate the hormone secretions, replenish and restore the thyroid tissue through the pituitary and other glands as a whole allowing the body to heal itself. Thus, homeopathic remedies will help boost your energy, improve circulation, and soothe metabolism by balancing “hyper” or “hypo” thyroid functions. To conclude, homeopathy heals by finding and curing the roots of the disease. It has a cleansing effect and stimulates thyroid activity by implementing a general regulating influence on the thyroid.

Subj: Homeopathic Treatment of Hyperthyroidism, Causes of Goiter, Signs and Symptoms of Goiter, Tests and Diagnosis of Goiter, Treatment of Goiter by homeopathy, Homeopathic Treatment of Goiter, Homeopathic Treatment of Thyroid Diseases Treatment of Hyperthyroidism, Hyperthyroidism, Causes of Hyperthyroidism, Causes of Hyperthyroidism, Symptoms of Hyperthyroidism, Tests and Diagnosis of Hyperthyroidism