Thyroid aur menopause

Thyroid gardan ke saamne wale hisse mein titli ki shakal ka aik chhota sa ghadood hai. British Thyroid Foundation, jo Bartania mein thyroid ki beemari wale logon ka khairati idara hai, batati hai ke yeh do hormone banata hai, thyroxine (T4) aur tri-iodothyronine (T3), jo tay karte hain ke jism ke khaliye kitni tezi se kaam karein, aur yeh ke dimagh ke neeche wale aik ghadood (pituitary gland) ka hormone, TSH, ise batata hai ke kitna banana hai. EMAS, yani European Menopause and Andropause Society, kehti hai ke yeh hormone jism ke metabolism mein aham kirdaar ada karte hain.

Yeh do taraf se bigar sakta hai. Thyroid ka kam kaam karna (hypothyroidism), yani hormone bohat kam banana, jism ko sust kar deta hai. Thyroid ka zyada kaam karna (hyperthyroidism), yani bohat zyada banana, ise tez kar deta hai. EMAS ne 2024 mein is par aik mauqif shaya kiya ke thyroid ki beemari aur menopause aapas mein kaise milte hain. Woh kehti hai ke bachche paida karne ki umar ke aakhri saalon mein auraton mein thyroid ki beemari aam hai, taqreeban usi waqt jab perimenopause (mahwari band hone ke aas paas ka waqt) shuru hota hai.

NICE ya NHS ki menopause ki koi hidayat in donon ko aapas mein nahin jortin, aur NHS ke thyroid wale safhon par menopause ka zikr nahin. Yahan sab se bare hawale EMAS ka mauqif aur British Thyroid Foundation ke thyroid aur menopause wale safhe hain.

NHS ki website thyroid ke kam kaam karne ki yeh alamaat batati hai. Inhein perimenopause ki alamaat ki fehrist ke saath rakh kar parhein:

• Bohat thaka hua mehsoos karna (thakawat)
• Aam se zyada sardi lagna
• Wazan barhna
• Qabz
• Tawajjo jamane ya saaf sochne mein mushkil
• Udaasi ya depression
• Jild ki khushki, baalon ka khushk hona ya baal girna
• Awaaz baith jana
• Beqaida ya bhaari mahwari

Thyroid ke zyada kaam karne ki apni fehrist hai, aur is ka kuch hissa hot flush jaisa lagta hai. British Thyroid Foundation thakawat, paseena, garmi bardasht na hona, wazan kam hona, neend ki kami, kapkapi aur dil ka tez ya zor se dharakna (dil ki dharkan tez hona) ginwati hai. Graves' disease mein aankhon mein ret si chubhti mehsoos ho sakti hai aur un mein dard ho sakta hai.

EMAS in alamaat mein, jo menopause aur thyroid ki beemari mein mil sakti hain, joron aur patthon mein dard, bechaini, zyada paseena, neend ke masle aur jinsi khwahish mein kami bhi jorti hai.

Donon aik doosre ko aur mushkil bana sakte hain. British Thyroid Foundation kehti hai ke thyroid ka kam kaam karna aur menopause mil kar aurat par alamaat ka bojh barha dete hain, isi liye woh chahti hai ke donon ka achhi tarah khayal rakha jaye.

EMAS batati hai ke kisi khaas nishani ke baghair, jaise gardan mein soojan ya aankhon ke aas paas tabdeeli, alamaat ko aik beemari ke khaate mein daalna aur doosri ke nahin, mushkil hai, aur isi se tashkhees mein der hoti hai. Is ka jawab yeh hai ke doctor menopause ki umar ki aisi alamaat wali aurat mein thyroid ke hormone aasaani se check kar lein. British Thyroid Foundation yahi baat doosri taraf se kehti hai: thyroid aur menopause ki alamaat aam hain, saaf pata nahin chaltin aur aapas mein milti julti hain, aur aik ko doosri ke khaate mein daal dena koi anokhi baat nahin.

NHS ki website kehti hai ke thyroid ke kam kaam karne ki sab se aam wajah, Hashimoto's disease, auraton mein sab se zyada hoti hai aur aam taur par 30 se 50 saal ki umar ke beech shuru hoti hai. British Thyroid Foundation kehti hai ke Bartania mein doosri aam wajah thyroid ke zyada kaam karne ya thyroid ke cancer ke ilaaj ka baad ka asar hai. Thyroid ka zyada kaam karna zyada tar Graves' disease se hota hai, jo aik aur autoimmune beemari hai, yani jis mein jism ka difai nizam apne hi jism par hamla karta hai, ya aik ya zyada be zarar giltiyon (nodules) se jo bohat zyada hormone banane lagti hain. Foundation ke 2023 ke webinar mein us ke mahireen ne kaha ke Graves' disease sab se zyada 30 se 60 saal ki umar ke beech hoti hai, mardon ke muqable mein auraton mein kahin zyada, aur jinhein yeh hoti hai un mein se taqreeban aadhe batate hain ke un ke khandan mein yeh pehle se hai.

• Khoon ka test. NHS ki website kehti hai ke thyroid ke kam kaam karne ki tashkhees khoon ke aise test se hoti hai jo TSH aur thyroxine naapta hai. Menopause ke baare mein khoon ke test kya bata sakte hain aur kya nahin, is ke liye kya menopause ka koi test hai? dekhein.
• Agar pehla test borderline ho to doosra test. British Thyroid Foundation kehti hai ke ab test zyada hote hain, is liye borderline, yani normal ki had ke bilkul qareeb, nateeje aam hain, aur kisi aur wajah se tabiyat kharab ho to aik baar ka nateeja bigar sakta hai, is liye doctor aam taur par test dobara karwata hai. Doosri baar nateeja normal aaye to thyroid ke wajah hone ka imkaan kam hai. Jo nateeja borderline hi rahe ya kharab hota jaye, woh subclinical hypothyroidism ho sakta hai, yani thyroid ki halki kami, jis se hamesha alamaat nahin hotin aur jo aage chal kar thyroid ka kam kaam karna ban sakti hai. Gardan mein soojan ho to scan ki zaroorat par sakti hai.
• Waqt se pehle menopause ke baad aik check. Agar aap ko ande dani ka waqt se pehle kaam chhor dena (premature ovarian insufficiency) ho, to British Thyroid Foundation kehti hai ke yeh autoimmune thyroid ki beemari se jura hai, jin auraton ko yeh ho un mein se 14 se 27% ko thyroid ke masle hote hain, aur jab yeh pata chale to un ka thyroid antibodies aur TSH ka test hona chahiye.
• Doctor ko supplements ke baare mein batana. EMAS likhti hai ke darmiyani umar mein auratein baalon aur jild ke liye jo supplements leti hain, un mein se bohat son mein biotin hota hai, jo thyroid ke kuch khoon ke test ka ghalat nateeja de sakta hai, aur doctoron se kehti hai ke aurat jo bhi dawa leti ho, dukaan se li hui bhi, us ke baare mein poochein. Agar aap biotin leti hain to test se pehle doctor ya laboratory ko bata dein.
• Neend. British Menopause Society ki neend ki hidayat doctoron se kehti hain ke jab aurat ki neend kharab ho to thyroid ki beemari ko bhi zehan mein rakhein, aur shak ho to test karein. Neend ki kami dekhein.
• Ilaaj shuru hone ke baad har saal aik check. British Thyroid Foundation kehti hai ke saal mein aik baar khoon ka test mamool hai, aur is se pata chalta hai ke dose badalne ki zaroorat hai ya nahin. Woh yeh bhi kehti hai ke menopause ke dauran, badalte estrogen aur wazan ke saath, aurat ko jitni dose chahiye woh badal sakti hai.

British Thyroid Foundation kehti hai ke thyroid ke kam kaam karne ki dekh bhaal aam taur par GP karta hai, aur zyada kaam karne ki, kam az kam shuru mein, thyroid ka mahir (endocrinologist). NHS ki website kehti hai ke thyroid ke kam kaam karne ka ilaaj aam taur par un goliyon se hota hai jo kam parne wale hormone ki jagah leti hain, jinhein levothyroxine kehte hain, aur foundation kehti hai ke Bartania mein hormone ki kami poori karne ke liye levothyroxine hi tajweez ki jati hai. Nateeja borderline ho to, woh kehti hai, doctor yeh dekhne ke liye ilaaj aazma sakta hai ke alamaat behtar hoti hain ya nahin. Thyroid ke zyada kaam karne ke liye EMAS kehti hai ke ilaaj wajah par munhasir hai, aur foundation antithyroid dawaein, radioactive iodine aur operation ginwati hai.

Jo auratein thyroid ka ilaaj le rahi hain aur HRT (hormone ki dawa) ke baare mein soch rahi hain, un ke liye EMAS kehti hai ke thyroid ki beemari ke saath HRT aik mehfooz raasta hai, aur teen baatein mazeed kehti hai. Woh kehti hai ke HRT aur thyroid ki dawaon ke aapas mein takrao par koi maloomat saamne nahin aayin. Woh likhti hai ke munh se liya jane wala estrogen khoon mein thyroid hormone ko le kar chalne wale aik protein ko barha sakta hai, jis se test ke nateeje badal sakte hain aur levothyroxine ki dose badalni par sakti hai. Aur woh khabardar karti hai ke menopause ke baad thyroid ka zaroorat se zyada ilaaj patli haddiyon se jura hai, is liye dose aham hai.

British Thyroid Foundation kehti hai ke HRT menopause ki alamaat ka sab se moassar ilaaj hai, aur thyroid ka ilaaj HRT se rokne ki wajah nahin. Is ki tafseel is baare mein hai ke HRT kis tarah li jaye. HRT ki goliyon ke saath, jo aurat pehle se levothyroxine le rahi ho use zyada dose ki zaroorat par sakti hai, is liye woh tajweez karti hai ke shuru karne ke baad thyroid ke test dobara karwaye jayen. Jild ke zariye estrogen, yani gel, spray ya patch, se dose nahin badalni chahiye, aur HRT mein shamil progesterone se zyada farq parne ki tawaqqo nahin. Woh kehti hai ke jin auraton ko thyroid ka koi masla nahin, woh aam taur par HRT ke saath achhi tarah dhal jati hain.

Foundation ke 2023 ke webinar mein us ke aik mahir ko patch aur gel ke baare mein itna yaqeen nahin tha: saboot wazeh nahin, aur kuch is tarah jazb ho sakte hain ke levothyroxine par asar pare, jabke usi jagah lagane wala estrogen (vaginal estrogen) itna jazb ho ke farq pare, is ka imkaan kam hai. Usi mahir ka mashwara tha ke agar aap levothyroxine le rahi hain, ab tak theek thin, aur achanak tabiyat kharab lage, to thyroid ka test aik aasaan aur sasta check hai, aur dose mein chhoti si tabdeeli bara farq daal sakti hai.

Webinar mein thyroid ki beemari wali auraton ke liye aur baatein bhi huin:

• Thyroid ke cancer ke baad, mahireen ne kaha ke thyroid ka cancer ho chuka ho to bhi HRT ka raasta band nahin hota, ke HRT shuru hone par levothyroxine ki dose badalni par sakti hai, aur estrogen ke thyroid ke cancer ko barhane ka saboot adhoora aur ghair wazeh hai.
• Operation se hone wale menopause ke baad alamaat aksar shadeed hoti hain, aur unhon ne kaha ke aam taur par hormone ka ilaaj diya jata hai, aur jin auraton ki ande daniyan nikali gayi hon un mein testosterone zyada madad karta dikhayi deta hai. HRT shuru hone ke baad thyroxine ki dose ko aksar thora theek karna parta hai. Foundation ke sawal jawab mazeed kehte hain ke khoon mein normal satah par testosterone se thyroid ki dawa par asar nahin parna chahiye.
• Wazan ke baare mein unhon ne kaha ke wazan kam karna har kisi ke liye mushkil hai, aur jis aurat ka TSH barh gaya ho, shayad HRT shuru karne ke baad, ho sakta hai woh levothyroxine ki sahi dose par na ho. Unhon ne kaha ke dose theek ho jaye to us ke liye wazan kam karna kisi aur se zyada mushkil nahin hona chahiye.
• Aam taur par HRT ke baare mein unhon ne kaha ke is ka asal maqsad menopause ki alamaat ka ilaaj hai, ke is ki koi waqt ki had nahin, ke is par koi bain-ul-aqwami ittefaq nahin ke yeh dementia se bachati hai, aur tehqeeq donon taraf ishara karti hai, aur yeh ke qudrati menopause ke baad osteoporosis (haddiyan kamzor hona) se bachao ke liye is ki sifarish nahin ki jati. Bohat jaldi menopause, yani 40 se pehle, mein woh haddiyon aur dil ki hifazat ke liye is ki sifarish karte hain. Unhon ne kaha ke 60 se kam umar mein HRT aam taur par mehfooz tareeqe se li ja sakti hai, aur 65 saal ki jis aurat ko ab bhi alamaat hon, us ke liye ise aazma kar dekhne ka raasta band nahin.
• Selenium ke baare mein unhon ne kaha ke is se thyroid ki antibodies ki satah kam ho sakti hai, magar tehqeeqi tajurbaat mein yeh saabit nahin hua ke is se thyroid ka kaam ya alamaat behtar hoti hain. Is ka saboot zyada tar thyroid eye disease, yani thyroid se aankhon ki beemari, mein hai.

British Thyroid Foundation menopause ki alamaat ke liye mila kar banaye gaye, baghair license wale hormone (compounded HRT) ki sifarish nahin karti. Woh kehti hai ke yeh kitne mehfooz aur moassar hain, yeh abhi wazeh nahin, yeh doosri dawaon se takra sakte hain, aur in ke saath andaam nihani se zyada khoon aane aur bachedani ke cancer ki khabrein hain. Bioidentical hormone dekhein.

Goli ke saath jo kuch andar jata hai, woh bhi aham hai. British Thyroid Foundation kehti hai ke thyroid ki goliyan khaali pait lena behtar hai, ke bohat jaldi baad liya gaya khana, doodh, chai aur coffee rukawat daalte hain, aur yeh ke saath hi liya gaya calcium carbonate ka supplement thyroxine ke jazb hone ko taqreeban aik tihai kam kar sakta hai. Woh donon ke liye waqfe ka mashwara deti hai. Kitna waqfa, yeh apne pharmacist se poochein.

• Soya. British Thyroid Foundation kehti hai ke soya wale khane thyroxine ke jazb hone ko kam kar sakte hain aur zaroorat ki dose barha sakte hain, agarche is ka kam hi saboot hai ke yeh theek kaam karne wale thyroid par asar daalte hain. Jis ke thyroid ki satah borderline ho aur jism mein iodine kam ho, us mein soya thyroid ke kam kaam karne ka khatra barha sakta hai. Phytoestrogen dekhein.
• Iodine. British Thyroid Foundation kehti hai ke iodine ki zyadati thyroid ki beemari ko bigar sakti hai. Woh zyada miqdaar wale iodine supplements aur kelp, yani samandari ghaas, se bachne ka mashwara deti hai, jin mein iodine ki miqdaar bohat mukhtalif hoti hai, aur batati hai ke menopause ke kuch supplements mein iodine ki miqdaar bohat zyada hoti hai. Koi bhi jari booti wali ya koi aur dawa shuru karne se pehle woh mashwara deti hai ke doctor ya pharmacist se pooch lein ke is ka aap ke thyroid par kya asar ho sakta hai, aur apni dawa ke saath aane wale parche mein takrao ke baare mein dekh lein. Supplements dekhein.
• Haddiyan. EMAS ki tanbeeh ke saath British Thyroid Foundation yeh bhi kehti hai: menopause ke baad thyroid ka zyada kaam karna kulhe ki haddi tootne ka khatra barhata hai, aur thyroid ka kam kaam karna, jis ka ilaaj zaroorat se zyada ho, bhi haddi tootne ka khatra barhata hai. Osteoporosis, yani haddiyan kamzor hona dekhein.

Agar thakawat, wazan ki tabdeeli, udaasi ya mahwari ki tabdeeliyan aap ko nidhaal kar rahi hain, to appointment lein aur apne thyroid aur perimenopause, donon ke baare mein poochein. Aap ko aik chunna zaroori nahin.

Agar aap ko pehle se thyroid ka masla hai aur chaalees ki dahai mein nayi alamaat aayin, to un ka zikr karein. EMAS kehti hai ke yeh donon aik saath chal sakte hain. Agar aap HRT ki goliyan shuru karein, ya levothyroxine lete hue achanak tabiyat kharab lage, to poochein ke kya thyroid check karne ki zaroorat hai.

Agar aap ki ammi ya koi behan thyroid ki goliyan leti hain to yeh batayen. EMAS kehti hai ke in donon mein se kisi bhi beemari ke ilaaj ka faisla aurat ke khandan ki beemariyon, us ki pasand aur is faisle mein us ke apne hisse ko saamne rakh kar ho.

Ramzan mein levothyroxine lene wali auratein aksar poochti hain ke sehri aur iftar ke aas paas ise kab lein, kyunke British Thyroid Foundation kehti hai ke yeh khaali pait, aur khane peene se pehle kuch waqfe ke saath, sab se achha kaam karti hai. Yeh sawal us se poochein jo dawa likhta hai, maheena shuru hone se pehle. Khud roze ke sawal kisi mustanad aalim se poochne ke hain.