Iningi labantu abane- hypothyroidism- noma i-thyroid engasebenzi-e-United States ngabesifazane. Abaningi balaba besifazane baneminyaka yobudala yokubeletha noma bangama- perimenopausal / menopausal . Lokhu kusho ukuthi ngenkathi bephathwa nge-hypothyroidism yabo, abanye babo baphinde bathathe imithi kadokotela njengamaphilisi okuvimbela ukubeletha noma ukuphathwa kwe-hormone yokwelashwa esikhundleni.
Ngokusho kocwaningo oluvela ku-Guttmacher Instutute, abesifazane abangaba yizigidi ezingu-10 + abaphakathi kweminyaka engu-15 no-44 basebenzisa iphilisi yokukhulelwa ekulawuleni ukuzalwa.
Kulinganiselwa ukuthi izilinganiso ezingu-57 kuya ku-75 zezimithi zokwelashwa ezithathelwanayo, eziningi zazo zihlanganisa uhlobo oluthile lwe-estrogen, zilotshwe e-United States. Abanye ochwepheshe balinganisela ukuthi abaningi abangamaphesenti angu-5 abo bonke abesifazane nabasemuva-besilisa abesilisa bayathatha kokubili ukwelapha okushintshwa kwe-hormone kanye nemithi yokwelapha i-hormone ye-thyroid.
Kubalulekile kunoma yiliphi owesifazane othatha izidakamizwa ze-hormone esikhundleni sokuphuza i-hypothyroidism-njenge-levothyroxine noma i-thyroid ekhishwa ngemvelo-ukuze aqaphele imiphumela yokuthi izidakamizwa ezine-estrogen zingaba ne-thyroid kanye nokwelashwa kwe-hypothyroidism. Ngokufanayo, kudingeka uqaphele ukuthi ngabe yini imithi ebizwa ngokuthi i-hormone substitution imithi ye-hypothyroidism ngemuva kokuba iphilisi yokukhulelwa equkethe i-estrogen, noma usuvele uthatha i-hormone yokwelashwa esikhundleni sokufaka noma yiluphi uhlobo lwe-estrogen.
Imiphumela ye-Estrogen kwi-Thyroid
Ukwanda kwe-estrogen kungaba umphumela wokukhulelwa, ezinye izakhi zofuzo, kanye nokusebenzisa imithi efana namaphilisi okuvimbela ukuvimbela noma i-hormone therapy esikhundleni. I-Estrogens ethathwa njengemithi ingaba ngesimo se-estrogen zokwenziwa njenge-ethinylestradiol, noma ama-bioidentical ama-estrogen njenge-estradiol, i-estriol, noma i-estrone.
I-Estradiol nayo yaziwa nangokuthi i-beta-estradiol engu-17.
Kungakhathaliseki ukuthi i-estrogen enyukayo eyenziwa ngumzimba wakho noma ithathwa njengemithi yomlomo, i-estrogen inamandla okukhulisa amazinga wakho we-thyroxine-binding globulin, eyaziwa njenge-TBG. I-TBG iyiprotheni ekhethekile eyaziwa ngokuthi "i-globulin." Indima ye-TGB ukuxhuma kuma-hormone ekhanda amabili ayisihluthulelo-thyroxine (T4) ne-triiodothyronine (T3) -circulating egazini lakho, nokusiza ukuthutha lawo mahomoni emasethini akho .
Uma i-TBG iphakanyisiwe, i-TBG ibopha ngaphezulu kwe-hormone yakho ye-thyroid, futhi ngenxa yalokho, ihlisa inani lamahhomoni e-thyroid mahhala egazini lakho legazi. Lokhu, kungase kuholele ekukhuleni kwezinga lakho le- TSH , okungavuselela ukukhiqizwa kwamahomoni amaningi wegciwane.
Ngokusho kocwaningo, emva kwamasonto ayisithupha kuphela we-estrogen therapy, i-TBG ivela enani elibalulekile labesifazane be-hypothyroid. Ukwanda kwe-TBG kuvame ukuphakama emavikini angu-12 ngemuva kokuqala ukwelashwa. Ngokufanayo, amazinga e-Free T4 awela-futhi kwezinye izimo, i-TSH iphakama-ngendlela efana naleso sikhathi. Lezi zinguquko azitholakali kubesifazane abangenayo i-hypothyroid.
Iziguli Zigciwane: Izinyathelo Zakho Ezilandelayo
1. Hlola umsebenzi we-Thyroid Ngemuva kokuqala nokuyeka iPilisi noma ukushintshwa kwamaHormone
Abesifazane abanempilo ngokuvamile abakutholi izinguquko eziphawulekayo emsebenzini we -roid ngenkathi bezokwelapha izisu noma i-hormone le-substitution therapy ne-estrogen. Ucwaningo luye lwabonisa ukuthi cishe amaphesenti angama-40 abesifazane abamba imithi yokwelapha i-hormone efaka imithi equkethe i-estrogen inciphise emazingeni egazi we-T4. Lokhu kusho ukuthi izimpawu ze-hypothyroidism ezifana nokukhathala nokuzuza kwesisindo kungabuya ngaphandle kokuthi umthamo wezokwelapha wegciwane ukwanda. Lokhu kuyingozi nabesifazane abasinda umdlavuza wegciwane futhi badinga ukugcina ama-hormone e-thyroid acindezelwe ukusiza ukuvimbela umdlavuza we-thyroid.
Ngenxa yokuthi cishe ingxenye yesiguli se-hypothyroid izothinteka yi-estrogen, kubalulekile ukuthola i-thyroid yakho ibuyele ezinyangeni ezintathu uma ususelwa emithini ye-hormone esikhundleni sokuqala futhi uqale noma umise ukukhulelwa komlomo noma imithi yeselro yomlomo. Kungase kudingeke ukwanda noma ukwehla emtheni wakho we-thyroid esikhundleni somuthi we-hormone.
2. Ungayeki Ukuthatha Amaphilisi Okwakho Wokuvimbela Ukubeletha Noma Ukushintshwa KwamaHormone Ngaphandle kokuhlola umsebenzi we-Thyroid
Ngokomcwaningi uDkt. Robert Utiger, abesifazane abathile be-hypothyroid abathatha i-estrogen noma ukulawulwa kokubeletha bangathola izimpawu, futhi banqume ukuyeka ukuthatha indawo ye-hormone esikhundleni, ukulawulwa kokuzalwa noma i-hormone esikhundleni. Kunalokho, ngokusho kukaDkt. Utiger, ukuhlola ama-hormone e-thyroid bese ukwandisa imithi ye-hormone ye-thyroid ingase ixazulule inkinga kulabo besifazane.
Cabanga nge-Mini-pilill yokuNakekela
Iningi labasebenzisi bepilisi lokukhulelwa bathatha iphilisi "inhlanganisela" ehlanganisa i-estrogen kanye neprogesterone. Ezinye zezinhlobo ezidumile zala maphilisi enhlanganisela nyangazonke zihlanganisa Lo / Ovral, Loestrin, Lybrel, Mircette, Norinyl, Ortho-Novum, Ortho Tri-Cyclen, Seasonique, Seasonale, Yasmin, neYaz. Lawa maphilisi angathinta amazinga e-TBG kanye nomsebenzi we-thyroid.
Amaphilisi okuvimbela ukubeletha engahlanganisi i-estrogen ayithinti amazinga e-TBG, futhi ngenxa yalokho, angeke ashintshe umsebenzi we -roid. Lezi philisi zokuvimbela ukuvimbela isisu ngokuvamile zibizwa ngokuthi "i-mini-pilill." Ezinye zamagama ezidakamizwa athandwayo ala maphilisi a-estrogen ahlanganisa uCamila, Errin, Micronor, Nor-QD, Norethindrone, no-Ovrette. Amaphilisi e-estrogen-free contraceptive ayasetshenziswa kangako uma kuqhathaniswa namaphilisi okuhlanganiswa, futhi kukhona neminye imibuzo yokuthi ngabe ibhekwa njengempumelelo.
Amaphilisi enhlanganisela ayasebenza kakhulu ekuvimbeleni ukukhulelwa kunokuthi "iphilisi encane." Uma kuthathwa kahle, iphilisi yokuhlanganisa ilinganiswa phakathi kuka-91% no-99.9% ephumelelayo. (Uma kuthathwe ngokunembile, i-mini-pilisi ilinganiswa kusuka ku-87% kuya ku-99.7% esebenzayo.)
Uma unemithi ye-hormone esikhundleni somuthi futhi ufuna ukuqinisekisa ukuthi ukwelashwa kwakho kwe-thyroid ngeke kuthinteke ngamaphilisi okukhulelwa nge-estrogen, noma kunjalo, kufanele uxoxe "ne-pilisi mini" nomsebenzi wakho wezempilo.
4. Cabanga ngePatch Patch
Kukhona isikebhe sokulawula ukuzalwa, esetshenziselwa isikhumba, esinokuhlanganiswa okufanayo kwamahomoni, esinikezwa i-transdermally (ngesikhumba), njengamaphilisi omlomo. Ezinye izimpawu ezithandwayo ze-patch zihlanganisa u-Ortho Evra no-Xulane.
Lezi zimpawu zokulawula ukubeletha aziphazamisi amazinga we-TBG, futhi ngenxa yalokho, akunakwenzeka ukushintsha umsebenzi we -roid.
Uma ususelwa emithini ye-hormone esikhundleni somzimba futhi ufuna ukuqinisekisa ukuthi ukwelashwa kwakho kwe-thyroid ngeke kuthinteke ngamaphilisi okukhulelwa nge-estrogen, kufanele uxoxe ngenketho yokusebenzisa isiqeshana sokulawulwa kokuzalwa nomsebenzi wakho wezempilo.
5. Cabanga nge-Transdermal Forms of Hormone Replacement Therapy
Ucwaningo lubonise ukuthi kuphela amafomu omlomo we-estrogen anomthelela kumazinga e-TBG. Ama-brand-popular amagama omlomo (amaphilisi) ama-estrogen-kuphela noma i-combination hormone therapy esikhundleni sokufaka esikhundleni se-Activella, Angeliq, Cenestin, Enjuvia, Estrace, Femhrt, Femtrace, Menest, Prefest, Premarin, ne-Prempro.
Uma ucubungula ukwelashwa kwe-hormone esikhundleni sokufaka i-estrogen, kufanele ucabange izinhlobo ze-transdermal ze-estrogen-kuphela noma i-combination hormone therapy esikhundleni, njengama-patches, ama-gel, noma amaphilisi e-vaginal kanye nokufaka. Imikhiqizo ethandwayo ihlanganisa isiqephu se-Alora, i-Climara patch, i-Combipatch patch, i-gel Divigel, i-Extraderm patch, i-Estring inserted, i-EstroGel gel, i-Evamist spray, i-Minivell patch, i-Vagifem ithebhulethi yangasese, ne-Vivelle patch.
> Imithombo:
> Agren, U et. U-Al. "Imiphumela ye-contraoptive yomlomo ehlangene ne-monophasic equkethe i-nomegestrol acetate ne-17β-oestradiol uma kuqhathaniswa nelinye eliqukethe i-levonorgestrel ne-ethinylestradiol emakhonini wokusebenza kwe-endocrine." 2011 Dec; 16 (6): 458-67. i-doi: 10.3109 / 13625187.2011.614363. I-Epub 2011 Septhemba 26.
> Guttmacher Institute. Ukusetshenziswa Kwezinkinga E-United States: I-2016 Fact Sheet. " https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
> Pinkerton, J, Santoro, N. "Ukwelashwa kwe-hormone ye-bioidentical." Ukunqamuka kwesikhathi, 2015; I-DOI: 10.1097 / GME.0000000000000420
> Raps, M et. U-Al. "Ukusetshenziswa kwezizalo zokubeletha kwe-hormone kuholele emazingeni aphakeme we-TBG, amazinga we-TSH aphakeme kakhulu." I-Thromb Res. 2014 Ngo-Apr; 133 (4): 640-4. doi: 10.1016 / j.thromres.2013.12.041. Epub 2014 Jan 7.
> Santin, A et al. "Indima ye-Estrogen emisebenzini yeTroid and Growth Regulation." J Thyroid Res. 2011; 2011: 875125. Ishicilelwe ku-intanethi ngo-2011 Meyi 4. i: 10.4061 / 2011/875125