Menopause - or thyroid disorder?
You sleep badly, the cycle does what it wants, and your 50th birthday is coming up. Welcome to menopause, many women think. But these typical symptoms of hormonal upheaval can also have another cause: the thyroid gland. And that is easily overlooked.
Disorders of this organ are widespread and especially often affect women. The risk increases from mid-life. More than half of over-45s are affected by change. "But even in hormonal transition phases, we often experience inflammation and autoimmune diseases of the thyroid gland," says Hamburg gynecologist Dr. med. Katrin Schaudig. This may be the case after the birth of a child, but also immediately before and during menopause. Why this is so, the doctors do not know exactly.
Confusingly similar: symptoms of menopausal symptoms and a diseased thyroid gland
But one thing is certain: The symptoms of menopausal symptoms and those of a diseased thyroid gland can feel confusingly similar. And they can reinforce each other. An underactive thyroid is manifested, for example, by weight gain, freezing and fatigue; an over-function of inner restlessness, sleep disorders and heart problems - all problems, as they can cause the menopause. Irregularities in the cycle can be attributed to both the menopause and the thyroid gland. Mood lows are not uncommon during menopause, especially in the period before the last period, but may also be the first signs of thyroid disease. And the complaints are mutually dependent: depressive moods can promote the onset of a hypofunction, the hypofunction can in turn cause or sustain depression.
There are also symptoms that vary slightly depending on the cause, such as sweating. "Typical of the menopause is a rising in the body heat, which arises spontaneously and without effort," says Katrin Schaudig. "Moist skin and shaky hands, however, indicate an overactive thyroid, the women do not experience the hot flush as ascending." For a thyroid problem speaks also a constantly tense neck.
However, it often takes a long time until the correct diagnosis is made. "The relationship between the various ailments and a thyroid disorder is often not seen, so sometimes for years wrong or not treated," complains the thyroid expert Christina Sachse. The symptoms do not even drive many women to the doctor - the mother finally had it during the menopause.
The thyroid gland is an underrated organ. Some people just know about her that she sits in the neck and can be responsible for a goiter. But the butterfly-shaped gland, weighing no more than 18 grams in women and as big as a walnut, is one of the most important control centers of the body. It regulates the function of nerves, heart, circulation and muscles and provides the body with the energy it needs. It influences the utilization of the food, the body temperature, the cycle and the psyche.
A fine-tuned circulation determines her work. With the help of dietary iodine or dietary supplements, the thyroid forms the hormones thyroxine (T4) and triiodothyronine (T3). If the concentration of these hormones in the body decreases, the pituitary gland releases a messenger substance, the hormone TSH, which stimulates the thyroid gland. It stimulates the absorption of iodine and thus the formation and release of thyroid hormones. If this cycle is disturbed, the whole organism gets mixed up.
Whether a malfunction is present shows in most cases a blood test. The laboratory value for TSH indicates whether the body is sufficiently supplied with thyroid hormones. In addition, the free thyroid hormones (fT3 and fT4) that act directly in the cells are often measured. Also important is an ultrasound scan so that the doctor can see the size and structure of the thyroid gland, as well as any nodules in it.
An elevated TSH level and low levels of fT3 and fT4 indicate hypothyroidism. There are too few thyroid hormones circulating in the body, the metabolic processes are slower, the digestion does not work properly, the heartbeat is also slowed down, the concentration suffers. On the other hand, if a low TSH value and high values for fT3 and fT4 are present, there is an overactive thyroid; Weight loss, sweating, nervousness can be the consequences.
The number and severity of symptoms vary among those affected.Sometimes typical ailments occur before the blood levels derail. Other women barely feel it when the thyroid gland is not working properly anymore. Symptoms like fatigue or dry skin are hard to pin down and are easily overlooked. Between three and 16 percent of people in Germany are said to have such a latent sub-function, most often women over 60. Sometimes patients only realize at the beginning of the treatment that something was wrong before. "The body gets used to the low energy level," says the nuclear medicine doctor. Matthias Glawe from the joint practice Cardiologicum Hamburg-Wandsbek.
Hashimoto's thyroiditis can trigger hypofunction.
The most common cause of hypofunction was previously iodine deficiency. Meanwhile, the doctors know that often an autoimmune disease is to blame: the Hashimoto's thyroiditis. The body repels its own thyroid tissue and destroys it, causing chronic inflammation. The plant for this disease is in the genes, affecting ten times more women than men. Times of hormonal upheaval increase the risk of her outbreak as well as age. Mental stress, bacterial and viral inflammation, smoking and selenium deficiency can also promote the disease. So far, it is not curable, the missing thyroid hormones must be replaced lifelong by the intake of tablets. The risk of getting more autoimmune diseases like rheumatoid arthritis is increased.
Often, antibodies in the blood indicate Hashimoto's thyroiditis without diagnosing hypothyroidism. "Then there is no need for treatment, but the autoimmune disease is present and must be monitored," says Professor Dagmar Führer, Vice President of the German Society of Endocrinology. For example, cycle changes may already occur even if the thyroid function is still intact.
Knots are often to blame for an overfunction.
Hyperthyroidism, on the other hand, is often caused by nodules. These develop from cells that resist the messages of the brain and work autonomously. While cold knots do not produce hormones, hot knots are highly active and produce high levels of thyroid hormone. The risk for knots also increases with age. Studies show that only about 10 percent of 25-year-old women have nodes in the thyroid gland, but over half of 70-year-olds. It is promoted by iodine deficiency, a genetic predisposition and smoking.
An overactive thyroid can be treated with drugs that inhibit iodine intake and thus limit hormone production (antithyroid drugs). Because of their side effects, doctors do not prescribe them permanently.
In hot knots, doctors often use radioactive iodine therapy. In the process, radioactive iodine is administered to those affected, which accumulates in the particularly active cells of the thyroid, which are destroyed by the radiation. In addition, around 120,000 thyroid surgeries take place each year in Germany. The reasons for this are a very large thyroid that presses on the neck, hot knots and suspected cancer. However, the high number of experts is also criticized. "A better prior clarification of the thyroid would be desirable," says Dagmar leader.
According to many doctors, it would also be important to have a regular check-up of the thyroid gland, especially during menopause. Because just an overfunction should be revealed as quickly as possible; it increases the risk of cardiac arrhythmias, strokes and Alzheimer's. In postmenopausal women, it can promote the development of osteoporosis, bone loss. By contrast, a subfunction is unpleasant, medically but not dangerous, says nuclear medicine doctor Matthias Glawe. At least at a low level, however, the risk of increased diastolic blood pressure, elevated cholesterol and arteriosclerosis increases over time. Therefore, doctors are increasingly turning to treat not only manifest malfunctions, but also latent ones where only the TSH value deviates, as they too can have negative consequences.
So far, the effects of hormone replacement therapy during menopause on the thyroid gland have been little investigated. The only certainty is that a supply of estrogens less free thyroid hormones act directly in the cells. "Women who get the thyroid hormones concomitantly with estrogens may need a higher dose," says Professor Alexandra Kautzky-Willer. The endocrinologist at the Medical University of Vienna knows that patient patience is often needed to treat a diseased thyroid gland. If the disorder lasts longer, it can take months to get the hormone balance back in balance. "Not every woman responds equally well to the treatment, despite the substitution of the thyroid hormone, it can be difficult to lose weight or come out of a mental depression," says Alexandra Kautzky-Willer. Often it turns out that it was not all thyroid problems that caused the thyroid gland.Sometimes they are signs of menopause.
Read on
- "The thyroid gland, a small organ with a great effect" by Christina Sachse (64 p., 6 Euro plus shipping costs), to order at www.ffgz.de
- "Living with Hashimoto's Thyroiditis" by Leveke Brakebusch and Armin Heufelder (210 p., 14.90 euros, Zuckschwerdt 2012)
Beware, iodine deficiency!
The thyroid gland needs iodine, in case of iodine deficiency, it expands, a goiter (goiter) may arise. The iodine supply in Germany had improved since the mid-1990s, mainly through the use of iodized table salt and the iodination of animal feed. Studies show an average iodine supply in this country in the "lower optimal range". However, the situation now seems to worsen again: "The food industry has reduced the iodine content of their products due to international regulations," says the endocrinologist Dagmar Führer. To absorb enough iodine (180 to 200 micrograms a day), it is recommended to use regular iodized salt, to consume daily milk, dairy and cheese, and sea fish once or twice a week.
However, various factors may inhibit the uptake of iodine or the formation of thyroid hormones. These include smoking, a lack of selenium, zinc and iron, but also the frequent consumption of certain foods such as cabbage, radish, corn and millet. In Hashimoto's thyroiditis, increased levels of iodine can increase the disease. Therefore, sufferers should not regularly take iodide tablets. However, you can eat normally and also use iodized table salt.
