[Kimberly]

#1061181

Hello – There are several posters here who have had healthy babies after being diagnosed with Graves’. However, being hypER *or* hypO during pregnancy is dangerous for both the mother and the baby. Hopefully, by “hypO”, your doc was suggesting RAI or surgery, with a regimen of thyroid hormone replacement. If you do pursue RAI or surgery, keep in mind that it can potentially take months to find the “sweet spot” of thyroid hormone replacement that will normalize your levels and get you to feeling good again. (Because it takes time for the replacement hormone to build up in your body, testing can only be done every several weeks – and it can take multiple adjustments before finding the right dose).

Also, be aware that PTU is preferred over methimazole during the first trimester of a pregnancy, because there is an increased risk of two specific birth defects during the first trimester with methimazole.

Here is an article about pregnancy planning and Graves’ – you will need to use your browser’s “back” button to return to the bulletin board after viewing the article.

http://www.ngdf.org/cms/modules/files/uploads/46291.pdf

[jblasky]

#1017831

Hello,

This is my first time visiting this foundation & trying to post anything. So I apologize if something is incorrect here. I just hope that you can read this & help me with information.

I was diagnosied with Grave’s fall of 2010 after having my first child 3 months prematurely. The doctors now think that the premature labor might have been because of the thyroid being so far off. I had never had my thryoid levles checked before then, which was at least 6 months after having the baby. I am now 36 & I guess that is too old to have never been checked before.
Anyway, at least the doctor I work for was smart enough to order a TSH & FT4 with the symptoms I was having; enormous swelling in the ankles & feet & palpitations.

Again, anyway, my husband & I were wanting to try to get pregnant again this fall so that the next baby would come in spring to early summer of 2012 & our first child would then be just over 2.

When I spoke with my endo on Wednesday for my 6 months visit she said my levels were still back within range but I would need to do some investigation & make some decisions before trying to get preo again.
She said I could stay on the 10mg of Methamozole like I am on now for the rest of my life BUT if I was thinking about getting prego again that I should maybe seek out some other options because being hyperthryoid & prego are not always the best combos. It would be better to be hypothryoid & prego.

She did mention surgery, having the thryoid out . . . I just don’t know – being on meds for the rest of my life – really??
I don’t like that idea – I still feel like I am too young to be going that route already.
And I would very much prefer NOT to do the radiation – mainly because of having my little one at home; andthe endo said that it can be very hard to manage meds & thryoid levels for many months after radiation.

I am looking for any & all suggestions, info, thoughts, whatever on this.
It concerns me to try to become pregnant again at all!!!

Thank you!!
jen

[deblitz]

#1061182

I was dx last September. I was breastfeeding at the time, and put on meds… In December I did RAI, my doc said it was a lot safer to do that than surgery, because the recovery time and complications were worse. I had to wait 3 months to ttc again, and am currently pregnant. I had a pretty low dose of RAI, and I am still a little hyper, but my endo said it is okay to be a little high. I only had to be away from my kids for a week or two. I just arranged for someone to do bedtime and such. My doc said it is about closeness and the length of time near them. I could be in the same room, but not have them sit on my lap for hours. I think I avoided ALL contact for about a week.

There are meds you can take while pregnant, so you don’t have to do surgery to get pregnant. My doc did tell me the hypo drugs are safer than the hyper drugs… Just take your time, make a pro and con list to all of your options… it was really hard for me to make a decision knowing I wanted another baby… relatively soon after my diagnosis.

[Bobbi]

#1061183

To add specific to Deblitz’ comments:

The "drug" you would need to take after RAI or surgery to remove the thyroid is thyroid hormone. It is chemically identical to the body’s own T4(thyroxin) except for the inert ingredients used to make it into pill form. Rarely, someone reacts to one of these inert ingredients (more often than not one of the dyes used to identify one dose of the pill from another), but other than that, this chemical has no side effect issues other than making us hyperthyroid if we take too large a dose, or hypothyroid if we take too low a dose. The body is designed to use this chemical, so it adds no other problematic issues.

The antithyroid drugs do have some adverse side effect issues, but if you are tolerating the drugs well, that would not be a consideration for you. It might create a problem for the baby, however, if the dose you need to be on to attain normal levels of hormone is too high. These drugs do cross the placental barrier and can, as a result, adversely affect the thyroid function in the developing baby. There is a balancing act required: if you take too little of the drug and remain hyperthyroid, the pregnancy itself could be jeapardized. There have been successful pregnancies (meaning full-term healthy babies) for women who are on these drugs, but since you have a choice here — albeit perhaps not one you would prefer making –you should understand the pros and cons and discuss carefully with your doctor whether YOUR required dose of medication presents potential problems for the baby.

[LaurelM]

#1061184

Hi,

I was 8 mo postpartum with our 1st baby when I was diagnosed. I too started Methimazole which I was on for about a year when we got pregnant with our 2nd child. By then I was on a low dose, stable, and doing well. We had planned on having a second but hadn’t planned to conceive while still on the ATDs. I was switched to PTU which I was able to discontinue at about 6-8 weeks into the pregnancy (I wasn’t keeping much of it down anyway). My endo thought I was probably heading into remission and the the pregnancy just helped to calm my immune system down that much more. We were however expecting to see the Grave’s come back again post-partum which would mean making a treatment choice again. I have been lucky and have remained in remission for about 5 years. Both my kids are very healty and happy tots who run me ragged some days.

The 12 months post-partum period is something you need to think about when making your treatment choices and pregnancy planning. I personally would have preferred to have had the surgery knowing that we would have our second fairly close to our first. I did not like the idea of being on an ATD especially during time when the baby’s thyroid gland is forming and starting to function. I, of course, also worried about taking a medication that might have a potential for a birth defect (both PTU and Methimazole are in this catagory but PTU is preferred). The research on that however seems to be uncertain. They are not sure if the birth defects are due to being hyperthyroid during pregnancy or due to the medication.

Another concern is if you want to breastfeed. Both ATDs will pass through the breastmilk. This also caused my hyperthyroid anxiety ridden exaused post-partum new mommy hormone wacked out psyche a bit of a freak out. All our Dr.’s (my endo, our family Dr, and the pediatric endo who was consulted) assured us that it should be fine and that the continued nursing benefits far outweighed the small risk. Our 1st baby however did have to have thyroid levels monitored periodically (a quick heel stick every few weeks) as a precaution that her thyroid levels were OK. However, just because we were able to continue breastfeeding on an ATD does not mean that everyone can. The recomendation may be influenced by the baby’s size and the size of the dosage. Being hyperthyroid also decreased my milk production – not fun.

That said, everything has worked out well and all my worry at the time was for naught and I have two fantastic kids and I feel great with a functioning thyroid. On the other hand, I have a friend who had thyroid cancer in her 20s, had a complete surgical removal AND the much bigger dose of RAI that cancer patients recieve. She now in her 30s takes replacement hormone and she has a healthy toddler.

Whatever you choose, they will want to follow your thyroid levels closely during and after your pregancy. The ideal thyroid levels change during pregnancy and lactation so if you are on ATDs or replacement, dosages may need to be adjusted accordingly. Also make sure that your newborn’s Dr knows of your Graves history. They will keep a close eye out for an very, very, very, very (did I say very?) rare complication of the baby being temporarily hyperthyroid in the first couple of months after delivery. Even if you have been treated and your levels are normal, the autoantibodies may still be present and can cross the placenta causing the newborn to be temporarily hyperthroid. Super, super rare but still something to be aware of.

I hope my story helps some. This board was a lifesaver for me so I still check in once in awhile.

Laurel

[jblasky]

#1061185

Thank you for everyone’s replys.
I am still very confused on what we should try to do.
I was also breastfeeding at the time when the hyperthroid was discovered. My endo put me on the Methimazole because it was safer for breastfeeding but she did say the PTU was safer for pregnancy.
When I visited her a couple weeks ago she suggested that I read the latest published info from the American Throid Association that is now stating that you should remain on Methimazole while trying to conceive & through the first trimester – then after that switch to the PTU.
I really don’t want to do surgery – the endo is making it sound like this is my best option if I am wanting another child soon.
I am more worried about staying on these meds while prego though.
My current dose of Methimazole is only 10mg once a day is that good??
What is considered "remission"?? Having your TSH & FT4 in range for so many years??

I am concerned about having the gland removed & then obviously having to stay on meds for life. If I don’t have it removed & stay on meds this could go into remission & be fine for some years??
HElp!!

[Kimberly]

#1061186

Hello – All of the treatment options have risks and benefits, so no one hear can *tell* you which option is best. Yes, some patients to enter a period of remission after a course of Anti-Thyroid Drugs. “Remission” is usually defined as a period of one year or more with no meds, where your thyroid hormone levels remain stable. The latest guidelines from the ATA and AACE state that remission rates are 20-30% in the U.S. and 50-60% in Europe.

Also, PTU is actually considered the safer drug during the *first* trimester of pregnancy. Methimazole is associated with a higher risk of a couple of specific birth defects if taken during the first trimester.

[Author]

Posts