[tdfromny]

#1018187

Hello,
I am new to the forum. I was diagnosed with Graves in April 2010, about 6 months after giving birth to a premature baby. I have been on methimazole and have been slowly weaned down from 20mg to 2.5 mg daily. My TSI was as high at 6.7 during the summer, but a change in diet and lifestyle seems to have helped as it’s now at 1.7. My latest labs were TSH 1.08, Free T4 is 1.0 (range .6-1.6). I am looking for any success stories with women with graves who have gotten pregnant and have had healthy babies. I have surgery scheduled for next month for a thyroidectomy, but I am not sure it’s the route I want to go. I would like to get pregnant in the very near future, but my endo said I would have to be completey off meds before he would consider it safe. I have read it’s best to have Free T4 levels slightly higher than mid range before TTC. I would love to hear from anyone who has gotten pregnant without having surgery or RAI. Seems everything I read online says how dangerous it is to get pregnant if Graves is left untreated, but what about while on a low dose of meds? Thanks for any input!

[Bobbi]

#1063155

The optimal level you speak of is "normal" levels of thyroid hormone in you body. Our thyroid levels seem to move about within the normal range. So, when we’ve had our thyroids removed, our doctors try to keep us well within the normal range, and more or less away from the edges of the normal range. Similarly, if you are on antithyroid meds, you need to be in the same general spot.

We have heard from people throughout the years who have gone through a successful pregnancy while on the antithyroid drugs, and you may well hear from them. The drug of choice, however, was typically PTU, not methimazole. Both PTU and methimazole are known to cross the placental barrier and pose potential danger to the baby. PTU was thought to cross over in lesser percentages, and therefore was considered somewhat safer. When I was diagnosed in the late 90’s, it was routine for doctors to put their pregnant Graves patients on PTU. But PTU has recently been shown to cause liver damage in sufficient numbers to give the medical community pause, and our doctors seem to be more cautious with its use. Because the meds cross the placental barrier, the dose of the medication you need to keep yourself within normal ranges is extremely important to the baby’s health.

Comparatively: replacement hormone — which is what you would go on after a thyroidectomy — IS thyroid hormone. It is chemically identical to the body’s own T4. The only side effect issues with replacement hormone is whether or not you are taking the proper dose. If you are taking too much, you will have hyperthyroid symptoms; if you are taking too little, you will have hypothyroid symptoms. So, replacement hormone itself does not present the same risks to the baby, or to you for that matter, that the antithyroid meds do. You can receive adequate treatment for yourself, without worrying about the effects on the child. It is not at all uncommon for women to have successful pregnancies after removing their thyroids. The pregnancy is still considered a higher risk than for a normal, healthy woman, because attention must be paid to keep the mother’s thyroid levels within the normal range, and must be adjusted manually, but that is the same consideration as with the antithyroid drugs.

Not treating your disease in order to go through a pregancy though, is probably you worst choice. If you were completely off the meds, in remission, etc., that is one thing. If you need the antithyroid meds to stay within the normal range however, you really do need to keep your treatment going. Both for your sake and the baby’s sake.

There are no easy choices when you’ve been diagnosed with a disease like Graves. You must weigh the factual pros and cons, and then decide which option is most comfortable for you. Your doctor has weighed in. I really think you should get additional input from another, equally well-qualified doctor, and from your baby’s pediatrician about the issues associated with taking the antithyroid meds. You have the ability to "plan" this out, so it makes sense to get input from the most knowledgeable sources around you. And, a pharmacist could give you additional insight about the issue of the antithyhroid meds/replacement hormone.

I do wish you good luck.

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