[mawahit]

#1058671

Hello again,

I am scheduled for 12 mcis of RAI for Graves disease next month (I am 31 and have been taking methimazole since March, 2011). I was wondering if someone could describe the recovery process: what side effects are most common, how long will I wait to start taking medication for hypo, what is the best hypo medication that will agree with pregnancy? I know it’s recommended to wait for up to a year before thinking about getting pregnant, so my motivation is to get well as soon as I can so my husband and I can start planning to have a baby.

I would appreciate if someone could share their experience with me. Thank you!

[Bobbi]

#1169285

The two, typical reactions to RAI will be a sore throat and a brief period of extra hyperness approximately one week after you swallow the RAI. The extra hyperness occurs as dying thyroid cells release their stored thyroid hormone into the body.

As to how long it takes for the full impact of the RAI to demonstrate itself — it varies. I went hypo within five weeks of my RAI. Other people take months. It can help to pay attention to the symptoms of hypothyroid (cold intolerance, constipation being the main ones) so that if you detect them you can call for blood tests to confirm. It’s preferable not to go too hypo, if possible. That requires monitoring things at reasonable intervals — which your doctor/endo will indicate.

Then, you’ll start replacement hormone. It starts to work immediately, but you won’t feel normal right away, even if your first dose level is the proper one. It takes us some months AT normal levels of thyroid hormone for our bodies to heal from the damage done while we were hyperthyroid. Since you’ve been on ATDs, your body may have already done some healing. But it still takes some time. It helps, overall, for us to watch for "improvement" rather than any absolute "normal" while the healing is taking place. More likely, your initial dose of replacement will have to be changed. Some doctors start out with a conservative estimate, planning to raise the dose little by little until the proper level of replacement is found. If that is the case, you will have to wait six weeks to three months between blood tests to evaluate how the dose change worked. It is VERY important to wait the required amount of time, even if you think things might be "off." That is because the blood tests used can lag behind the reality. TSH, for example, which is the main test because it can detect really teeny amounts, is a type of running average, and it can lag weeks behind the regular thyroid hormones themselves. If you have blood tests too soon, and the test is wrong, it can put you on a hormonal roller coaster. That has, in fact, happened to me. It’s not ideal.

[mawahit]

#1169286

Thank you, Bobbi!

Do you know what hormone replacement drug is preferred during pregnancy’? Thank you!

[Ski]

#1169287

Thyroid hormone replacement "brands" are all supposed to be chemically identical to each other, so whatever you find that works for you will also work through pregnancy. It’s not the same situation as anti-thyroid drugs, which have different chemical compositions and work in different ways to accomplish the same result, so they have different side effects and different recommendations regarding use during pregnancy.

Thyroid hormone replacement is made to be chemically identical to the thyroid hormone your thyroid would put out if it were working, so there’s no effect that one would cause, different to another, that could cause harm to the baby. The issue during pregnancy, while taking thyroid hormone replacement, would be to make sure your levels are normal, and stable, so you may need to adjust doses while pregnant, but you would not switch brands of medication.

We have found that it is not always dose-equivalent across the brands — in other words, the dose that successfully manages your thyroid hormone levels using one manufacturer’s thyroid hormone replacement will not necessarily be exactly the same dose that successfully manages your thyroid hormone levels using a different manufacturer’s thyroid hormone replacement. For that reason, we recommend that you stick with whichever brand you began with, unless there is some compelling reason to switch. If you need to switch, due to insurance program changes in coverage or some other thing, you should just realize that it is important to get tested every six weeks or so until you have determined how well that dose is working for you, and make adjustments to maintain your normal, stable thyroid hormone levels.

I hope that helps!

[Author]

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