[cormiers]

#1060208

Has anyone successfully conceived their first child after being diagnosed and treated for Graves? And if so, what treatment did you choose and how long did it take afterwards to get pregnant?
It has been very discouraging trying to manage both Graves and infertility and my husband and I are both of an age where we are running out of time

[LaurelM]

#1181250

Hi,
I was first diagnosed about 8 months postpartum with our first. I was treated with Methimazole for about a year when we became pregnant with out second. Because i was pregnant and because I developed hives at the same time, I was switched to PTU. PTU is the preferred antithyroid drug for the first trimester. I was able to stop taking it within just a few weeks of conception as my levels were normal pregnancy levels. Autoimmune diseases often calm (but not always) during pregnancy as the mother’s immune system supresses so as not to reject the fetus as something foreign. However, up to 12 months postpartum is the flipside. After delivery, the immune system kicks back on and this is often a time that autoimmune disease will flare up. We fully expected me to have a recurrence after delivering our second. For reasons unknown, I experience about a 6 year remission. Both my kids are happy, healthy, and doing well in school.

I came out of remission about 17 months ago and restarted PTU. Because of the hives, I was unable to try the Methimazole again. This time it was controlling the levels but I kept having to adjust and just kept having to take more andmore to stay in range. My endo and I agreed that a TT should be considered but he left the treatment choice up to me. I had the TT in August and am feeling better and better all the time. It was a good choice for me.

During my pregnancy, I was officially considered high risk. In addition to the GD, my first baby was a shoulder dystocia so off to a high risk OB. We just did some extra monitoring on things like growth and heartrate. The mother’s TSI should also be check in the 3rd trimester regardless of treatment choice because of the rare possibility of the autoantibodies crossing the placenta and causing the baby to be temporarily hyper after birth. The baby’s doctor should also know of the mother’s GD history. That said, I had the most uncomplicated pregnancy and delivery on my doctor’s roster. He actually called it ‘pleasantly boring’.

I have a good friend who had thyroid cancer and had both a TTand RAI at much higher dose than GD patients receive. She had a healthy pregnancy about 5 years ago. She had no problems related to her treatment other that paying close attention to her levels as the thyroid levels normally change during pregnancy and replacment doses may need to be adjusted.

Another consideration for treatment choice when wanting to conceive quickly is that there is a recommended wait time between RAI and conception. This ranges anywhere from 3 to 12 months based on dose and how conservative the practitioner is. With TT or ATDs pregnancy is OKas soon as your levels are stable but this may take some time. TTmay bethe quickest way to acheive this.

I know you are probably focused on the the quickest way to conceive as you said time is a factor. I would also recommend considering the postpartum period. The first year after our first child was born was so very difficult being a new Mom and struggling with GD symptoms. Much of that first year is a blur because I was so ill. I also struggled quite a bit with milk supply do to the fluxuating hormones. I alsoworriedabout taking the ATDs while nursing. All my docs including the ped endo who was consulted encouraged me to continue nursing as the benefit outweighted the very small reversible risk of the ATD passing through the milk and affecting our daughter’s thyroid levels. We did however have to have her tested via heel stick every 6 to 8 weeks. Not fun.

I this helps. I know it is a difficult decision. You can also search the forum with key words like pregnancy and read several past threads on the topic from lots of other posters.

Laurel

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[cormiers]

#1181252

I apologize-I guess my post was confusing. I appreciate your response but I’m really looking for someone who was diagnosed before their first pregnancy. I do not think RAI or TT are good options given what you said about antibodies being present afterwards and causing complications-it’s why I’ve chosen the ATDs. I’m just looking to connect with people who were in a similar situation who had to decide whether or not to continue TTC given the risks with GD

[LaurelM]

#1181253

I hope some other posters with pregnancy experience post diagnosis will jump in. Kimberly has also provided a link in other threads to the medical management recomendations for pregnancy and postpartum care of the GD patient. Do try the seach feature.

I think I wasn’t clear enough about the antibody issue. The very, very, very, very small risk is there for ALL post onset GD pregnancies REGARDLESS of which treatment option was chosen, ATDs, RAI, or TT. The complication is call Neonatal Graves disease and is a temporary hyperthroid condition for the baby that can be managed. It typically resolves within a very few weeks. Stable thyroid levels are the most important thing for a healthy pregnancy. TT is often the fastest way to acheive this. But like I said, I had a healthy pregnancy on ATDs but had already been on them for a year when we conceived so my levels were stable. And, at that point it was a very low maintenance dose.

Perhaps the best thing is to consult with a Fetal Maternal specialist as these are specially trained docs who deal with complicated pregnancies.

Best wishes,
Laurel.

[cormiers]

#1181254

There are a number of reasons but I don’t feel comfortable with surgery and I’d rather have my antibody levels lowered before TTC. Thanks anyway tho

[Kimberly]

#1181251

This is the link that LaurelM mentioned – it’s from the American Thyroid Association on pregnancy and thyroid issues.

(Note on links: if you click directly on the following link, you will need to use your browser’s “back” button to return to the boards after viewing, or you will have to log back in to the forum. As an alternative, you can right-click the link and open it in a new tab or new window).

http://thyroidguidelines.net/sites/thyroidguidelines.net/files/file/thy.2011.0087.pdf

The section on Graves’ starts on page 1094 of the original journal article (page 14 if you download as a PDF).

[michelle36]

#1181255

Hi there, I was diagnosed with Graves Disease after TTC for 9 months. My doctor referred me to an Endo and he put me on carbimazole (anti thyroid drug). This is the only treatment I have ever had for my GD. I have been in and out of remission a few times. I have not chosen any other treatment and I was diagnosed in 2004. Whilst pregnant my symptoms were good and I was only taking 1 tablet per day (5mg).

As far as getting pregnant was concerned that is a different story. My thyroid levels were good after 6 months of treatment but after 2 more years of TTC I found out that I had another underlying factor that affects fertility and that was Endometriosis.

It is very discouraging when you are TTC and then find out you have GD. But once you find a specialist who understands that you want to become pregnant you will feel better.

Hope this helps.
Michelle

[miyogirl]

#1181256

Hi,
Everyone is different, but I have had two children post RAI.

After initial diagnosis about 13 years ago- First i tried Tapazole for a year but popped right out of remission. I didn’t want to do RAI because i fear/feared radiation, but I was VERY sick. At first diagnosis I was a mess, so I knew I needed to do something, and I knew I wanted kids in the future and I was scared I would keep popping out of remission. I contemplated surgery, and sometimes wish I had considered surgery more, but the docs recommended RAI. I waited quite a while before having kids after RAI (approx 5-6 years) and had been very stable blood levels-wise by the time we started trying. I didn’t purposely wait 5-6 years for any reason other than I wasn’t even dating my husband yet at the time. So it was 5-6 years for us to date, get married and have our first child.

We did not have fertility problems and conceived easily but my levels like I mentioned earlier were stable and my eye disease was in remission and everything had calmed down. There are great apps you can use to chart your fertility that can be helpful.

I was fortunate to have an AMAZING endo who guided me and my thryoid levels every step of the way (you have to adjust your med levels very carefully and consistently throughout the pregnancy) I also had more extensive ultrasounds than the avg person because they want to keep tabs on the baby. And more gestational diabetes tests as well. Be VERY honest and clear about your family planning goals, the more honest and clear you and your doctors are, the better the outcome for everyone involved.

Best wishes to you. I can’t recommend any “way” you should handle treatment options, because honestly everyone is completely different. Thyroid disease or not, nobody can predict the future as far as pregnancy goes.

My only recommendation– find a quality endocrinologist who you feel comfortable with, who you can trust, and who you can communicate effectively with. Find an OB who is comfy with either communicating with your endo, or at least an OB who has at least some knowledge of graves disease.
Best wishes to you!!!

[miyogirl]

#1181257

Also if you are looking into RAI, find out all the side effects and facts and consider ALL of your options. Like i mentioned i wish I had considered surgery more. I am dealing with some salivary gland issues now which docs say is from RAI, but still learning about it. So, whatever route you choose/need research all of your options and the pros and cons of each.

[cormiers]

#1181258

Unfortunately I am on my 4th endo. I told all of them upfront that my #1 goal was to have a baby and my concerns about all the treatment “options” and literally all of them were unsupportive and even inappropriate. One tolds I only THINK I want a child and she would give hers back of given the choice. One said if I was concerned about side effects of treatment on a fetus it means I’m not ready to be a mother. One told me this diagnosis might be a sign that parenthood isn’t meant to be for us. Everyone stresses the importance of finding an endo you trust but i can’t seem to find one who isn’t a total jerk!

[miyogirl]

#1181259

Wow. that’s kind of shocking. I never had reactions like that. I have been VERY lucky with some of the docs I have used, and the ones I wasn’t lucky with i stopped using.

I wish you the best in finding a great doc!!!

Oh and I went to my Endo today and she doesn’t think my dry mouth is RAI related like an ENT thought….. the search for answers is still on, so you can ignore my previous post about salivary issues related to RAI— although i still think it is important to discuss pros and cons and ALL possible side effects of any treatment option you choose.

Contact GDTF for doc recommendations and look in thyroid books for doc lists— and there is also the American Adacdemy of Endocrinology that has a listing as well i believe.

Best wishes to you!

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