[aprilmom]

#1058732

Hi all,

I’m new to the board, was diagnosed with Graves AND Hashimotos about 1+ year ago, when I found out I was pregnant with my first child. I was on PTU during the pregnancy, and went off right before birth as my thyroid levels had stabilized. The levels were all in high end of normal range 1 month post partum. Now, 7 months later, my levels are all out of range. I’ve posted them below… Question #1: can anyone tell me if these levels could be characterized as mild, moderate or severe hyperthyroidism?

TSH: <0.01 (reference range 0.30-3.00)
Free T3: 13 (1.5-4.1)
Total T3: 507 (65-185)
T3 Uptake: 39.3%
Total T4: 16.2 (4.5-12.5)
FTI: 6.37 (1.13-5.00)

I thought for some reason that only the "free" T3 and T4 numbers matter, but my endo basically freaked out at my "total" numbers. I’ve been on 20mg of methimazole per day for three days now. Heart rate is around 100-105. Doc says if the heart rate doesn’t come down into th 80s or 70s range quickly with MMZ, he wants me to go on atenolol. But, I’m still breastfeeding, and apparently atenolol isn’t recommended during lactation. Question #2: has anyone taken atenolol or other beta blockers while breastfeeding?

Finally, does anyone out there have Graves, but no insurance? My good friend doesn’t have insurance and has severe Graves and TED and she and I are wondering if there’s an affordable way to get some medical attention. The practice I go to has a self-pay plan for uninsureds, but it’s around $500 for the initial consulation and lab fees are separate. Any way to see an endo for cheaper than that??

Thanks in advance for your replies!

[Kimberly]

#1169676

Hello and welcome – We aren’t doctors here, just fellow patients, so we can’t make specific comments on your lab results. In general, though, the latest guidance from the American Association of Endocrinologists and the American Thyroid Association recommends reliance on Free T4 versus Total T4 in making treatment decisions. Certain substances, such as birth control pills, can “bind” thyroid hormone, thus making it unavailable for the body’s use, so the Free T4 is believed to be a more accurate benchmark. However, when it comes to T3, the accuracy of the Free T3 test versus Total T3 is a subject of some controversy — so there is quite a bit of variability in whether doctors order Free or Total T3.

Hopefully, you will get some responses from others on the beta blocker issue. There are actually several different prescription beta blockers, and I believe that atenolol is one that is NOT recommended during breastfeeding. The latest guidance from the American Thyroid Association on pregnancy/postpartum issues does not specifically mention beta blockers and Graves’, although it does say that Propranolol (another beta blocker) is the preferred drug to treat Postpartum Thyroiditis. I would definitely seek further guidance from your doctor or pharmacist on this issue.

As for affordable health care options, the following web site is a good resource for finding free and low-cost clinics by zip code. (You will need to use your browser’s "back" button to return to the board after viewing). http://www.hrsa.gov/index.html

Other options include your specific state’s Health Department, Welfare Department (even if you are not Medicaid eligible, the office might be able to suggest other resources), and local hospitals, universities, or medical schools. It definitely takes a lot of patience and persistence, but you definitely want a provider who will be able to give you consistent care.

Take care!

[Bobbi]

#1169677

Just a word of advice, regarding your question about whether anyone had taken beta blockers while nursing. In this internet world, you may, indeed, find individuals who continued beta blockers while they breast fed a baby. This doesn’t mean that they SHOULD have done it. Even if they report "no problems," you should –for your baby’s sake — ONLY use reliable medical recommendations, which would come either from your doctor, or your pharmacist (pharmacists tend to know a lot about drugs and their side-effect issues), or both.

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