[melaluca]

#1059148

Hi, i have only last week been diagnosed with GD, so i am still getting my (very confused) head around it all.

What is alarming me the most is that my GP has told me i need to wean my son of breastfeeding to start the meds ASAP(i dont know which meds, sorry).
Have others with GD breastfed their babies? If so, what meds?

I cant just stop, it would have to be gradual, but i REALLY REALLY dont want to stop at all – yes i have created a rod for my own back here, but i breastfeed my son to sleep at night, he has more throughout the night when he wakes, and i feed him again for his day nap, plus other feeds throughout the day, comfort nursing with teething, when he hurts himself etc… My son and i are very much attatched to doing this, and i dont want to go thru the stress of rejecting him again and again until he no longer asks for it.

I would really appreciate advice and support from others who have been in a similar situation, as i am just so anxious about what to do.

[adenure]

#1172520

Hello!!!
Welcome I was you just a short 6 months ago! I was diagnosed with Graves after my 4th son was born, and I was and STILL AM breastfeeding! YES, you CAN breastfeed through everything except RAI!!! The 2 ATD (anti thyroid drugs) you are probably going to be offered are PTU or methimazole (maybe carbimazole? bc of wear you live?) I took methimazole (5 mg daily) and continued to breastfeed. Methimazole is considered safe for breastfeeding for up to 20 mg. a day. It does pass through breastmilk, but it has never been shown (in studies) to cause a problem to a breastfeeding infant. It is recommended, however, to get a baseline TSH of your baby just to test his blood work every 3 months to make sure he is okay. My endocrinologist & pediatrician were completely fine with me nursing my infant while on methimazole. PTU is also fine for breastfeeding (actually it does not pass into breastmilk as much as methimazole). PTU is also safe for pregnancy. You will find information that methimazole is not safe for breastfeeding. Again, Dr. Thomas Hale (who specializes in medicines in mother’s milk) has deemed it safe (again, in a dose that is 20 mg. or less a day). You do not have to wean. No, I am not a doctor, but I have done a TON of research, questioned my endocrinologist and pediatrician and my La Leche League consultant friend and they all said it was fine. My LLL friend had & nursed 4 children on both drugs over a 10 year span. As a side note, PTU is considered an L-2 drug (“safer”) and methimazole is considered an L-3 (moderately safe). L-1 is considered safest (like Tylenol for example). L-4 is still considered safe and L-5 would be shown to cause problems. Often L-3 status drugs are not necessarily unsafe, it’s that they haven’t been tested enough to warrant an L-2. There have been studies (per Dr. Thomas Hale) with methimazole though and again, no infants had an adverse effect to nursing on up to 20 mg. a day. I do not have the studies accessible to me right now (I’m not at home for the next week), but if I can find them, I will post them for you so you can see the actual studies. I did post them on the forum a month or so ago, so it might be around somewhere if you do a search with the key word breastfeeding or Dr. Hale.

To take care of yourself, when you get your blood work, do ask to have a liver panel to check your enzymes as both of the ATD drugs can (although rare) damage your liver. I happened to be that rare 1% & had to stop the methimazole after 7 weeks time. So, in the end, I got a thyroidectomy (surgery) to treat my Graves. Actually I just had the surgery this past Friday!!! I did have to wean for the 7 days leading up to it to take a prep. medication for surgery (SSKI- potassium iodine drops). I pumped & dumped and my baby is nursing happily again.

If your doctor wants you to get an uptake scan you can get it done with a temporary weaning of 3-5 days depending on the isotope used. But, you will have to check with the nuclear doctor to see what they’re using. I-123 has a very short half life and as long as there is no I-131 being used and the amount of I-125 is very minimal, you only have to wean temporarily. It sounds as if you have been diagnosed without the scan though, so you probably won’t need the uptake scan unless you decide to treat your Graves with RAI (radioactive iodine). I-131 is used for the treatment and that does require complete weaning for your baby. Any babies you would have later in life you could breastfeed though.

Stay positive and strong and know that yes, you can continue to breastfeed through all of this with the precautions of TSH testing for your baby and a lower dosage of methimazole (under 20 mg). I believe the dosage for PTU
and safety with breastfeeding is fairly high.

Alexis

[adenure]

#1172521

Here we are! Dr. Hale’s studies & info. on methimazole & PTU. Also, Shirley on the board breastfed her baby through out her journey with Graves as well.

METHIMAZOLE

Trade Names: Tapazole

Uses: Antithyroid agent

LRC: L3

AAP: Maternal Medication Usually Compatible with Breastfeeding

Methimazole, carbimazole, and propylthiouracil are used to inhibit the secretion of thyroxine. Carbimazole is a prodrug of methimazole and is rapidly converted to methimazole. Milk levels of methimazole depend on maternal dose but appear too low to produce clinical effect. In one study of a patient receiving 2.5 mg methimazole every 12 hours, the milk/serum ratio was 1.16, and the dose per day was calculated at 16-39 µg methimazole. This was equivalent to 7-16% of the maternal dose. In a study of 35 lactating women receiving 5 to 20 mg/day of methimazole, no changes in the infant thyroid function were noted in any infant, even those at higher doses. Further, studies by Lamberg in 11 women, who were treated with the methimazole derivative carbimazole (5-15 mg daily, equal to 3.3 -10 mg methimazole), found all 11 infants had normal thyroid function following maternal treatments. Thus, in small maternal doses, methimazole may also be safe for the nursing mother. In a study of a woman with twins who was receiving up to 30 mg carbimazole daily, the average methimazole concentration in milk was 43 µg/L. The average plasma concentrations in the twin infants were 45 and 52 ng/mL, which is below therapeutic range. Methimazole milk concentrations peaked at 2-4 hours after a carbimazole dose. No changes in thyroid function in these infants were noted. In a large study of over 134 thyrotoxic lactating mothers and their infants. Methimazole therapy was initiated at 10-30 mg/day for one month, and reduced to 5-10 mg/day subsequently. Even at methimazole doses of 20 mg/day, no changes in infant TSH, T4 or T3 were noted in over 12 months of study. The authors conclude that both PTU and methimazole can safely be administered during lactation. However, during the first few months of therapy, monitoring of infant thyroid functioning is recommended.

Pregnancy Risk Category: D, D

Lactation Risk Category: L3, L3

Adult Concerns: Hypothyroidism, hepatic dysfunction, bleeding, drowsiness, skin rash, nausea, vomiting, fever.

Pediatric Concerns: None reported in several studies, but propylthiouracil may be a preferred choice in breastfeeding women.

Drug Interactions: Use with iodinated glycerol, lithium, and potassium iodide may increase toxicity.

Relative Infant Dose Range: 2.3%

Adult Dose: 5-30 mg daily.

Alternatives: Propylthiouracil

T½ = 6-13 hours M/P = 1.0
PHL = PB = 0%
Tmax = 1 hour Oral = 80-95%
MW = 114 pKa = 11.64
Vd =
References
1. Tegler L, Lindstrom B. Antithyroid drugs in milk. Lancet 1980; 2(8194):591.
2. Azizi F. Effect of methimazole treatment of maternal thyrotoxicosis on thyroid function in breast-feeding infants. J Pediatr 1996; 128(6):855-858.
3. Lamberg BA, Ikonen E, Osterlund K, Teramo K, Pekonen F, Peltola J, Valimaki M. Antithyroid treatment of maternal hyperthyroidism during lactation. Clin Endocrinol (Oxf) 1984; 21(1):81-87.
4. Rylance GW, Woods CG, Donnelly MC, Oliver JS, Alexander WD. Carbimazole and breastfeeding. Lancet 1987; 1(8538):928.
5. Azizi F, Khoshniat M, Bahrainian M, Hedayati M. Thyroid function and intellectual development of infants nursed by mothers taking methimazole. J Clin Endocrinol Metab 2000; 85(9):3233-3238.

PROPYLTHIOURACIL

Trade Names: PTU, Propyl-Thyracil

Uses: Antithyroid

LRC: L2

AAP: Maternal Medication Usually Compatible with Breastfeeding

Propylthiouracil reduces the production and secretion of thyroxine by the thyroid gland. Only small amounts are secreted into breastmilk. Reports thus far suggest that levels absorbed by infant are too low to produce side effects. In one study of nine patients given 400 mg doses, mean serum and milk levels were 7.7 mg/L and 0.7 mg/L respectively. No changes in infant thyroid have been reported. PTU is the best of antithyroid medications for use in lactating mothers. Monitor infant thyroid function (T4, TSH) carefully during therapy.

Pregnancy Risk Category: D, D

Lactation Risk Category: L2, L2

Adult Concerns: Hypothyroidism, liver toxicity, aplastic anemia, anemia.

Pediatric Concerns: None reported, but observed closely for thyroid function.

Drug Interactions: Activity of oral anticoagulants may be potentiated by PTU associated anti-vitamin K activity.

Relative Infant Dose Range: 1.8%

Adult Dose: 100 mg TID

Alternatives:

T½ = 1.5-5 hours M/P = 0.1
PHL = PB = 80-95%
Tmax = 1 hours Oral = 50-95%
MW = 170 pKa = 12.89
Vd = 0.87
References
1. Cooper DS. Antithyroid drugs: to breast-feed or not to breast-feed. Am J Obstet Gynecol 1987; 157(2):234-235.
2. Kampmann JP, Johansen K, Hansen JM, Helweg J. Propylthiouracil in human milk. Revision of a dogma. Lancet 1980; 1(8171):736-737.

[Bobbi]

#1172522

Having breast fed my babies long ago, I understand completely what you are saying. But there are some issues that you need to confront directly.

The reality is that some mothers in the U.S. do breast feed their babies while on one of the antithyroid meds. I believe in Australia the drug you use is called carbamazole, which is similar to something we call methimazole here. If this is the drug you have been prescribed, it is considered a Class D drug in the U.S., which means that it does cross through to the baby in breast milk. The issue is what dose of the medication the mother is on. It is thought that if the mother is on a dose of 20 mg or less a day, that it is safe for the baby to continue breastfeeding. The recommendation I read is to wait until after nursing the baby to take the medication, in the morning to try to minimize the dose. But of course you will be nursing the baby throughout the day, so I’m not sure how that recommendation plays out. There is no evidence that the drug is safe for the baby if the mother is on a higher dose than that, so the recommendation then becomes that the mother stop breastfeeding.

The second reality is that you must treat your disease. You cannot even begin to think about letting treatment go — even for a little while — in order to continue breastfeeding. Complications of the condition can be life threatening. It is VERY treatable. We do get well again, with our treatments. But left untreated, it can be lethal. Your baby needs a healthy mother.

So, of course you don’t want to stop breastfeeding, but it might be the wisest and most loving thing you could do, if you need a bigger dose of the medication than is safe for your son.

[adenure]

#1172523

Hi again

I agree with Bobbi. Getting treatment is number 1 right now. As my endocrinologist put it, you need to be well for your family. I also wanted to say that I would take Dr. Hale’s info. I posted and talk with your endocrinologist and pediatrician. If your endo. is totally against it, maybe find a 2nd opinion, but I think getting your pediatrician’s okay is important since he/she is your baby’s doctor & we’re talking about the effect the drug will have on your baby. Maintaining a good relationship with your endo. is important as Graves is a journey, and you want someone who you can communicate with and who will hear your concerns and work with you the best way possible. But, yes, if you require a bigger dose of methimazole/ carbimazole than 20 mg. and that is the way you need to heal, then it is very important that you do what is needed to get better. Again, I think PTU dosing is allowed to go higher as far as breastfeeding goes bc it does not secrete as heavily into breastmilk, so if your endo. is agreeable, maybe you want to try that first. My endo. was willing to let me choose between the 2 meds. I went with methimazole bc it’s considered the safer of the 2 drugs for the person taking it (as far as the liver etc…- although not for me- kind of glad I didn’t go with PTU!).

I know my first post might sound like I’m defying your doctor. I just want you to know that, with certain doses and the right circumstances, breastfeeding is possible while dealing with Graves and the medications. But, yes, DO get treatment. That is first and foremost.

Alexis

[LaurelM]

#1172524

Hi,
I’m so sorry you are in this position. It is really an emotional issue to determine what is best for both you and your baby while struggling with hyperthyroidism and treatment options. Without question, you do need treatment.

I was in a similar situation after our first baby. She was 8 months old when I was diagnosed and we were breastfeeding. I was put on Methimazole at a fairly high dose at first and able to taper to a lower dose fairly quickly. I was really freaked out by the thought of using a medication but also heartbroken to give up nursing. My endrocrinlogist reassured me that continued nursing was better for my baby than the very small and managable and reversable risk of exposure. I wasn’t completely convinced and so checked with my baby’s doctor. She was fine with it as well but also consulted the pediatic endocrinologists at our regional children’s hospital. They were also fine with it and all said that the benefits of continued nursing outweighed the risks for us – by a lot. To error on the side of caution, we did monitor her levels at about 3-4 weeks to start and then about 5-6 weeks after that. I have to be honest and say that having to put her through the heel sticks was really hard but they were at least quick. We continue nursing for several months until she decided to wean herself. I also got pregant with our second about that time but that is another story (that has a happy ending as well).

One source I checked is the American Academy of Pediatrics policy statement on the transfer of drugs and other chemicals into human milk. Both Methizmazole and PTU are listed on the table for medications ususally compatible with breastfeeding Table 6.
http://pediatrics.aappublications.org/content/108/3/776.full

With all that said, it may not be safe for everyone, and you should consult with more than one doctor until you are comfortable with whatever you and your medical team decide.

Best wishes,
Laurel

[Kimberly]

#1172525

Hello – This is from the American Thyroid Association’s guidelines on thyroid disease and pregnancy/postpartum:

“The conclusion drawn from these studies is that breastfeeding is safe in mothers on ATDs at moderate doses (PTU less than 300mg/d
or methimazole 20–30mg/d). It is currently recommended that breast-feeding infants of mothers taking ATDs be screened with thyroid function tests and that the mothers take their ATDs in divided doses immediately following each feeding.”

If you are interested, you can check out the full guidance document here:

(Note on links: if you click directly on the following links, you will need to use your browser’s “back” button to return to the boards after viewing. 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

Hope this helps!

[adenure]

#1172526

One thing I felt about the breastfeeding was that it was kind of my connection to “normalcy”. Maybe you feel that way too? Breastfeeding gives you those calming, happy hormones and with all the wacky thyroid hormones, nursing just helped me. So, I can understand wanting to breastfeed- especially through this time. Like Shirley said to me once, “I get it”. So, know that we understand. Getting well is your number 1 priority, but I’m hoping you will be able to do that and continue nursing. Maybe your endo. will be willing to start you on 20 mg. of methimazole; did he say what dose he wanted to give you?

Alexis

[melaluca]

#1172527

Thankyou so much for your insights. This has been really helpful for me to find this kind of information and suggestions, i have now got a good idea how to talk to my GP when i see him tomorrow – as this is my first appointment since being told i have GD. Im also seeing another doctor soon who specialises in hormonal issues, who has after hearing my situation breifly suggested i dont start weaning my son yet.
So i feel quite postive, thankyou to you all for replying.

[GLo22]

#1172528

Hi all… I am a breastfeeding mom, recently diagnosed with GD two weeks ago. I share the same concerns as our dear Aussie friend and would LOVE any updates on your personal experiences nursing while on MMI (methamizole). My MD, endo, and ped MD are all saying it is fine but some personal stories would be encouraging! Thanks!

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