[Bobbi]

#1075323

Hi, Janet:

I cannot answer all of your questions, but I can give you some facts to digest to help your daughter make her decisions (or you, if your daughter is a minor).

Your daughter’s thyroid is permanently diseased. While it is possible for remissions to occur (in 20-30% of patients who go on ATDs), these are, by definition, temporary and of predictable duration.

Whether or not there is a flare-up during a pregnancy is not predictable. Pregnancy is one of the times when it is more common for Graves to appear, so it is always possible for a woman who already has Graves to experience a flare-up. If there IS a flare-up during a pregnancy , both your daughter and the baby are put at increased risk. It might be a slight risk, or it might be a greater risk — no one can tell you in advance. Women have had successful pregnancies while on PTU, but whether or not it is safe for the baby depends upon the dose the woman needs to keep her thyroid levels in check. PTU does cross the placental barrier. And it exists in breast milk is small quantities as well. THe levels might be tolerable for the child, or they might not.

Assessing the potential level of risk to mother and child needs to be done by your daughters’ doctors, and perhaps a pediatrician. No one online can give you those "best guesses."

I wish you and your daughter good health,
Bobbi — NGDF Online Facilitator

[sjharner2001]

#1019968

Hi There!
I’m looking into the future for my daughter with Graves. Since she has graves, does anyone know if she will HAVE to have RAI before trying to get pregnant? So if she goes into remission with meds will she need to have RAI to prevent potential Graves’s flare up with pregnancy?
THanks for your help! I’m glad I have you folks to turn to!
Janet

[cathycnm]

#1075324

Janet – I agree with all Bobbi has said. As a nurse-midwife, I have seen some women struggle with fertility and miscarriage with thyroid issues. Still, the sickest thyroid patient I ever saw as a practitioner was in full blown storm when she came in for her first OB visit during the first 3 months of pregnancy. She had not been diagnosed before that day – here I was doing her exam when suddenly it clicked what was going on. I got her to the residents who admitted her to get this under control. Everyone predicted she would miscarry – but she carried to term and had a healthy baby.

In addition to a pedi, I might suggest you talk to a OB or better yet a perinatologist about what we know about thyroid in pregnancy – this will give you a heads-up about current research so you can anticipate what your daughter will be facing. My best to you! Cathy

[sjharner2001]

#1075325

Thanks for the information and reassurance I was looking for! I appreciate your help.
Janet

[mitchell24]

#1075326

This is my first posting. My question is for anyone that may have been in this situation. A few days ago I saw my endocrinologist for a "clean bill of health" to begin having a baby. Well, after 11 months in remission, my Graves is back. I am back on medication until I can decide about having the RAI. Does anyone know how long in real life people are having to wait until they can begin getting pregnant after having RAI? I know what the doctors say, but they only have an arbitrary number. My husband is a Radiologist and cannot tell me exactly why the Nuclear Medicine people say 1 year and some say 6 months. Has anyone been in this situation or have any information? I guess I was VERY crazy to believe that I had actually beaten the disease.

[Bobbi]

#1075327

I cannot give you the definitive answer you are looking for, but I can explain a bit about what is going on with the different recommendations you have been given about how long to wait after RAI before getting pregnant.

There are two basic issues, that work together to make waiting prudent. The first, of course, has to do with any radiation exposure to the ovaries. Waiting through six to twelve months of menstrual cycles uses up eggs that were "mature" or close to mature at the time of the treatment. It is a precaution, because there is a possibility that as RAI is eliminated from the body via the kidneys and bladder, some radiation could affect the more mature eggs. It is not thought to affect those eggs which are not ready to be released. As to why there is no agreement among professionals? Your guess is as good as mine. If there were detailed clinical studies available, I would assume there would be a fair level of consistency between the advice given. This is not, however, something that has been studied with control groups, double-blind, etc., so I think the estimates we patients are given when we ask the question is the doctor’s best guess.

But, second, and also very important is the issue of your health. It can take a good six months at the very least for us to get regulated on thyroid replacement hormone, and many of us take longer. Our bodies begin to heal once we are on a dose of replacement hormone that is reasonably close to what we need . Prenancy puts strains on the body, so it is preferable that we be in good health when we become pregnant. OUt-of-whack thryoid levels can cause problems during a pregnancy, so being stabilized is a huge help. You might regulate onto replacement hormone faster than someone else — or slower. It is wise for you to wait until you’ve got reasonably good health back, and stable thyroid hormone levels, and that means probably a good 9 months if not a tad longer. You being healthy going into the pregnancy is going to be a huge help to both you and to your baby.

Bobbi – NGDF Online FAcilitator

[DianneW]

#1075328

Just a comment in addition to what Bobbi said. Some people take even LONGER than 6-12 months following RAI for replacement hormone to be regulated. In these cases it probably wouldn’t be advisable to become pregnant until the patient attained a stable dose and had some time for her body to heal. In my case, this process took four years. For this reason, thyroidectomy is another option to consider for women who want to avoid the risk of waiting to start a family.

Dianne W
Online Facilitator

[Ski]

#1075329

Bobbi and Dianne have given you the best possible information to consider ~ I just wanted to point out that since you have been in a remission for nearly a year, you may find the process to "normal" a little easier, no matter which treatment you choose, because hopefully at this point you have not been hyperthyroid for very long. You also probably have a good idea of what your own personal "normal" thyroid hormone level IS, which makes it easier to dial in. Do remember that you will need at least six weeks between thyroid hormone replacement dose changes (when you get to that point), so even though you know where you’re headed, it may take a little while to get there.

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