[msturgis]

#1059856

I am newly diagnosed with Graves and have been on PTU for one month. I live out of the country so this is all very tricky. I am in the States now and have seen a good endo and explained my situation. I am 41 with a toddler and we want to get pregnant again as soon as possible my egg count is now low (we lost 2 pregnancies last year). He said because of my situation of being out of the country where he couldn’t monitor me while pregnant, and with my age, he would recommend either RAI or surgery. I was not expecting this and don’t know much about the pros and cons of either (I printed out the link from this site with the info) and am just in town for 2 weeks so need to decide soon.

He said I shouldn’t have been on PTU and that ended anyway, and he prescribed me Meth for if I decide to continue with meds, but I asked him if he and his wife were in this situation what would be tell her to do and he said surgery. He said he rarely recommends surgery (a he is not the surgeon) but in this case that or RAI would be the best to get past this fast and then try to get pregnant. And also because if I was on meds and trying I would have to move back to the States and that is not an option for a few more years with my husband’s job.

So it looks like those are my two options…any advice from those who have done one or the other?

Thanks!!!

[snelsen]

#1178303

Hi, it just happens that I wrote a rather lengthy post this morning which touches on quite a lot of your concerns. It is the one right above your initial post, I think the title is “how not to obsess about GD and tEd”
It especially addresses your interest in getting pregnant asap. There is a lot more time to wait after RAI for trying to conceive than after a thyroidectomy.
Of course, there is a little time to get the right hormone replacement dose, but after that, you are good to go.

I think your endo had good thinking,and it pretty much reflects what I just said.

Not sure what county you’ll be in, but you definitely should find a good OB doc, maybe a high risk one, with your history, and have good communication between you endo and that doc. You will need thyroid labs while you are pregnant.

So- mine is just a beginning of the responses you will receive.
I suggest you ask the US endo, for names of the above named docs in the country where you’ll be. he/she may or may not be able to help you with this.
If you don’t mind saying where you are, there might be someone on this forum who is already there.
Shirley

[Kimberly]

#1178304

Hello and welcome! Wow, this is an already difficult decision, and I’m sure the international travel further complicates things! Hopefully, you will hear from some of our other members who have had to make a decision regarding treatment option and future pregnancies.

The attached guidance document from the American Thyroid Association will hopefully be of interest. The section on Graves’ and pregnancy starts on page 1094 of the original journal article (or page 14 if you download the document as a PDF).

(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

We’re all fellow patients here, not docs, but a few thoughts…

Regardless of which treatment option you choose, you will ideally want to get your levels stable before trying to conceive, as it’s safest for you and the baby if you are not hyper *or hypo.

Anti-thyroid drugs can be used during pregnancy, although the preference is to use PTU during the first trimester. Although Methimazole has a better safety track record with regard to liver side effects, it is associated with a higher risk of a couple of specific birth defects if used during the 1st trimester.

I’m not really sure I understand the doc’s comments on monitoring. Maybe he is saying that he doesn’t want you to start on a particular dose, if it might take a while to get a follow up done at home to see if you need a dose adjustment? *All* three options require close monitoring of bloodwork to see if dosing (whether with anti-thyroid drugs or replacement hormone) needs to be adjusted.

With RAI, there is a recommended waiting period before trying to conceive of at least 6 months (some docs will say 12 months).

You might also want to discuss antibody testing with your doctor. The above guidance recommends testing antibodies in *all* pregnant women with history of Graves’ at the 20-24 week mark, with the involvement of a maternal-fetal specialist recommended if antibodies are extremely elevated. This is especially important post-RAI, as antibody levels can become elevated post-treatment.

Take care – hope that this helps!

[adenure]

#1178305

Hi!

I agree with your doctor. If you want to have another baby as quickly as possible (and you’re not going to stay on methimazole or PTU), then you need to choose surgery. Methimazole is NOT safe for the 1st trimester (when all the organs and bodily systems are devleoping). It is okay for the 2nd and 3rd trimesters though. PTU is preferred for pregnancy. It sounds like you’re going to choose between RAI and surgery though. Once you have surgery, you should wait to conceive until your thyroid levels and your Synthroid dose is stable for a few months so as to have a healthy pregnancy. I was stable 2 months after surgery. I needed one dose increase 6 weeks after surgery. My levels were stable 2 weeks after that. I’ve been on the same dose for 6 plus months now and am doing well.

RAI, on the other hand, will take longer. It will take some time for your thyroid to actually “die out” so to speak. Also, once you’re hypo, you’ll have to go through the same process of getting your Synthroid dose correct. On top of that, people who have RAI are supposed to wait 6 months to 1 year to conceive following RAI because of the radiation risk to the baby. So, I would opt for surgery if conceiving sooner than later is your goal.

I had surgery for many reasons. I was breastfeeding (still am), and didn’t want to be away from my family. I also wanted to be “done with it” so to speak. I didn’t want a “dead” gland in my body and I was nervous about possible TED implications with RAI. Also, just wanted to avoid radiation.

I am happy I had surgery; it was a very good decision for me. The most important thing is to find a surgeon who is very experienced and does a lot of thyroidectomies with a low if any complication rate. Good luck!

[adenure]

#1178306

I think Kimberly and I were posting at the same time- hee hee!

[msturgis]

#1178307

You guys are so helpful, thank you thank you! I was leaning towards surgery and now I feel much better about it- I just wanted to make sure I was not missing something. I posted on the Babycenter.com forum on thyroid issues too (where I have formed a relationship with a couple of girls) and everyone had similar responses.

We live in Trinidad, in the South Caribbean off Venezuela. We moved there last year from Brazil, where the healthcare is topnotch and where we had our first child. There is only one endo there who is properly trained (in the UK) and she is still not that great. She did diagnose me with Graves and was right, and I suppose I can use her as backup. But my doc here will handle my dosing and monitoring and I will email him all of my blood test results. am seeing one other endo today for a second opinion and then choose.

My good friend with Hashi’s came over last night (we are in Houston now, where I am from so if anyone knows of great endos here I would be willing to get a third opinion!) and hers was totally eaten away and is now gone and she said she has no symptoms or side effects from meds, etc so that made me feel better too.

And can’t see your posts here now that I hit reply so if I forgot something let me know! I printed out the info on the link and am going to read it right now. Thanks again!

[Author]

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