[jamie_johnston]

#1019732

Hello! I have a few questions that I’m hoping I can get some advice on…But first, let me tell you about myself. I was diagnosed with GD in 2001 shortly after the birth of my 2nd son. The birth was premature, complicated by gestational diabetes, and my son had to be intubated and spent 10 days in the NICU. My endo blames the stress of that and of being in an abusive marriage for the onset of my GD. I was on Methimazole for 2yrs before going into remission. I was fine for a long time. I went to nursing school, became an RN, got a divorce from my abusive husband and was doing wonderful. My symptoms came back suddenly about a year ago. I lost approx 15lbs from my already thin frame over the Thanksgiving/Christmas holiday, was having tremors severe enough to effect my ability to start IV’s (as an ER RN, that can be a problem ” title=”Wink” /> ), tachycardia, night sweats, hair falling out, insomnia, diarrhea, and mood swings. I immediately made an appointment with my endo and was started back on Methimazole. After discussing the possibility of having another child, he switched me to PTU. I am now on PTU 3 times a day and Propranolol 2-3 times daily as needed. We keep having to play with the dose of PTU, but my symptoms are gone and I feel great. I work full-time as an RN, working 3 12hr night shifts a week. My endo discussed the treatment options with me and I elected to remain on PTU for the time.

So this brings me to my questions… I had a tubal ligation in 2001 and have regretted it ever since. I am now remarried to an amazing man who does not have any children of his own, and we are planning on having a tubal reversal next month. I spoke with the anesthesiologist at the surgery center this AM and she was less than thrilled about my diagnosis (lol). I had anticipated this and had already obtained recent TSH and free T4 levels proving that I am euthyroid. But she is giving me 5 more hoops to jump through before giving the go ahead. I am sure that my endo will give me the green light since he already knows about the plans for the surgery and pregnancy, so I am not expecting any trouble having the surgery done. But after speaking with the anesthesiologist this am, I have been doing research about having surgery while you have the diagnosis of GD. I cannot find ANYTHING but info regarding thyroid surgery. There is nothing that I can find giving any info about having a non-thyroid surgery while having GD. Have any of you had any surgeries while having GD? If so, did you have any complications? And then, of course, I will be trying to get pregnant. There is plenty of info about pregnancy and GD, but there is also a lot of varying opinions. My endo tells me we will just have to monitor my labs more closely, but that I should be fine. Considering my history of gestational diabetes twice, I will almost surely have it again – along with GD. Has anyone else had the fun of these 2 diagnosis at the same time? I have been reading that there is a risk of a thyroid storm during labor and delivery. Does anyone know how often this happens? Is it enough of a risk that a c-section would be warranted? I get the impression from my endo that he would have preferred I had either surgery or RAI prior to my going ahead with the reversal and pregnancy, but I am afraid of the surgery and I didn’t want to have RAI and then get pregnant. Stubborn, I know. But he and my OB/GYN have given me the thumbs up! Anything you all could provide would be greatly appreciated!

Thanks ” title=”Smile” />
Jamie Johnston

[Ski]

#1073746

Hi Jamie,

I can’t help with the surgery questions, so I hope someone else will jump in if they’ve had a separate surgery while being treated with PTU.

As for the pregnancy, from what I understand, our immune system typically "rests" during pregnancy, in part I guess to protect the fetus (keep the body from thinking the fetus is a foreign object to fight), so you may find your symptoms/levels actually getting better on their own as you progress through a pregnancy. I have not heard of any particular risk of thyroid storm during labor/delivery, but we do hear about a lot of women whose GD symptoms accelerate after delivery (days or weeks after delivery, I mean). Presumably that is linked to the immune system "waking up" again after the pregnancy is over.

This is bound to be a tough road for you in all respects, so do all of your research and make sure you’re in the best possible position to handle ALL of the steps you need to take in order to accomplish your goal. You may want to assemble a team of doctors who are all in touch with each other ~ surgeon, endocrinologist, pediatric endocrinologist ~ so they can come up with the best possible solutions for you.

[DianneW]

#1073747

I had two surgeries with undiagnosed GD, within six months of each other. They were both 4-hour surgeries under general anesthesia, and I had absolutely no complications. I was in my early 40’s at the time. My GD diagnosis was made about six months after the second surgery, but there was no doubt in retrospect that I had GD (and was hyperthyroid). If I did okay, it seems like since you’re euthyroid, surgery for you would be safer than it was for me. What is the concern of your anesthesiologist, anyway?

Your doctors would at least have full knowledge of your condition and be prepared for the rare event of complications during the reversal of sterilization.

Many women choose to give birth while in remission or while on ATD treatment, with their doctors’ blessings. I wish you all the best, both for the reversal and for a healthy, safe pregnancy and delivery!

[jamie_johnston]

#1073748

Thank you both for your insight. I think the concerns that the anesthesiologist had were related to the rare possibility of a storm while in surgery and the fact that they are just a surgery center and not in a hospital should there be any issues. Between myself and my endo, we apparently convinced her that I was stable enough for the surgery because she call me on Friday morning and said that the head anesthesiologist had approved me for the case. So, we have the reversal scheduled for March 12! We are very excited! But because of all of this questioning related to my GD, my husband has started researching and finding things that he didn’t know (and that I didn’t tell him ) and is becoming very worried. Now I have to convince him that everything will be fine! Lol, at least we have the surgery scheduled and we can move to planning our family ” title=”Very Happy” /> . Thanks again for all your info. I’m really relieved to know that you, Dianne, had 2 surgeries and did not have any difficulties! I will keep you all posted!

jamie

[mamabear]

#1073749

Jamie, welcome.

I was told to have RAI done as well and opted not to. But I was LUCKY and took well to PTU and have not had too many issues. THere are many that even though they do well go in and out of remission and of course the possiblity of thyroid storm. Your new husband should be concerned and you should give him all the info you have compiled so he can also make the choice to continue this quest to have a baby. I am not saying don’t try but I am saying that you should not hold back anything from him and make sure you both know the same exact facts so both of you can say yes or no. You already have a child to take care and it wouldn’t be fair to put yourself in danger and your child wonder what is wrong. It is not an easy road… you will still have to wait for the dr. to give you the ok to try to have a baby and please head their warnings of waiting the proper time. You do not want a problem or tubal problem along the way.

You might once you become pregnant need to go off of your PTU because your levels might rise to high and risk of misscariage might happen again your endo will help you there with testing you often.

The risk of Thyroid Storm after your delivery is something to think about it. You need to know your symptoms and know that at any sign of tremor or forgetfulness (out of the ordinary lol) that you shouldn’t hesitate to get a TSH level.. Any sign that you are feeling like the wheels are turning in your body ( that is how I describe it) or you feel the (crazies) coming on you again need to get bloods drawn. Even the simpliest thing like getting the baby’s bottle and you get the formula and you get the scoop and you feel like you are shaking again go get a blood test. THese little things are things that you learn about yourself (yes I have been there) and you have to go with that and get your tests done.

Please also find out about his family history because your Graves disease is hereditary and can be passed on to your children so please find out about his side as well so you have a good idea of what you might be up against.

Treat your hair well during this time and your skin as well. Good luck with this.

[Author]

Posts