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That’s a REALLY tough call to make, and it has a lot to do with your own emotions, so I wouldn’t take advice from anyone on this topic, truly. It’s your decision completely. You sound like you know a lot about your options and the risks and benefits of each, so let me see if I can just clarify a couple of things for you.
First, I always thought remission was ANY period of time without medication where your levels remained normal. Not so, we were told at this conference. Remission is actually defined by a period *longer than one year* where you are off medications and your levels remain normal. So, suggesting that you are headed for remission at this point MAY be premature. You may have just hit a level of medication that works perfectly for you, which is no small achievement, I know!
Methimazole is very much discouraged for pregnant women, due to several birth defects it can cause, and lower doses are something you can talk about with your doctors, but I’m not sure the science is in to say that doses below a certain level can be classified as "safe." One of the doctors at the conference was asked this very question, because PTU is recommended for pregnant women, but it can produce liver damage in the mother and has been discouraged, in general, for everyone lately. This doctor suggested using PTU in low doses for the first trimester of pregnancy, because that is when the fetus is most at risk from methimazole, then going back to the methimazole in the fourth month of pregnancy. Now, the fact that you’ve been on PTU and had a severe side effect IS a concern, so that’s something you’d have to discuss VERY frankly with your doctors ~ I would include not only your general practitioner, but also your endocrinologist, AND a high-risk ob/gyn. The really tough part, if you tried to manage it this way, would be knowing when you’re in the first trimester, as that’s a particularly "iffy" time for a pregnancy in many ways. It is POSSIBLE that you would not react to the PTU the same way as you did the first time, FYI, but that’s a really big risk to take, I understand that.
Typically the antibodies "quiet" during pregnancy, because your body is trying to protect the new "foreign body" (your baby), so low doses DO generally do the job at that time. Antibody levels tend to escalate rather quickly after pregnancy, so your thyroid levels should be carefully monitored throughout, and after, the pregnancy.
Now, if you WANT to do RAI so you don’t have to suffer this dance during the period of time you’re also trying to get pregnant and going through a pregnancy, that’s certainly a valid option. You’d need to wait for six menstrual cycles to pass before trying to get pregnant, and you’d also want to be fairly well regulated before trying to get pregnant. Your chances for a successful pregnancy are better once you have achieved a stable thyroid hormone level.
It’s POSSIBLE that thyroid surgery is a good option for you, simply because you know you’re hypo sooner, and you can achieve stable levels more quickly, plus you don’t have to wait the six cycles (if you get regulated that quickly).
This may not be helping much.
” title=”Very Happy” /> Good decisions come from having the best possible information, so I really hope these points help guide you. Make a list of things that are important to you, including timelines for getting pregnant and having the new baby, and the picture should start to form as you go through that process. Include your doctors in the process as well, I know you’ll be glad you did.
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