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Hi Christa,
I had been on methimazole for about a year and was well controlled when I became pregnant with our 2nd. (She was ahead of our schedule and still has us running to catch up.) I was switched to PTU and was on a small dose for about 6-7 weeks into the pregnancy (when I could keep it down
). I was able to stop taking it. Apparently I was probably headed to remission and the pregnancy may have sealed the deal. My ‘baby’ is now a happy and healthy 3 year old and I have remained in remission. I didn’t really expect the remission to stick post-partum since I was diagnosed 8 months after our first child was born. In hindsight I am sure the onset was really at about 4 month post-partum. I just assumed all the symptoms were ‘normal’ post pregnancy stuff.I would have to say that I had the advantage of the best possible care for my pregnancy. I was referred to a high risk OB who worked closely with my endo and PCP. That said, being on medication when I became pregnant was still very worrisome. I stressed over the Catagory D rating. I read everything I could find about birth defects with ATDs. I worried about what would happen if my levels went wonky during pregnancy. Would we be able to safely contol it? I read probably too much but learning all I could WAS something I could control. I was also concerned about relapse post-partum. I was kind of waiting for that shoe to drop for a whole year after she was born. I think that if we had been thinking 2nd child right away, I may have opted for surgery. At the time I didn’t want RAI as I was nursing and my endo was very supportive of that.
Everything worked out really well for us. One thing you may want to consider is where your TSI level is currently. This is the measurement of your auto-antibody level. If it is high, you may be less likely to be heading for remission and may have more need for ATDs during the pregnancy. Oddly, I broke out in hives right when we conceived so swapping to PTU was done based on the hives and the potential pregnancy (my blood test to confirm wasn’t back yet but we just assumed I was – it was too early for a home pregnancy test). This also meant that I had only one ATD option should I have needed it. I personally like to have more options than just one.
TSI should also be measured somewhere near the start of the 3rd trimester regardless of what treatment you have choosen. This will give an indicator of the possibilty of Neonatal Graves Disease. This is a very very rare transitory hyperthyroid state for the baby caused by the auto-antibodies crossing the placenta. Your baby’s Dr should be informed of your Graves history as they will need to keep a tad closer eye on the baby for a couple of months after birth. Also, if you need to go back on ATDs after birth, they may want to monitor your baby’s thyroid levels while you nurse. We did this for several months with our first and it was always fine. The American Academy of Pediatrics has published a policy statement regarding ATDs and breastfeeding that you may want to read.
I hope that this was somewhat helpful.
Laurel
Yes I did go into remission. I was plesantly surprised to remain in remission post-partum after our 2nd baby. It has now been almost 4 years off ATDs. For that first 12 months I was kind of just waiting for the proverbial other shoe to drop but it never did. My endo actually ‘fired’ me
and currently my PCP checks my levels once or twice a year. With two small children I wasn’t even reading this board for a couple of years but it was a lifeline at the time I needed it so I started checking back in once in awhile. It had been so helpful to hear from people who had been there and done that.
