[LaurelM]

in reply to: Graves’ treatment prior to pregnancy… #1169865

One issue that I don’t really see addressed in the above discussions is that if there is a flare up post-partum (which is highly likely) then it will require treatment at that time. You need to factor into your decision that treatment cannot wait until a baby is weaned. If you are planning on nursing, RAI will interrupt it (at least temporarily if not permantly). ATDs MAY be a choice for a nursing mother but there is a small risk of passing the medication throught the breast milk. I was able to continue nursing but we had to do regular blood work on my infant to ensure her thyroid levels were not being supressed.

My daughter is now a healthy 7 year old but I wouldn’t choose that route if I were planning a pregnancy again. It was very stressful at the time.

Best wishes as you make this difficult decision.

Laurel

[LaurelM]

in reply to: Pregnant and questions! #1169203

I’m sorry that you received that kind of response. If your Dr. gave you the OK, then I

There is always a rare (very, very, very rare) possibility of of the auto-antibodies crossing the placenta during pregnancy and causing a transient period of hyperthyroidism in the baby. This can happen regardless of the type of treatment the mother received (or is receiving if taking an ATD). And, it can happen at anytime including years after treatment and in mother’s who have been at normal thyroid levels for a long time. Because of this posibility, it is important for your OB AND the newborn’s Dr to know of any maternal history of thyroid (esp. Graves) disease. You new baby will be monitored just a little more closely for a couple of months post-partum to ensure all is well.

As I said, it is very, very, very rare. My post-Grave’s ‘baby’ will be 5 in a couple of weeks. She is happy and healthy and I can’t believe how quickly the time goes!

[LaurelM]

in reply to: Pregnant and questions! #1169201

Congratulations!

I think as long as you and your OB are comfortable with each other and that there are good lines of communication between your OB and your endo then you don’t have to have a high risk OB. Mine was but it just worked out that way. I’d had a difficult birth with my first so the two issues together got me sent to the high-risk OB. My pregnancy turned out to be very boring for my OB. ” title=”Very Happy” />

I would recommend that you get your levels checked soon. It’s better to error on the side of caution. The changes that occur for thyroid demands occur early in the pregnancy and you are right to want to be on top of it.

Best wishes for healthy pregnancy and little one!

Laurel

[LaurelM]

in reply to: Nursing while taking methimazole and intense vertigo #1169278

Hi AshleyLL,

First of all, congratulations on your little one! You didn’t mention how old your baby is. Sometimes the age & weight of your baby may factor into the recommendations for continued nursing while on Methimazole. In general however, it is considered generally safe by the American Academy of Pediatrics. They have produced an official policy statement to that effect. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 You will find Methimazole in Table 6.

I certainly understand your concern. I was a bit of a wreck (understatement) about being able to nurse safely. As it turned out, I was able to safely continue nursing my baby for several months while taking Methimazole. My endo told me the meds were safe. My baby’s Dr. also checked with the pediatric endos at our regional children’s hospital. They all concured that continued nursing was safe and encouraged. To error on the side of extra caution, they did check our baby’s thyroid levels at 4-6 week intervals for a few times (via a heal stick). There was never an issue. She is now a happy and healthy almost 7 year old.

I do echo the advice to check with your doctors regarding the dizziness. I hope all goes well.

Laurel

[LaurelM]

in reply to: New to Graves #1169538

Hi Again,

No mention of the dosage affecting the BF recommendation was mentioned. I was on a fairly high initial dose but was able to taper down fairly rapidly. I only had to take it once per day (which was awesome as my memory was shot). Initally they checked my daughter’s thyroid levels every 3-4 weeks (by heel stick) just to be super cautious. As my dose decreased, the interval lengthed considerably. She weaned herself between 13-14 months. I was also newly pregnant in the meantime and switched to PTU for the 1st trimester. My second baby nursed until she was 2 1/2. She was much more attached to it and since she had a dairy allergy, it made life easier. At 6 weeks old, we noticed she was having intestinal bleeding and I had to go dairy-free. She still has not out-grown it. Rats!

Had I known we would be pregnant again so soon, I likely would have opted for the surgery as I didn’t like being on medication during pregnancy. I was able to stop taking it by about 4-6 weeks in but it was a big worry. We were all pretty sure that the GD would come back again post-partum and I would again have to make a treatment choice. Unexpectedly, I have maintained a remission.

The benefits of breastfeeding do continue past the first year. The World Heath Organization officially recommends up to 3 years of age. The American Academy of Pediatrics officially recommends at least one year. So, 12 months is the minimum recommendation – more is better (for both baby AND mom and there is a preponderance of science to back up those recomendations).

You will still have to weigh what is best for you and for your child. Nobody can make this difficult decision for you and it totally sucks that you are in this position. I get it.

Laurel

[LaurelM]

in reply to: New to Graves #1169536

Hi,

A possibility would be to ask if you could try to switch to Methimazole to see if you tolerate it better. I was diagnosed post-partum (8 months) and breastfeeding. I was started on Methimazole. Luckily for me, my endo was supportive of continued breastfeeding. My baby’s Dr conferred with the pediatric endos at our area children’s hospital who also supported continued nursing. I think I live in a region that is generally more supportive than many other areas of the country.

Surgery can also be a breastfeeding supportive option. It would only require a few hour break from nursing. Some of the newer advice is a short as 2-4 hours post-op. The old school advice is 24 hours. Doctors will vary in their recommendations but you should research this for yourself so that you can make an informed decision.

The worst option is not getting treatment. It is important to your child to have a healty and happy parent and in the Graves emotional roller coaster and brain fog, it can be difficult to see the long term goal when the present is so chaotic. It will get better and the difference is night and day.

Best regards and congratulations on your little one.

Laurel

[LaurelM]

in reply to: Pregnancy with Grave’s Disease #1061184

Hi,

I was 8 mo postpartum with our 1st baby when I was diagnosed. I too started Methimazole which I was on for about a year when we got pregnant with our 2nd child. By then I was on a low dose, stable, and doing well. We had planned on having a second but hadn’t planned to conceive while still on the ATDs. I was switched to PTU which I was able to discontinue at about 6-8 weeks into the pregnancy (I wasn’t keeping much of it down anyway). My endo thought I was probably heading into remission and the the pregnancy just helped to calm my immune system down that much more. We were however expecting to see the Grave’s come back again post-partum which would mean making a treatment choice again. I have been lucky and have remained in remission for about 5 years. Both my kids are very healty and happy tots who run me ragged some days.

The 12 months post-partum period is something you need to think about when making your treatment choices and pregnancy planning. I personally would have preferred to have had the surgery knowing that we would have our second fairly close to our first. I did not like the idea of being on an ATD especially during time when the baby’s thyroid gland is forming and starting to function. I, of course, also worried about taking a medication that might have a potential for a birth defect (both PTU and Methimazole are in this catagory but PTU is preferred). The research on that however seems to be uncertain. They are not sure if the birth defects are due to being hyperthyroid during pregnancy or due to the medication.

Another concern is if you want to breastfeed. Both ATDs will pass through the breastmilk. This also caused my hyperthyroid anxiety ridden exaused post-partum new mommy hormone wacked out psyche a bit of a freak out. All our Dr.’s (my endo, our family Dr, and the pediatric endo who was consulted) assured us that it should be fine and that the continued nursing benefits far outweighed the small risk. Our 1st baby however did have to have thyroid levels monitored periodically (a quick heel stick every few weeks) as a precaution that her thyroid levels were OK. However, just because we were able to continue breastfeeding on an ATD does not mean that everyone can. The recomendation may be influenced by the baby’s size and the size of the dosage. Being hyperthyroid also decreased my milk production – not fun.

That said, everything has worked out well and all my worry at the time was for naught and I have two fantastic kids and I feel great with a functioning thyroid. On the other hand, I have a friend who had thyroid cancer in her 20s, had a complete surgical removal AND the much bigger dose of RAI that cancer patients recieve. She now in her 30s takes replacement hormone and she has a healthy toddler.

Whatever you choose, they will want to follow your thyroid levels closely during and after your pregancy. The ideal thyroid levels change during pregnancy and lactation so if you are on ATDs or replacement, dosages may need to be adjusted accordingly. Also make sure that your newborn’s Dr knows of your Graves history. They will keep a close eye out for an very, very, very, very (did I say very?) rare complication of the baby being temporarily hyperthyroid in the first couple of months after delivery. Even if you have been treated and your levels are normal, the autoantibodies may still be present and can cross the placenta causing the newborn to be temporarily hyperthroid. Super, super rare but still something to be aware of.

I hope my story helps some. This board was a lifesaver for me so I still check in once in awhile.

Laurel

[LaurelM]

in reply to: Postpartum and Graves #1061481

Hi Erin,

I was 33 and 8 months postpartum when I was diagnosed but in hindsight, I had probably been hyper for 4-5 months before I finally went to see my Dr knowing that something was wrong. I too was nursing and wanted to continue. My endo also started me on Methimazole. I started at a fairly high dose but was able to taper down after just a few weeks. My endo had no problem with my continuing nursing and was very supportive of it. My family Dr (for me and baby) consulted with the pediatric endos at our regional children’s hospital and they were also supportive of the continued nursing without restriction (no pump and dump). The only suggestion was to test our baby’s levels periodically (a heel stick was all that was needed – not fun but relatively quick). They tested at her at 4 weeks of me on the meds and then about at 8 week intervals for 2 more times.

I was still on the Methimazole when we got pregnant with our 2nd (Mother Nature brought her ahead of our shedule ” title=”Wink” /> ) My endo switched me to PTU ASAP – not that it mattered much as I wasn’t keeping much down. My levels were good so we stopped it altogether about 6-8 weeks into the pregnancy.

Suprisingly, I have stayed in remission after the birth of our 2nd and I am feeling great. Our 2nd is now 4 1/2. Both kids are happy , bright, and very healthy. It has worked out really well for me. I am aware that it is a remission so there is no guarantee how long it will stick around and I’ll have to make another treatment choice. I will also say that it was still a little worrisome starting a new pregnancy while still on the ATD even though my endo and OB seemed to totally relaxed about it. If I could have forseen the future, I might have gone for the surgical removal with a toddler at home and an upcoming pregnancy. On the other hand, like I said, I’m still in remission and I feel great.

I just wanted to share my story with you as there are a few similarities for where you are now in treatement. I will say that after 2-3 months on the beta-blocker and the Methimazole, I was better able to process information and make better informed decisions. I too became an information junkie. I read books and every scholarly article I could find (trying to discrimate for reliable sources – there is a lot of bunk out on the internet).

I hope this is somewhat helpful. It’s tough having the pressure and uncertainties of being a first time Mom regardless; Grave’s postpartum is a doubly whammy.

Take care of yourself (get extra help when you can) so that you can take care of your little one.

I’d be happy to answer any questions about my experience.
Laurel

[LaurelM]

in reply to: Looking for the light (Introduction) #1061607

Hi,

That is a lot of stuff to deal with all at once. Your body has really taken a hit. You have had back to back stresses. Don’t forget that even though the pregnancy was eptopic, your body still treated it as pregnancy and now as post-partum and you have all those hormone shifts in addition to the shifting thyroid hormones to deal with. Double whammy. Hopefully you can get some extra help right now with your little one or shopping or the house or whatever else is on your plate. You will eventually recover. It will feel like it takes a long time but it will happen. In the meantime, be sure to keep the lines of communication open with your Dr. Make sure s/he knows about all your symptoms as they may be able to help you mangage some of them. I really hope you are feeling better soon!

Laurel

[LaurelM]

in reply to: The past 2 days I can’t stop crying #1061794

Hi,

It was actually the frequent bouts of crying (which just isn’t me) that finally drove me to see my Dr. (I was ignoring all the other symptoms as being normal post-partum issues). One day at work I was just sitting in my office with the tears just streaming down my face and I couldn’t stop and I didn’t know why. I knew that wasn’t normal so I left work early and saw my Dr. Luckily she checked my thyroid numbers (and heartrate, etc.) before assuming it was PPD. The next day she had my results and called me, got me started on a beta blocker, and an appt. with an endo a few days later. The beta blocker seemed to help control the crying some but it wasn’t until I had been stabilized (on ATDs) in the normal range for 2-3 months that I felt mostly like my old self emotionally. Within about a year, I felt completely like my old self and continue to feel great.

The floopy feelings will subside with time and stable normal numbers.

I hope that helps some.

Laurel

[LaurelM]

in reply to: Managing stress and diet #1062404

Hi,

I think Yoga can be great way to reintroduce activity. I’ve been doing Yoga on my Wii as I haven’t figured out how to juggle getting to a class with young children. I think it is a good start but having an instructor to help you with correct form would be useful and does give you some ‘me’ time.

Tai Chi might also be a good option. I used to take a 45 minute class on my lunch hour. It is another activity that you push your body only as far as feels comfortable. It would make me feel comfortably warm but would not make me all sweaty which was good since there wasn’t enough time to shower before I had to get back to my office and look professional. For the rest of the day, I would feel energized and relaxed.

So sorry you have been feeling so nauseated. My suggestion would be to try some the whole fruit popcicles like Breyers Pure Fruit bars or make smoothies to sip. My favorite easy recipe for smoothies is to blend some non-fat plain yogurt (or whatever flavored stuff I have on hand) with a little fruit juice, banana (optional), and frozen fruit (whatever sounds good – strawberries, blueberries, peaches). Kids love them too! You could also check the healthfood store for powered protein and vitamin supplements. When my roommate broke her jaw playing softball and had her jaw wired shut for several weeks, she had to get creative.

Good luck! I hope the nausea eases soon.

Laurel

[LaurelM]

in reply to: it’s back…so I’m back…post-partum :( #1062460

Hi Emily,

I don’t know if you can find my old freaking out posts when faced with the breastfeeding issue. They are on the old bulletin board.

I was 8 months post-partum & breastfeeding when I started Methimazole. My endo knew I was BF and was supportive of my continuing to do so. My baby’s Dr checked with a pediatric endo at our well respected area children’s hospital. They agreed that the benefits far outweighed any risks for us. We did set up a schedule to have our baby’s thyroid levels checked. That part was no fun as it does involve a heel stick.

Both PTU and Methimazole are listed as medications usually compatible with breastfeeding according to the American Academy of Pediatrics policy statement http://aappolicy.aappublications.org/cg … ;108/3/776

I can’t say that my experience can be applied to everybody. They may factor in the size/age of the baby and the size of the dose when considering their advice. I don’t know but I was started on a moderately large dose and tapered down rapidly.

My ‘baby’ is now in Kindergarten and doing great.

Hope that helps some.

Laurel

[LaurelM]

in reply to: Deciding to have a baby #1062793

Hi,

Like ely2009, I didn’t really decide to become pregnant with our 2nd when we did. We had always planned that we would probably have two but mother nature sent her ahead of our schedule. I was likely already in remission or just on the verge like ely2009 when we discoverd the pregnancy and I was switched to PTU but was only on ATDs for about 1 month (or less since I really didn’t keep much down my first trimester) before I stopped taking it.

I had a medical team of my endo, a high-risk OB, and my family (also our children’s) Dr who all communicated and followed me closely. I had a nice & boring (my Dr’s description) pregnancy and birth. The nurse got the do the ‘catch’ the second time as my OB did not make it in time – I didn’t even have to push.

In my case, we suspect that the GD was triggered post-partum with our first. I was diagnosed 8 months after her birth but in hindsight had probably had it for at least 5 months prior to diagnosis. I just chalked up all the symptoms to new-motherhood, long commute, stressful job, etc. I was on Methimazole for about a year (my memory is getting fuzzy for the exact length).

Any woman who has had GD and becomes pregnant does need to make sure that she has the right doctors and that they know about the GD history so that they can just keep a closer eye on the pregnancy. There is a super rare, rare, rare possibility the baby having a transient hyperthyroid state at or shortly after birth. One test they may do in the 3rd trimester is a TSI as an elevated TSI (even if the mother’s thyroid levels are normal) indicates the baby as a slightly elevated risk for this happening. All babies have the thyroid levels checked anyway. Again, a very, very, very small risk.

I was pretty much resigned that I would fall out of remission after our 2nd baby so I really thought about what kind of treatment I would want considering I would have two small children and wanting to be able to breastfeed. I was still nursing our first when I was put on the ATD. My endo wanted me to be able to continue nursing. My endo, my baby’s Dr, and a pedicatric endocrinologist all agreed that for us the benefits outweighted the risks for continued nursing while on the ATD. RAI would have forced switching to formula. Different Drs will have different opinions about ATD use and nursing and individual circumstances will factor in.

Prior to our second baby’s birth, I decided that if I came out of remission post-partum, I would again consider ATDs or a surgical thyroidectomy. Also, knowing that you are at risk, they would check your levels frequently so you have minimal time at hyper levels. Now that my children are older (4 & 6) if I were to fall out of remission, I’d consider all 3 options.

Anyway, my advice would be to talk to your spouse, your dr, find a high-risk OB, and find a pediatrician or family MD who you trust to be your medical team and get all their opinions and their advice.

Best wishes!

Laurel

[LaurelM]

in reply to: Want to have baby #1062980

Hi,

I also had Graves following my first pregnancy and went on to have a healthy second baby. I was still on ATDs when we conceived. The pregnancy or the ATDs put me into remission in my 1st month of pregnancy. I was sure it was going to come back post-partum but I am still in remission.

You can search for more of my posts/responses using my user name. I’ve written some lengthy responses about my experience. If you have more questions about my expirence that I didn’t cover in those other posts, I’d be more than happy to answer them!

It will all work out – eventually.

Laurel

[LaurelM]

in reply to: Hard to get pregnant long after RAI #1063224

Hi Amanda,

I can tell you about a friend of mine who had thyroid cancer in her mid-twenties. She is now in her late 30’s and has a beautiful and healthy 1 year old son. For her cancer treatment, she had a much higher dose of the RAI than Graves patients receive. She was required to stay in a special hospital room for a couple of days for radioactive patients. She also had her thyroid surgically removed. Because she has NO thyroid left, she takes replacement thyroid at a dosage that keeps her euthyroid (normal thyroid level). When she and her husband were ready to try for a baby, it did not take any longer than typical. When she was pregnant, they frequently checked her thyroid levels to adjust as necessary.

A reproductive endrocrinologist can be a useful specialist if pregancy remains elusive. There may be other issues going on not related to Graves.

Keep us posted.

Laurel

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