Just diagnosed - best treatment options when trying to conceive
Last Post 15 Nov 2019 03:54 PM by Elaine Moore. 1 Replies.
Author Messages
MamabooUser is Offline New Member New Member Posts:
07 Nov 2019 07:58 PM

    Thank you Elaine for running this forum - what a great resource! I was just diagnosed with Graves and a "Hashimoto component." I'm a little overwhelmed with treatment options and wonder if you could offer insight.

    I have basically no symptoms - the only reason I knew something was wrong is because my PCP did baseline bloodwork and my TSH came back low. My blood pressure and heart rate are actually low/normal. I guess I have some "symptoms" consistent with hyperthyroidism but I've had them my whole life so I'm not sure they really count as being symptomatic (e.g., hand tremor, thin hair, never gaining weight no matter what I eat, trouble sleeping). My endo says we can either try to manage with methimazole/PTU or do RAI and manage hypo with levithyroxine. I have a 19 month old baby who's still breastfeeding and my husband and I were planning on trying for baby #2 very soon (originally we were thinking January 2020). So I'm looking for what's best for my health long term, what's safest for my baby that's currently nursing, and what's the safest treatment during pregnancy. I'm also realizing that both treatment options will take many months to work before my levels will be safe for pregnancy. Do you have any insight on which treatment option is better for my situation (i.e., given my labs and lack of symptoms wanting to do what's safest for myself, current and future children, and hoping to be stabilized as soon as possible). Given my labs and lack of symptoms, how long do you think it would take to stabilize my levels for pregnancy (I think endo said my TSH needs to be 2.5 for pregnancy)? I also asked endo about surgery option instead of RAI and he said it's not really done anymore because it's not safe to operate on someone that's hyper. Do you agree? If I go that route surgery honestly sounds easier to me than having to be isolated from my family for a week and I've also read that RAI may increase risk of cancer later in life.

    Here are my current levels:

    TSH with reflex to FT4 <0.02 (REF 0.4-4 miu/mL) **low
    Free T4 1.82 (REF 0.7-1.8 ng/dl) **high (barely)
    Free T3 5.1 (REF 2-4.4 pg/mL) **high
    TBII 2.38 (REF 0-1.75 iu/L) **high
    TPO 13.8 (REF <9 iu/mL) **high
    Thyroglobulin antibody <1.8 (REF <4 iu/mL) **normal

    I had an ultrasound and the only findings were heterogeneous texture and hyperaemia.

    Thank you!
    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:3415
    15 Nov 2019 03:54 PM
    Sorry to be slow. Had an accident and still recovering.
    You don't want to have RAI when you have a small child. Just holding her could damage her thyroid gland.
    Your Graves' disease is very mild, almost subclinical. If you haven't started treatment yet, you could try dietary changes first and see if your thyroid hormone levels fall. This includes avoiding iodized salt and foods with a high iodine content, grains, artificial sweeteners and sugar. Avoiding processed and fast foods and using more whole foods can help.
    If you started meds or plan to, most people use methimazole and you would need a low dose or your thyroid hormone levels could fall too low. Since your FT3 is relatively higher than FT4 some doctors would skip the anti-thyroid drug for now and just prescribe propranolol since it inhibits the conversion of T4 into T3.
    So meds are better than RAI, and many countries do not use RAI for women of childbearing age. But since we have 10-20 times as much FT4 as FT3 (they measured in different units of measurement) treatment is based on your FT4 level, and the goal is to use the lowest dose needed to keep FT4 near the high end of the reference range, which is about where you are now. TSH is low because of your TBII antibodies and not worrisome. best, elaine