Hi ,

You helped me back in 2020 before my first pregnancy. I actually ended up conceiving a healthy little girl. When I conceived her i was on a very low dose. I think maybe 2.5 mg/3.75mg. After I delivered her i was in remission but got a bad flare up of graves about 6 months after I delivered her, which was this past June/July. I started on a 20 mg dose and it made my labs normal by September but i havent been able to lower my dose since then! This is shocking since before i got pregnant i went from 20mg to 5mg in a few short wereks. So we are going on 6-7 months now. And in fact, in Jan/Feb my T4 was just a little out of range on the hyper side again! i think top is 4.77 and mine was at 4.96. I maybe missed 4 doses thats it, i didnt think that was enough to make me hyper.. so my doctor said to take 30 mg, which now im hypo. So now she told me to go back to 20mg. during our appointment yesterday, she said she was a little concerned that i have been unable ot lower my dose but then in the same breath she said it takes 6-8 months to lower the dose. So i am around the 6-8 month range right now so maybe this is normal still? should i stop gluten and dairy to see if that helps? anything else?

Also my husband and i have been considered another baby. I am 39 yo. i dont have much time left. so it makes it kind of complicated and particularly frustrating. bc she made me so anxious that maybe i shouldnt try to conceive. She seemed to want me to think i should ablate thyroid. maybe doctors just dont like to treat graves? anyway, just worried about the risk on pregnancy with such a high dose. i dont desperately need another child. im ok with one but this is still a big decision one way or the other... any input would be much appreciated!

Lisa F.

Hi Lisa,
It's more like some doctors don't know how to manage dosing with anti-thyroid drugs. It's possible that you have postpartum thyroiditis along with a relapse. Normally it takes 6-8 weeks, not months, before you can lower your dose. But Covid and vaccines are known to cause relapses so this can delay remission.
I'd ask for a TSI with your next labs to help gauge what's going on. Eliminating gluten and dairy can help if you're reacting to them. Ask for a 25 OH vitamin D level too to make sure your level is adequate. Low vitamin D is associated with high thyroid antibodies, and this may be preventing remission. Missing 4 doses makes it difficult to tell if your current dose is effective.
Try to take your meds as prescribed and you may find that you're able to lower your dose the next time around. Once you're on a stable dose, as long as it's less than 20 mg MMI, you should be able to conceive with the lowest dose needed being the best. You probably were on 2.5 mg or 3.75 mg last time. If you do have postpartum thyroiditis know that it usually resolves within one year. Best, Elaine