Graves Disease - Try to Get Pregnant Now or Wait?

[beachvb]

So my wife and I are in this dilemma...  We really want to try to get pregnant now... She's turning 28 this month and I'm 32 and we really want children.  About a year ago, she was diagnosed with what appears to be Graves Disease due to her thyroid level tests.  She was on Tapozole for a couple months, which did not work, so in November or December 2009 she switched to PTU.  Her levels have been improving up to this point and the Endo has been lowering the PTU dosage amounts - she is now taking 25mg in the morning and 25mg at night most days but a couple days a week she takes 50mg in the morning and 50mg at night.

Here are her last lab results from May...

T3 - Triiodothyronine: 92 ng/dL (Range 71-180)
TSH: 0.973 ulU/mL (Range 0.450 - 4.5)
Thyroxine (T4): 6.4 ug/dL (Range 4.5 - 12)
T3 Uptake: 33% (Range 24-39)
Free Thyroxine Index: 2.1 (Range 1.2 - 4.9)
Thyrotropin Receptor Ab (TRAB), Serum: 3.30 IU/L (Range 0 - 1.75) *HIGH*
Thyroid Stimulating Immunoglobulin: 625% (Range 0 -139) *VERY HIGH*

Here are the lab results from March:

T3 - Triiodothyronine: 95 ng/dL (Range 71-180)
TSH: 0.855 ulU/mL (Range 0.450 - 4.5)
Thyroxine (T4): 6.8 ug/dL (Range 4.5 - 12)
T3 Uptake: 32% (Range 24-39)
Free Thyroxine Index: 2.2 (Range 1.2 - 4.9)
Thyrotropin Receptor Ab (TRAB), Serum: 3.40 IU/L (Range 0 - 1.75) *HIGH*
Thyroid Stimulating Immunoglobulin: NOT TESTED (Last time it was tested was August 2009: 238% - which is better than latest results)

Anyway, we're just not sure if it's smart to go ahead and try to get pregnant or wait until the lab test numbers get better (even though we really don't want to, but we want to be smart about it).  

We received the "green light" from the Endo, but haven't received a second opinion except from an OBGyn that said she gives us the green light if the Endo did (which doesn't really sound like a second opinion).  The main thing that worries us are the high antibody numbers in the lab tests since the others seem to be pretty stable in the normal range.

I will say that the Endo did not recommend surgery or the radioactive iodine in this case - she does not think it is severe enough to do any approach other than the thyroid medicine.

Thoughts? Recommendations? Suggestions?  Thank you so much!

[Smilerdeb]

Your wifes TSI level is high and you need to get more advice before proceeding as pregnancy with Graves and Hyperthyroidism can result in miscarraige and premature births.
Personally it seems the Graves Antibodies are attacking the thyroid function even harder than before.And the only thing keeping the levels good are the anti-thyroid meds.
There may come a time during the pregnancy that the anti-thyroid meds will have to be increased because the TSI level goes even higher.
These antibodies can cross over to the feotus.
I would be getting a 2nd opinion.

[Sherri90049]

You should see a perinatologist. (high risk pregnancy doctor) The good news is her thyroid levels are looking ok. That is half the battle! But you should check if there's a risk to the fetus from the high antibodies. I think I recall my peri telling me there was some risk, but he didn't stop me from trying to conceive. (I have Hashi's with Thryoid Peroxidase ABS and am hypo.) Luckily you're both still very young! You'll get there! (I stupidly waited and didn't start trying to conceive until I was 40!) Good luck!

[Dogdancing]

Pregnancy will mess with the levels, so just be sure she is stable and not wildly fluctuating.

PTU is the drug of choice to use with/during and after pregnancy.

It does cross the placenta and supress the babys thyroid. Be aware of this. The side effects it causes are reversable after birth. Untreated Graves side effects include death of fetus so no thinking, "I'll go off my meds to protect my baby".

Exspect lots of ultrasounds and being treated as a high risk pregnancy. When you do conceive get a call into the OB mucho-pronto stressing that you are hyperthyroid. In most cases they will want you in there early to run labs and get a base line.

The amount of PTU that crosses in breast milk is minimal. (about 0.025% of the dose).
The American Academy of Pediatrics considers PTU compatable with breast feeding.

peace be the journey

Paja (Graves/RAI), Son 8, daughter 3...hyperthyoid pregnancies - both healthy with no lasting effects from exsposed to PTU