Graves Disease trying to get pregnant options?

[fische]

I was diagnosed with Graves Disease approximately 10 years ago and have been treating it and dealing with it fairly well. I have even gone off maintenance meds (methimozole) was on very low dosage, did not respond well after a long time. Recently was put on PTU and it has been suggested that I do Radioactive Iodine Therapy or Thyroid Surgery even though I am responding to PTU positively. I am on 150 mg a day and it is said that might be lowered to 100mg/day. We would like to try to get pregnant sooner rather than later and I can't get a straight answer whether or not being on PTU now is OK or not, or if I have to have the surgery. I am not really liking the idea of radioiodine treatment bc of the 6-12 month period after and any other effects and surgery, well I would rather avoid if I can. Is PTU safe or unsafe for me/a fetus and are my chance low for even becoming pregnant and keeping a hea;thy pregnancy under these circumstances? Thanks so much for your advice!

[Smilerdeb]

Regardless of whether you have surgery or RAI, the answer will still be the same.
You HAVE to get the levels stable in order to have a good pregnancy with no risk to the foetus.
Hyper and Hypo can cause brain function irregularities in foetus's and also miscarraige and stillborn births.
But then again, there are people who give birth to beautiful babies being Hypo and Hyper.

There has also been pregnancies with women taking PTU whilst pregnant.
My main concern would be thyroid storm whilst Hyper and pregnant should the PTU not do the job it is supposed to do - keep thyroid levels down.


There has also been speculation that long term use of PTU can cause chronic Liver damage so I would be looking into that too and weighing up the odds of the risks involved in either staying on the PTU, or having permanant treatment and biding time with a 6-12 month wait on becoming pregnant.

I cant really advise you what to do in regards to this but think if I was in your shoes, I would be getting a 2nd opinion and asking a lot of questions.

here is the write up on PTU..........


June 3, 2009 — The US Food and Drug Administration (FDA) issued a safety alert today about the risk for serious liver damage, including liver failure, or death with propylthiouracil (PTU) compared with methimazole. Both agents are approved for the treatment of hyperthyroidism associated with Graves' disease.

“Health care professionals should carefully consider which drug to initiate in a patient recently diagnosed with Graves’ disease," Amy Egan, MD, deputy director for safety, Division of Metabolism and Endocrinology Products, in the FDA’s Center for Drug Evaluation and Research, said in a news release. "If PTU therapy is chosen, the patient should be closely monitored for symptoms and signs of liver injury, especially during the first six months after initiating therapy.”

Physicians should promptly discontinue PTU therapy when liver damage is suspected; such patients should be evaluated and supportive care provided if needed.

The agency notes that 22 adult cases and 10 pediatric cases of serious liver injury linked to PTU use have been reported to its Adverse Event Reporting System. Twelve of the adult patients died and 5 required liver transplantation. In the pediatric cases, 1 child died and 6 required liver transplantation. In contrast, only 5 cases of serious liver injury associated with methimazole use have been reported. These cases, all in adults, resulted in 3 deaths.

"PTU is considered second-line drug therapy except in patients who are allergic to or intolerant of methimazole," according to an alert from MedWatch, the FDA's safety information and adverse event reporting program. "Rare cases of embryopathy, including aplasia cutis, have been reported with use of [methimazole] during pregnancy, while no such cases have been reported with PTU use. Thus, PTU may be more appropriate for patients with Graves' disease who are in their first trimester of pregnancy."

"PTU should not be used in pediatric patients unless the patient is allergic to or intolerant of methimazole, and there are no other treatment options available," the FDA points out.