Am I pregnant?
It is not unusual for Graves’ disease to occur during pregnancy. Or sometimes a woman with Graves’ disease will become pregnant. If you are pregnant, your treatment options become limited.
Radioactive iodine can not be administered to a pregnant woman, because it would permanently damage the baby’s thyroid gland or could conceivably cause other problems with the infant. Surgery is also best avoided during pregnancy unless it is absolutely necessary. So, antithyroid drugs are really the only treatment available in this situation.
Pregnant women with Graves’ disease are treated usually with PTU, since it does not cross the placenta very well. Your physician will attempt to use the smallest dose of this medicine possible.
Fortunately, Graves’ disease often improves during the course of pregnancy and patients may b able to stop the PTU altogether. However, a watchful eye must be kept on the thyroid hormone levels during the first six months after delivery, since Graves’ disease frequently returns at this time.
Small to moderate doses of PTU are safe for the nursing mother to take. Radioactive iodine cannot be used until after nursing has stopped.
Do I wish to become pregnant soon?
My advice to women with Graves’ disease who wish to become pregnant in the near future is to take a radioactive iodine treatment (or have surgery if they prefer) so that the Graves’ disease is over and done with.
This makes things simpler by avoiding the need to use antithyroid drugs during pregnancy and afterward during nursing. Although the patient will probably need to take a thyroid hormone supplement after the treatment, this is very safe to use during pregnancy and the dosage is easily adjusted.
One word of caution, however. A woman should wait six months after a radioactive iodine treatment before becoming pregnant.
Do I have significant Graves’ eye disease?
Recent medical studies have shown that a radioactive treatment may result in worsening of the eye problems in Graves’ disease. Usually the degree of worsening is not great, and this only happens in a few patients.
However, because of this concern, I usually advise patients with severe Graves’ eye disease not to take a radioactive treatment until their eye problems have calmed down. Long-term medications or surgery are, I believe, a better choice for these patients.
Another approach, however, is to have the patient take a steroid hormone, such as prednisone, for two to three months after the radioactive iodine treatment. This seems to prevent any worsening of the eye problems.
Am I a child?
Although Graves’ disease is less common in children than in adults, it does occur in childhood, and it can cause significant behavioral difficulties in addition to the other symptoms noted above. I use the same considerations in advising parents about the treatment of their children with Graves’ disease as I do in treating adults.
Thus, I suggest that medications, radioactive iodine and surgery are all options. However, some physicians prefer not to use radioactive iodine in children, though there is no evidence that this results in adverse consequences.
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